Private Practice quick questions

[Geraltofrivia]

Hello all,

I've read the previous posts on private practices (splik, sushirolls, Fl-prexa, and Atreides). Really outstanding information. But my questions are somewhat weird and maybe better suited for an attorney (but I'm not even sure what type of attorney I should be looking to help me?). I bolded the places I'm confused

Name: I have one and I checked my state's LLC thing and it's available
Website: I can register a domain, host it on bluehost or Siteground and build it on wordpress. I'm running out of time on Black Friday deals though and need to move very very fast on this

Email: I'm confused about Hipaa compliance. My personal email is an esoteric, privacy centric email. They offer a BAA for $10/month (for a 2 year contract). Bruce Bassi MD on YouTube recommends paubox in addition to Google workspace? This is confusing to me. If I get a BAA through my personal email (basically create a new business account), any email communicated with that through a prospective patient should be Hipaa compliant, is that right? Why get something else on top of that?

EHR: I've looked into Charm and Luminello. I'm not sure which of these two are better. I believe Luminello is web based so for me, I would prefer Charm I think. I am planning to do telepsychiatry only to start with.

Phone: I was going to use google voice or maybe get a cheap iPhone SE and create a separate line? Do I need to worry about "hipaa compliance" with a phone?
Address: ipostal1 has a virtual mailbox 5 min from where I live so I was going to use this
EIN: How do I even obtain this lol?
Billing: I've seen some posts by Sushirolls or maybe Splik or maybe Clozareal of how I cannot see Medicare patients at all? Also wtf is a Type 2 NPI? I am currently a FT inpatient psychiatrist and my boss is aware I am in the process of trying to figure out how to set this type of a practice up

Malpractice: PRMS for 20 hr/week part time is like $1300 occurrence based. Although I saw a post by Dr. Miller on doing Claims Made instead? Why would one pick this? Also, how does PRMS or the insurance company measure 20 hours / week?

Logo: I can use GPT4 for this or Smartcafe. The AI has gotten pretty good

Intake Forms: How do people do this???
Clinical Policies: Same?
Consent Forms: Same?

Am I overthinking this whole thing?

Thanks guys

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[splik]

you are asking a lot of good questions. these aren’t attorney questions. Consult someone in pp who helps people start pp ideally in your area (though not a deal breaker) to help guide you through this and any other questions you’ll inevitably have.

I will tell you pts sending emails to you and you replying on gmail is definitely not hipaa compliant. A BAA doesn’t magically make such communications secure outside of your domain. Patients do so at their own risk (and yours potentially).

 

[When is graduation again?]

Hello all,

I've read the previous posts on private practices (splik, sushirolls, Fl-prexa, and Atreides). Really outstanding information. But my questions are somewhat weird and maybe better suited for an attorney (but I'm not even sure what type of attorney I should be looking to help me?). I bolded the places I'm confused

Name: I have one and I checked my state's LLC thing and it's available
Website: I can register a domain, host it on bluehost or Siteground and build it on wordpress. I'm running out of time on Black Friday deals though and need to move very very fast on this

Email: I'm confused about Hipaa compliance. My personal email is an esoteric, privacy centric email. They offer a BAA for $10/month (for a 2 year contract). Bruce Bassi MD on YouTube recommends paubox in addition to Google workspace? This is confusing to me. If I get a BAA through my personal email (basically create a new business account), any email communicated with that through a prospective patient should be Hipaa compliant, is that right? Why get something else on top of that?

EHR: I've looked into Charm and Luminello. I'm not sure which of these two are better. I believe Luminello is web based so for me, I would prefer Charm I think. I am planning to do telepsychiatry only to start with.

Phone: I was going to use google voice or maybe get a cheap iPhone SE and create a separate line? Do I need to worry about "hipaa compliance" with a phone?
Address: ipostal1 has a virtual mailbox 5 min from where I live so I was going to use this
EIN: How do I even obtain this lol?
Billing: I've seen some posts by Sushirolls or maybe Splik or maybe Clozareal of how I cannot see Medicare patients at all? Also wtf is a Type 2 NPI? I am currently a FT inpatient psychiatrist and my boss is aware I am in the process of trying to figure out how to set this type of a practice up

Malpractice: PRMS for 20 hr/week part time is like $1300 occurrence based. Although I saw a post by Dr. Miller on doing Claims Made instead? Why would one pick this? Also, how does PRMS or the insurance company measure 20 hours / week?

