Private Practice Questions!

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foreverbull

foreverbull

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Hey folks, I'm looking to jump into private practice in the next 3-6 months and seeking some logistical pointers from private practitioners on this forum. I haven't had much mentorship in this area and am entering private practice much earlier than I had planned, so I feel a little out of the loop on preparing. I have a solid office leasing option, but that's about all I have secured at this point.

1. What software would you recommend for scheduling/charting/billing and what is the monthly fee?

2. What website host would you recommend for your therapy website? Is it free?

3. Any other pointers or advice to share just in general about setting up a private practice and what is involved logistically? Any surprises or things you wish you'd known starting out?

Thanks in advance!
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1. Of the three that I've used, I've liked Procentive the most. I couldn't comment on cost, however.

2. No idea

3. Credentialing. Good lord, credentialing. It can take months. Start now.
 
practice fusion is a free EHR and square space is advertised on literally every podcast in existence for creating a website, so it may be worth checking out
 
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+1 on the insurance paneling. I was lucky enough to have an office staff to do that stuff but it was still annoying.


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For web sites, you might look into WordPress, which is more customizable than TherapySites and similar cookie-cutter products, and much more cost effective if you are really just looking to host static content.
 
I am just starting a private practice as well.
1. Myclientsplus has been recommended. I think it's $30/month, but has a lot of helpful features.
2. Not sure. I'm starting to use Wordpress and it seems pretty good
3. If you want to take insurance you'll need to fill out a CAQH profile, get a tax ID #, and get a National Provider Identifier.
It can be helpful to have a psychology today profile depending where you live ($30/month). Some insurances require that you have a secure phone line (or at least voicemail) and a confidential fax. Then there's deciding which insurance panels to get on. Ask people in your area about that. It's good to make business cards (I love MOO.com) You can use Square or another service if you want to be able to take credit cards, which can be helpful especially if working with college students (though they charge about 3%). You'll also need to ask around about what people charge in your area and decide whether you'll have a sliding scale for people paying out of pocket.
Can't think of anything else at the moment. Hope that helps
 
foreverbull said:
Hey folks, I'm looking to jump into private practice in the next 3-6 months and seeking some logistical pointers from private practitioners on this forum. I haven't had much mentorship in this area and am entering private practice much earlier than I had planned, so I feel a little out of the loop on preparing. I have a solid office leasing option, but that's about all I have secured at this point.

1. What software would you recommend for scheduling/charting/billing and what is the monthly fee?

2. What website host would you recommend for your therapy website? Is it free?

3. Any other pointers or advice to share just in general about setting up a private practice and what is involved logistically? Any surprises or things you wish you'd known starting out?

Thanks in advance!
Click to expand...

I am just starting my private practice right now. It will officially be open for business on Monday (4/24). If anybody else who is doing this wants to share emails for questions, tips etc. I'd be game for that.

I used Wix to create my website. It was cheap and very easy to use. I didn't like the more expensive designs at places like therapysites.com. I like the simplicity of my Wix site. After all, a therapist website doesn't need to do a lot of things.

I registered with CAQH a little over a month ago. I hear it takes at least 3 months to get on any insurance panels. I'm "hoping" to do primarily out of pocket clients anyway.

Finding small office space was actually the hardest part. There are a lot of office shares, which financially is the way to go, but I'm tired of using someone else's mismatch furniture, and working around other's schedules.

You'll probably want to set up an LLC with tax ID and separate business banking account. You may want to start with the LLC because it will help you pick a business name that you will want to use for everything else (website, insurance billing, business cards, bank account, marketing directory profile, etc.)

I have read about some interesting ideas to market yourself. There is a ton of good free info on the web. It would be great to share that stuff with other people just starting.

I found a group of people just starting their practices too, and we keep in touch.
 
I have just started a private practice in March and in this short time I have learned A LOT!

1. In terms of EHR software, my recommendation is to try them out. There are many that allow you X number of days free trial. I went with the one that was most intuitive for me. Also keep in mind that there are often add on costs for things like client portals, insurance billing, etc. I also use a different software program on my iPad to for my psychotherapy notes. I am a bit freakish about keeping them separate but also using software that is itself hipaa compliant and has its own backup secure servers in case something happens to my computer. Many of the software also allows clients to complete intake documents prior to the first session - so my goal is to be paperless. Though I do still have about half who fill out forms at the office. I just scan those in and then shred them so I don't actually need file storage.

2. I ended up using TherapySites for my website. Part of it was that editing was easier for me. And with everything else I had to think about, having a template for the language was really nice. I also signed up with Psychology Today (Get 6 months free thru TherapySites or if you message me I'll send you a link and you can get 6 months free that way as well). I also signed up with Good Therapy. And I've gotten new clients from both referral sources.