Logo: I can use GPT4 for this or Smartcafe. The AI has gotten pretty good

Intake Forms: How do people do this???
Clinical Policies: Same?
Consent Forms: Same?

Am I overthinking this whole thing?

Thanks guys

I'm still early stage private practice, so I've just encountered most of these recently. I looked into Luminello and Charm, but ultimately chose Luminello because I felt like Charm had more nickel and dime elements. They're probably both good though.

Intake forms: Luminello came with some standard ones. I also had a friend send me hers, so I could compare. You can also google these types of forms. You basically want to have a consent for treatment, consent for telepsych, no surprises act (if cash pay), and maybe a consent for text/email at least. I'd include important clinic policies in the consent for treatment at least, so if patients violate your policies you have it in writing that they should've known about it. You can also consider the mental health screens, but not legally required.

Clinical Policies: These you create from past lived experiences and learn on the fly. Some recent things I had to make policies for were telehealth location (I'm near a border state which complicates things a little), cancelling intakes if insurance or no valid form of payment in my system before first appt (I had an issue where a complicated patient didn't pay me and I didn't know if I was going to get paid. Very rough when you have only a few patients), and of course no-show/late policies.

You're not overthinking things. Even expecting a lot of work to start a private practice, it ended up being a lot more unexpected administrative burden than I was prepared for. Especially, if you plan to panel with insurances.

 

[AcronymAllergy]

Hello all,

I've read the previous posts on private practices (splik, sushirolls, Fl-prexa, and Atreides). Really outstanding information. But my questions are somewhat weird and maybe better suited for an attorney (but I'm not even sure what type of attorney I should be looking to help me?). I bolded the places I'm confused

Name: I have one and I checked my state's LLC thing and it's available
Website: I can register a domain, host it on bluehost or Siteground and build it on wordpress. I'm running out of time on Black Friday deals though and need to move very very fast on this

Email: I'm confused about Hipaa compliance. My personal email is an esoteric, privacy centric email. They offer a BAA for $10/month (for a 2 year contract). Bruce Bassi MD on YouTube recommends paubox in addition to Google workspace? This is confusing to me. If I get a BAA through my personal email (basically create a new business account), any email communicated with that through a prospective patient should be Hipaa compliant, is that right? Why get something else on top of that?

EHR: I've looked into Charm and Luminello. I'm not sure which of these two are better. I believe Luminello is web based so for me, I would prefer Charm I think. I am planning to do telepsychiatry only to start with.

Phone: I was going to use google voice or maybe get a cheap iPhone SE and create a separate line? Do I need to worry about "hipaa compliance" with a phone?
Address: ipostal1 has a virtual mailbox 5 min from where I live so I was going to use this
EIN: How do I even obtain this lol?
Billing: I've seen some posts by Sushirolls or maybe Splik or maybe Clozareal of how I cannot see Medicare patients at all? Also wtf is a Type 2 NPI? I am currently a FT inpatient psychiatrist and my boss is aware I am in the process of trying to figure out how to set this type of a practice up

Malpractice: PRMS for 20 hr/week part time is like $1300 occurrence based. Although I saw a post by Dr. Miller on doing Claims Made instead? Why would one pick this? Also, how does PRMS or the insurance company measure 20 hours / week?

Logo: I can use GPT4 for this or Smartcafe. The AI has gotten pretty good

Intake Forms: How do people do this???
Clinical Policies: Same?
Consent Forms: Same?

Am I overthinking this whole thing?

Thanks guys

I'll add a few things based on at least what I think I know:

-Email: depends on how it's setup. Some are end-to-end encrypted while others are not. Best way to know is probably to check with the email company itself.

-Phone: yep, for VOIP (rather than a landline), you'll want to check if it's HIPAA-compliant. The standard/free Google voice is not, to the best of my knowledge.

-EIN: you apply to the IRS for this. It's not terribly complex, but if you setup the LLC/PLLC through a site like LegalZoom (which is what I did), they'll generally do this for you. I don't remember if they charge for it, but it's a legal site, so probably.

-Type 2 NPI is a practice/business entity NPI (as opposed to an individual NPI). So for a group practice that gets paid in the practice's name/EIN, for example, the practice will bill under its name and Type 2 NPI. All individual providers also have their own Type 1 NPI, which also usually gets submitted for billing to know who provided the service. Or something like that. If you bill and get paid under your own name/SSN, you may not need a Type 2 NPI.

The book, "The Paper Office for the Digital Age" provides lots of info on setting up a practice, policies that are useful/necessary to have, examples of various forms, and other stuff.

I'd also second the rec to connect with docs in your area who are in PP. Offer to take them out to lunch in exchange for picking their brain. If you want even more intensive help/mentorship, you could offer to pay them for their time.

 

[lol.psych]

Email isn’t hipaa compliant unless you’re both on the same service like proton mail or something (and you have a business account and BAA). I tell pts to email at their own risk, and that messaging through my EMR is hipaa compliant while email isn’t (unless they also have proton, which a couple of my pts do). I use iPlum for phone and fax (and have a BAA for that). I use zoom with a pro account and BAA.

My EHR is Luminello, which I love. Let me know if you want a referral code for a month free! I chose it because it’s all in one - notes, billing, payment processing, messaging, e-rx. It’s got lab integration but it’s not great… and quest refused to give me a provider account because I’m a one person operation and I guess that’s not big enough for them? So i put a little comment on my lab order sheets that says to please fax me; I end up calling the labs most of the time anyway, especially if I want some labs ASAP (e.g. Li or VPA) and don’t want to wait until longer labs result (e.g. lamictal level).

For business things - I got an attorney to do EIN things for me because I found myself freezing anytime I thought about it.

You don’t need a logo. But it might be fun to have one!

Website - I use squarespace, which I can’t say enough good things about!

Policies, etc: i modded Luminello’s stock ones to fit my situation… and tbh i kind of ripped off my own psychiatrist’s forms (ha!). For whatever reason, it was important to me to have my own (totally self written) policy forms, but it really helped to have something to use as a template.

I recommend getting in touch with local therapy groups and maybe the local psychoanalytic institute if you’re into that kind of thing! These are great referral sources!

 

[clozareal]

Excellent questions! Welcome to the PP community.

Email: I'm confused about Hipaa compliance. My personal email is an esoteric, privacy centric email. They offer a BAA for $10/month (for a 2 year contract). Bruce Bassi MD on YouTube recommends paubox in addition to Google workspace? This is confusing to me. If I get a BAA through my personal email (basically create a new business account), any email communicated with that through a prospective patient should be Hipaa compliant, is that right? Why get something else on top of that?

Other people have answered this already. BAA is compliant within the platform. So if you're sending an email to your staff within the same domain, it's HIPAA compliant. It's not with patients.

EHR: I've looked into Charm and Luminello. I'm not sure which of these two are better. I believe Luminello is web based so for me, I would prefer Charm I think. I am planning to do telepsychiatry only to start with.

If I had to do it over again, I would choose PracticeQ/IntakeQ. I use Luminello. Some of the administrative things that Luminello doesn't do creates extra workflow for me that eats into my clinical hours.

Phone: I was going to use google voice or maybe get a cheap iPhone SE and create a separate line? Do I need to worry about "hipaa compliance" with a phone?
Address: ipostal1 has a virtual mailbox 5 min from where I live so I was going to use this
EIN: How do I even obtain this lol?
Billing: I've seen some posts by Sushirolls or maybe Splik or maybe Clozareal of how I cannot see Medicare patients at all? Also wtf is a Type 2 NPI? I am currently a FT inpatient psychiatrist and my boss is aware I am in the process of trying to figure out how to set this type of a practice up

Google Voice also has a BAA for HIPAA compliance. Some people use Spruce for this too.