3. I decided during internship I wanted to go into private practice once I licensed so I set aside funds to pay for the first 6 months so I can fully dedicate myself to building the practice. This also meant that I wanted to have an office space that I wasn't restricted on times I can see clients because I was sharing. And frankly, the whole reason for me going into private practice was the autonomy. So being the boss of my own schedule was how I wanted to go so I found an office at an executive suites - which has various professionals and a large conference room available for groups if I wanted to run them. It was affordable enough that 2 clients per week paid for all of my monthly expenses, including my EHR, psychotherapy notes, therapySites fee and my clearinghouse fees. For furniture, I picked out the pieces that I wanted and then asked family to help pitch in for them rather than giving me other presents and got 0%financing for 2 years for the balance. Again, wanted to make the place my own at the same time wanted to keep my overhead low. When I got my third client, I joked that I'm now profitable (With free labor of course).

I also knew I was going to take Medicare and Tricare based on the clientele I wanted to work with and wanted to take insurance at least to start off. That meant a whole series of hoops that require you to jump through in a specific order. Mine was. EPPP. License. LLC. While waiting for the LLC to be accepted by the state commission: NPI for individual, NPI for the LLC, IRS TIN/EIN for the LLC, and Liability insurance for myself and my LLC name. Once the LLC was established, bank account for LLC (I recommend you get a letter from the bank as soon as you open it that states your account name, routing number, and checking or savings account number otherwise you will have to wait until you get your checks with your name printed on before you can submit to Medicare). Filled out CAQH proview info. And then fill out Medicare application. Filled out insurance applications.

Medicare approval took about 3 weeks from submission to approval as I did it online. It also sped up my contracting as I received contracts from a couple of insurance companies a week after I got my Medicare approval (about 4 weeks for those applications) whereas it took several of my friends 3-4 months to contract with these insurance companies. Picked my clearinghouse and linked it my EHR.

It's been about 6 weeks since I put up my info on psychology today and turned on my website and am at about 40% of what I want to carry in terms of weekly client load.

And what I've listed here has just been the tip of the iceberg. So please don't take this as a comprehensive review of everything. But I know it would have been helpful for me had I known the order of steps as I ended up waiting for a week on one thing and a week on another when I could have done things in tandem and shortened the time.

I would also love to joint an email group to share ideas, concerns, assistance, learning.


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This is all very helpful information, thanks!
I would love to connect as a group in discussing private practice-related tips and questions.
Anyone up for the task of organizing/creating the group/listserv?
 
protips:

1) tax returns prepared by a tax attorney, as opposed to a CPA, have an unusually low audit rate
2) credit cards taken out in the LLC name do not count against your personal credit score
3) If you start making bank, consider a SEP or a defined contribution plan.
4) There's tax and liability benefits to a multi tiered LLC formation.
5) avoid IRS red flags (e.g., home office, international structures, etc).
6) dictate
7) If there is doubt, there is no doubt

6 & 7 brought to you by those books I recommended.
 
This is all really helpful, thanks!

I'll be starting internship this fall in Boston (in the area I hope to start a pp in). In addition to speaking with local practitioners and reading about pp, I was wondering if anyone has any specific advice on how to prepare for pp as an intern?

Thanks!
 
Would love to be a part of a private practice listserve! Will be looking in the next 6-12 months to start a pp in the northeast. I've started doing some initial research on overhead, location etc. My hope is to start a mixed practice- assessment, therapy in my area of specialization and hopefully some consultation/training. Since I'm still in the initial phases I've just been working on networking and setting up potential referral sources.
 
brain hugger said:
This is all really helpful, thanks!

I'll be starting internship this fall in Boston (in the area I hope to start a pp in). In addition to speaking with local practitioners and reading about pp, I was wondering if anyone has any specific advice on how to prepare for pp as an intern?

Thanks!
Click to expand...

I knew early on at internship that I wasn't going to post doc but straight to pp. With that in mind, I always did more than was expected. I carried a larger caseload of individual patients than was expected so I could get the breadth of different presentations. I chose rotations in areas that I had no prior experience to round out my skill sets, and I worked more than I could have as I figured this was my last formal training opportunity like this. So my weeks were easily between 50-55 hours just to get all of the extra opportunities in. Become familiar with CPT codes - makes billing not as daunting as it was all familiar to me.