Using a UPS mailbox is likely going to be better than a virtual mailbox. It's a physical address and not a PO box. In my area, it's $20-40/mo.

EIN: IRS. Takes 5 minutes. Apply for an Employer Identification Number (EIN) Online | Internal Revenue Service

Billing: If you haven't opted out, you can see Medicare patients as a non-participating provider, but you'll be limited to 115% of their maximum rate that you can charge in your area per CPT code.

If they have Medicare as secondary, it's complicated. Their primary insurance from their or their spouses employer would be primary (unless their employer has less than 20 employees if the pt is over 65 or 100 employees if the patient is under 65. See here). The APA Quick Practice Guide has several PDFs on this that would be valuable to review.

If you're not sure how to reach your medicare contractor to change your status, the APA’s Office of Healthcare Systems and Financing has someone who can help (I think it's still Ellen Jaffe).

My understanding is that if you're opted in to Medicare at one location, you're opted in everywhere. They use Type 1 NPIs and disregard Type 2's unlike other insurances. Someone correct me if I'm wrong about this @Sushirolls, @splik. The most likely scenario is that you shouldn't see Medicare patients in your private practice although some people might age into it or get a disability. Either that or you opt out and can't see Medicare patients in your inpatient facility.

Malpractice: PRMS for 20 hr/week part time is like $1300 occurrence based. Although I saw a post by Dr. Miller on doing Claims Made instead? Why would one pick this? Also, how does PRMS or the insurance company measure 20 hours / week?

Claims made is cheaper upfront but you have to pay for tail at the end unless you retire or whatever other stipulation the insurance company has on it. Some employers will pay for the tail if you agree to work for them. Occurrence costs more but eliminates the financial hassle later on.

I believe it's 20 clinical hours per week.

Logo: I can use GPT4 for this or Smartcafe. The AI has gotten pretty good

Intake Forms: How do people do this???

You'll have to customize this yourself. Some people don't do any, others want to get all the information upfront. I'm not a big fan of Luminello's cumbersome intake forms. IntakeQ is so much better. Some people use Jotform or Google form.

Clinical Policies: Same?

Collect a bunch from other people and see what you like and don't like. It's about communicating expectations. Some people don't do any clinical policies. You'll need to have policies you decide for yourself on 1) intakes, 2) follow-ups, 3) prescriptions including controlled substances, 4) fees and billing, 5) cancellations/missed appointments, 6) communication outside of appointments, and 7) termination.

Consent Forms: Same?

See what your malpractice wants you to do and what your state legally requires you to do. Informed consent for treatment, telehealth, ROI, notice of privacy policies, good faith estimate/no surprises act, mediation consent, controlled substances contract, financial agreement, etc.

Am I overthinking this whole thing?

No I think you're being thoughtful about these. Many of these administrative issues aren't taught in residency/fellowship or even when you're out working in practice. This is the business side of things and you want to be intentional otherwise you might inadvertently create headaches later on.

 

[Sushirolls]

MEDICARE - is based on type 1 and even type 2 NPI.

If you are a resident or recent graduate or just recently have worked at an employed job, 99% chance you are in with Medicare.
But you are only in, at that practice location/site/entity.

Although your PP gig can't actively bill to medicare because you have not updated your Type I to have the money from medicare go to you... (they call this assignment of benefits). The catch with medicare is you can't charge cash to a medicare people because you are still technically with medicare even though your new PP isn't active to bill medicare...

If you want to cash charge medicare patients, you need to be opted out of medicare. And there is a form to do that... Once you do... they won't let you back in for 2 years if you change your mind. Bureacracy.

I filled out my medicare stuff to be for type 1 and type II NPI of my practice in case I ever do expand and bring on more people.

 

[clement]

Hello all,

I've read the previous posts on private practices (splik, sushirolls, Fl-prexa, and Atreides). Really outstanding information. But my questions are somewhat weird and maybe better suited for an attorney (but I'm not even sure what type of attorney I should be looking to help me?). I bolded the places I'm confused

Name: I have one and I checked my state's LLC thing and it's available
Website: I can register a domain, host it on bluehost or Siteground and build it on wordpress. I'm running out of time on Black Friday deals though and need to move very very fast on this

Email: I'm confused about Hipaa compliance. My personal email is an esoteric, privacy centric email. They offer a BAA for $10/month (for a 2 year contract). Bruce Bassi MD on YouTube recommends paubox in addition to Google workspace? This is confusing to me. If I get a BAA through my personal email (basically create a new business account), any email communicated with that through a prospective patient should be Hipaa compliant, is that right? Why get something else on top of that?

EHR: I've looked into Charm and Luminello. I'm not sure which of these two are better. I believe Luminello is web based so for me, I would prefer Charm I think. I am planning to do telepsychiatry only to start with.

Phone: I was going to use google voice or maybe get a cheap iPhone SE and create a separate line? Do I need to worry about "hipaa compliance" with a phone?
Address: ipostal1 has a virtual mailbox 5 min from where I live so I was going to use this
EIN: How do I even obtain this lol?
Billing: I've seen some posts by Sushirolls or maybe Splik or maybe Clozareal of how I cannot see Medicare patients at all? Also wtf is a Type 2 NPI? I am currently a FT inpatient psychiatrist and my boss is aware I am in the process of trying to figure out how to set this type of a practice up

Malpractice: PRMS for 20 hr/week part time is like $1300 occurrence based. Although I saw a post by Dr. Miller on doing Claims Made instead? Why would one pick this? Also, how does PRMS or the insurance company measure 20 hours / week?

Logo: I can use GPT4 for this or Smartcafe. The AI has gotten pretty good

Intake Forms: How do people do this???
Clinical Policies: Same?
Consent Forms: Same?

Am I overthinking this whole thing?

Thanks guys

MEDICARE - is based on type 1 and even type 2 NPI.

If you are a resident or recent graduate or just recently have worked at an employed job, 99% chance you are in with Medicare.
But you are only in, at that practice location/site/entity.

Although your PP gig can't actively bill to medicare because you have not updated your Type I to have the money from medicare go to you... (they call this assignment of benefits). The catch with medicare is you can't charge cash to a medicare people because you are still technically with medicare even though your new PP isn't active to bill medicare...

If you want to cash charge medicare patients, you need to be opted out of medicare. And there is a form to do that... Once you do... they won't let you back in for 2 years if you change your mind. Bureacracy.

I filled out my medicare stuff to be for type 1 and type II NPI of my practice in case I ever do expand and bring on more people.

Are you certain $1300 is for part time occurrence based? That’s what I’m getting quoted for part time (also 20 hours) on a claims made policy. Maybe a geographic difference but still seems low to be occurrence based.

 

[clozareal]

MEDICARE - is based on type 1 and even type 2 NPI.

If you are a resident or recent graduate or just recently have worked at an employed job, 99% chance you are in with Medicare.
But you are only in, at that practice location/site/entity.

Although your PP gig can't actively bill to medicare because you have not updated your Type I to have the money from medicare go to you... (they call this assignment of benefits). The catch with medicare is you can't charge cash to a medicare people because you are still technically with medicare even though your new PP isn't active to bill medicare...

If you want to cash charge medicare patients, you need to be opted out of medicare. And there is a form to do that... Once you do... they won't let you back in for 2 years if you change your mind. Bureacracy.

I filled out my medicare stuff to be for type 1 and type II NPI of my practice in case I ever do expand and bring on more people.

I thought that the Type 2 NPI was more for organizational billing and record-keeping rather than the fundamental rules about billing Medicare patients. The Type 1 NPI is the rendering provider who provided that service but the Type 2 NPI (that organization) is the billing provider to Medicare.

 

[theduderino]

You may want to get a type 2 NPI even if you don't plan on bringing on additional therapists/providers/whatever. BCBS gave me tremendous hassle last year for my billing NPI being the same as the rendering provider NPI (solo practice). It was a non-issue for the previous year but all of a sudden resulted in all claims being denied. Once I changed over my billing NPI to a type 2 NPI the issue was resolved. The change ended up being useful anyway as I started to take on ICs at my practice, but in retrospect it would be easy enough to do this from the get-go to avoid potential insurance bs and also be ready to expand without having to refile forms with insurance companies.