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HEM0305 said:
I knew early on at internship that I wasn't going to post doc but straight to pp. With that in mind, I always did more than was expected. I carried a larger caseload of individual patients than was expected so I could get the breadth of different presentations. I chose rotations in areas that I had no prior experience to round out my skill sets, and I worked more than I could have as I figured this was my last formal training opportunity like this. So my weeks were easily between 50-55 hours just to get all of the extra opportunities in. Become familiar with CPT codes - makes billing not as daunting as it was all familiar to me.


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Click to expand...

How did you obtain post doc hours? I want to do PP but have to get the post doc hours first and of course the license. However I was in PP with my LPC so I am desperate to get back to it.
 
virgoox said:
How did you obtain post doc hours? I want to do PP but have to get the post doc hours first and of course the license. However I was in PP with my LPC so I am desperate to get back to it.
Click to expand...

I live in a state that doesn't require post doc hours. You can also look into doing s post doc in a private practice setting (informal).


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Just wondering if someone is starting an organized group. I could do a FB one if anyone woulld like to join...
 
virgoox said:
Just wondering if someone is starting an organized group. I could do a FB one if anyone woulld like to join...
Click to expand...

I'd be interested too.


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Yet another requirement that no one warned psychologists about: general business insurance when you rent from a commercial building. My agent who is renting my office to me literally said "the big companies work" and was completely unhelpful, to say the least.

A lengthy search came up with dozens of companies. I filled out a few forms to get quotes, but haven't been happy with the results.

Can anyone recommend a cheap but reasonable company for general business insurance?
And just as importantly, what's the going rate for this type of insurance so I have a sense of what's reasonable to pay?

Thanks in advance!
 
foreverbull said:
Yet another requirement that no one warned psychologists about: general business insurance when you rent from a commercial building. My agent who is renting my office to me literally said "the big companies work" and was completely unhelpful, to say the least.

A lengthy search came up with dozens of companies. I filled out a few forms to get quotes, but haven't been happy with the results.

Can anyone recommend a cheap but reasonable company for general business insurance?
And just as importantly, what's the going rate for this type of insurance so I have a sense of what's reasonable to pay?

Thanks in advance!
Click to expand...

The trust offers this.
 
foreverbull said:
Yet another requirement that no one warned psychologists about: general business insurance when you rent from a commercial building. My agent who is renting my office to me literally said "the big companies work" and was completely unhelpful, to say the least.

A lengthy search came up with dozens of companies. I filled out a few forms to get quotes, but haven't been happy with the results.

Can anyone recommend a cheap but reasonable company for general business insurance?
And just as importantly, what's the going rate for this type of insurance so I have a sense of what's reasonable to pay?

Thanks in advance!
Click to expand...

I'm completely clueless regarding most things PP--is this essentially akin to homeowner's insurance for a business?
 
AcronymAllergy said:
I'm completely clueless regarding most things PP--is this essentially akin to homeowner's insurance for a business?
Click to expand...

Yes. It's for the physical office space. Patient slips and falls, gets hurt. Malpractice insurance doesn't cover this because it has nothing to do with the act of professional psychology practice. So either you pull out your wallet or have insurance. Most commercial office spaces require this as a condition of rent or ownership. In an office rental, the owner covers the common spaces like bathrooms. In an office condo, it's covered by what is essentially your home owners association fees.

Offices also have "triple net" or NNN, which is a varying fee that covers common space bills like electricity. The estimate average is always in face sheet for an office.
 
Since no one who currently purchases this insurance answered, I'll just offer some info for folks based on my research:

General liability insurance for your business office/building alone runs from about $350-$500 per year (in CA).
Hiscox = $350
Trust = $360
CNA = $500
Hartford quoted me at $550 for both malpractice and business insurance, but didn't give me individual quotes.

This insurance was way more expensive than I expected, so hopefully you won't be shocked by the sticker prices if you have a heads up first.
 
For those who want to join a private practice startup/tips group online, what format do you prefer?

1. An anonymous discussion board/group at Private Practice Psychologists @ groupbox.com | Professions, Business (specifically for psychologists in private practice; join it to post, open to the public to read posts). I created a free group on groupbox as a test just to see its user-friendliness.

OR

2. A non-anonymous, closed Facebook group (you'd have to PM me your Facebook name and add each other as friends, then add you to the group). I can't create the group without adding friends to it first.

Any votes for one or the other?
 
Thanks for doing this!

One vote for the Facebook group!
 
No interest in private practice here, but I did want to brag that I've never had instafacespace chat...🙂
 
3-1 for the Facebook group, so we'll go with that for now. If a bunch of people down the line become interested in the Google Group format, we can open that up later for the non-FB folks.

For now, everyone interested in Psychologists in Private Practice Group will need to private message me their Facebook names. I will add you as a friend and invite you to the group so we can get started.
Cheers!
 
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