 

[whopper]

I generally discourage email. Why? Aside that you need good encrypted e-mail (unless the patient signs a release saying it's okay to use e-mail despite it's risks), you sometimes then get patients that want to send you 20 screen e-mails expecting you to read 2-3 hours of material, and then develop a type of relationship where they expect you to send long e-mails back. You cannot bill for this unless you're completely private pay.

I tell my patients this simple rule. I want you to be able to communicate with me, but if it's not short and sweet you're going to have to schedule an appointment.

 

[Geraltofrivia]

I opted to hire an attorney to help with the PLLC formation. A lot of my stuff is on pause until I get my PLLC. I'm not sure whether I can still get my malpractice and at least start seeing patients or wait until my PLLC is formed and then take out a malpractice policy. But, things I wish I knew:

1. Check your state laws regarding PLLC vs. LLC.
1b. PLLC = You need a license to do your job. I don't know of any unlicensed psychiatrists so I needed a PLLC to do what I want to do in my state.

2. Do NOT use LegalZoom. They rip you off. LLC is very easy to establish and you can literally google this
2b. PLLC can be more complicated, depending on the state. In my state, it's extremely complicated. I found it easier to hire an attorney. BUT, if you hire an attorney, they will ONLY help with PLLC formation and will charge for everything else (policies, malpractice advice (policy wise etc)). Overall, not really worth it if you can find somebody that can help you through it (I couldn't).

3. Make sure everything is updated before you embark on this process. What I mean by this is your license address, DEA, etc. Have a prospective business address in mind. PO Boxes are disallowed. I ended up choosing a "virtual" address through ipostal1. Cost me about $100 or something for the whole year

4. Website: This is not hard to set up, but it is time consuming. If you are waiting for your PLLC to come through, you might as well just build it yourself. Use siteground or bluehost, buy a GeneratePress Pro license or ask around for one, and build. It's really not that hard.

5. Logo: Somehow my AI account got banned so I'm starting from square 1

6. Insurance: I'm following splik's sage advice of not paneling with insurance until you feel comfortable. He said it's easier to start without insurance and then go to insurance than reverse. Through my normal employer, I've had tons of inquiries about whether I had my own practice

7. Business Card: I'm still in the process of creating this, but I have checked out Canva (when it works). Lot of people recommended this to me

8. Email: I'll probably just buy a BAA through Protonmail and have a customized domain. I'm not sure whether it's better through gmail or not but I already have a pm.me for personal stuff

9. Phone: I am planning to use my Google Voice number on some type of backup phone that I haven't yet figured out. I'll keep it connected to WiFi at home and just check it once daily

10. Office: Not planning to have one unless people are actually interested in meeting me. Idk if this is true or not yet

11. Type 2 NPI: Still exploring this and not sure whether I can get this before my PLLC is approved for not

12. Policies: Still figuring this part out


Will probably keep adding to this as I learn more

 

[clozareal]

I opted to hire an attorney to help with the PLLC formation. A lot of my stuff is on pause until I get my PLLC. I'm not sure whether I can still get my malpractice and at least start seeing patients or wait until my PLLC is formed and then take out a malpractice policy. But, things I wish I knew:

You can get malpractice without your business being set up. Malpractice does not hinge upon your business structure since your business won't protect you from any liability from your practice of medicine.

1. Check your state laws regarding PLLC vs. LLC.
1b. PLLC = You need a license to do your job. I don't know of any unlicensed psychiatrists so I needed a PLLC to do what I want to do in my state.

2. Do NOT use LegalZoom. They rip you off. LLC is very easy to establish and you can literally google this
2b. PLLC can be more complicated, depending on the state. In my state, it's extremely complicated. I found it easier to hire an attorney. BUT, if you hire an attorney, they will ONLY help with PLLC formation and will charge for everything else (policies, malpractice advice (policy wise etc)). Overall, not really worth it if you can find somebody that can help you through it (I couldn't).

Yep. Same with an S corp. You can do it all yourself.

3. Make sure everything is updated before you embark on this process. What I mean by this is your license address, DEA, etc. Have a prospective business address in mind. PO Boxes are disallowed. I ended up choosing a "virtual" address through ipostal1. Cost me about $100 or something for the whole year

This won't cover you for a DEA license though legally. You need to have a physical address where you practice and where the DEA can visit.

4. Website: This is not hard to set up, but it is time consuming. If you are waiting for your PLLC to come through, you might as well just build it yourself. Use siteground or bluehost, buy a GeneratePress Pro license or ask around for one, and build. It's really not that hard.

Wix.com has been the easiest to work with in terms of template, Squarespace being second. I use Wordpress and built my own customized website.

5. Logo: Somehow my AI account got banned so I'm starting from square 1

Canva, 99designs, brandcrowd, and other crowd sourced logo companies feel too generic. It's best to hire a designer to make you one personally with one to one attention to what you want. You don't need a logo though. I don't have one.

6. Insurance: I'm following splik's sage advice of not paneling with insurance until you feel comfortable. He said it's easier to start without insurance and then go to insurance than reverse. Through my normal employer, I've had tons of inquiries about whether I had my own practice

Yes, don't do this. You'll be tempted to take one insurance to try to fill up but it's a hassle to then get off that panel. Continue to network and market yourself.

7. Business Card: I'm still in the process of creating this, but I have checked out Canva (when it works). Lot of people recommended this to me

I used moo.com and liked it.

8. Email: I'll probably just buy a BAA through Protonmail and have a customized domain. I'm not sure whether it's better through gmail or not but I already have a pm.me for personal stuff

Protonmail, hushmail, mailhippo, these are some popular ones. I use Gmail and don't email with patients unless they email me first. I call for the most part and use my patient portal otherwise. My voicemail directs them to my website to submit a new patient request and create an account.

9. Phone: I am planning to use my Google Voice number on some type of backup phone that I haven't yet figured out. I'll keep it connected to WiFi at home and just check it once daily

I use Google Voice. Other popular options are Spruce, RingCentral, or a land line in the office.

10. Office: Not planning to have one unless people are actually interested in meeting me. Idk if this is true or not yet

Probably not needed.

11. Type 2 NPI: Still exploring this and not sure whether I can get this before my PLLC is approved for not

12. Policies: Still figuring this part out

Bunch of sample policies from other people's websites that you can copy. Just run it by your malpractice and they'll point out any issues with it.

 

[Geraltofrivia]

Awesome advice as always Clozareal! So I basically can and should get malpractice now and just get started. Idk why my stomach dropped or something haha. Maybe I was comforted in knowing I have more time to be confident in myself or something I guess.

I'm not planning to prescribe controlled substances, but I guess it's probably important to have a physical address still. How do you handle this if it's virtual?

 

[splik]

3. Make sure everything is updated before you embark on this process. What I mean by this is your license address, DEA, etc. Have a prospective business address in mind. PO Boxes are disallowed. I ended up choosing a "virtual" address through ipostal1. Cost me about $100 or something for the whole year

Do NOT use ipostal1. There are several issues (I used them at one point). They aren't HIPAA compliant. And the address is not valid for your DEA or NPI (at least it didn't work for me). You will need to update the address for your NPI or else you won't be contracted with insurance and you if OON your pts won't get reimbursed.

As mentioned above, you need a physical address for your DEA. That could be your home address (though DEA could come inspect your home!) or a professional office.

 

[clozareal]

Awesome advice as always Clozareal! So I basically can and should get malpractice now and just get started. Idk why my stomach dropped or something haha. Maybe I was comforted in knowing I have more time to be confident in myself or something I guess.

I'm not planning to prescribe controlled substances, but I guess it's probably important to have a physical address still. How do you handle this if it's virtual?

Sublet an office one day a week. I had a UPS office for a bit since it came with a physical address that I could pick things up at but the best, more legally compliant way would be to sublet an office from another psychiatrist/therapist.

 

[ObsequiousAplomb]

As far as physical addresses for DEA, NPI, and to see patients, you can find really good deals in most markets with shared office systems. I and 30 other doctors all rent 6 rooms in a larger practice. That would work out to one day per week per doctor, but relatively few of us are actually using that space a full day a week. I pay $35/month for the address and mail forwarding, and $18/hour for the use of one of the offices. Works out to the exact same price per month if I were there 40hours/week as if I had rented an office that size (I live in a terrible market). Months without in-person patients I pay only $35. With my one half day a week of in person, that's only $325/month

 

[Atreides]

I'd advise against using Wix. I made my website using Wix and the SEO is terrible. I've since learned that it's got a reputation of having the worst SEO of any website builder period. Even after I was seeing patients for a year, you could straight up google my name and my practice name and I still wouldn't show up on Google.

I used Dorik for my current website and it's great. Squarespace is similar. I'd recommend going with one of those two unless you have a bit more technical know-how, in which case Wordpress is the best option.

 

[clozareal]

I'd advise against using Wix. I made my website using Wix and the SEO is terrible. I've since learned that it's got a reputation of having the worst SEO of any website builder period. Even after I was seeing patients for a year, you could straight up google my name and my practice name and I still wouldn't show up on Google.

That's good to know about SEO. I tried Wix and it seemed super simple to make a website, more-so than Wordpress or Squarespace. I haven't heard of Dorik. I've seen some psychiatrists use PatientPop or Weebly but I don't have experience with those either.

 

[Dopamemes]

What EMR are people using these days? Seems like Charm, Luminello, Athena, and PracticeQ are the big ones? I haven't heard anyone using Dr. Chrono for a while. Any thoughts about a good option for a full time solo clinic?

 

[clozareal]

If I could do it over again, I would choose to have everything with PracticeQ.

 

[Dopamemes]

If I could do it over again, I would choose to have everything with PracticeQ.

Oh really? What do you find superior?

 

[AcronymAllergy]

For phone, it may be a technicality, but I don't think the free version of Google Voice is HIPAA-compliant. It might be if you have a workspace account and a BAA in place.

For EMR, we use Kareo. It works well, but there are probably cheaper/easier options, especially for smaller practices.

 

[clozareal]

Oh really? What do you find superior?

Automation

 

[romanticscience]

What EMR are people using these days? Seems like Charm, Luminello, Athena, and PracticeQ are the big ones? I haven't heard anyone using Dr. Chrono for a while. Any thoughts about a good option for a full time solo clinic?

I use simple practice. Another PRO that I’ve come to appreciate is their associated website maker. Either because of the piggybacking off their corporate SEO or that all my patients going to that site to sign into their portals drive traffic, but I rank very high on Google for a search of {city} psychiatrist {disorder}.

I was tempted to switch to Drchrono because of their Apple health integration; I thought it would be super cool for behavioral therapy to have access to that. However, their price is ridiculously higher than SP ($600/mo).

 

[Geraltofrivia]

Some follow up questions:

I was initially planning on doing cash only, however somebody put a TMS and other interventional bugs in my ear. Is it possible to do a cash only practice with PRN insurance (for things like TMS)? eg do TMS evaluations and also offer TMS for patients that need it, taking insurance ONLY for these patients? Or is that not possible? Does anybody have any experience with anything like this?

 

[splik]

Some follow up questions:

I was initially planning on doing cash only, however somebody put a TMS and other interventional bugs in my ear. Is it possible to do a cash only practice with PRN insurance (for things like TMS)? eg do TMS evaluations and also offer TMS for patients that need it, taking insurance ONLY for these patients? Or is that not possible? Does anybody have any experience with anything like this?

No. You could do single case agreements for TMS or you could do have a separate business for TMS which you credential with insurance. Bear in mind there is not a huge demand for TMS, so you really have to have the volume to be able to refer your own pts for TMS as with limited exceptions it is unlikely you are going to get referrals specifically for TMS.

 

[TexasPhysician]

Some follow up questions:

I was initially planning on doing cash only, however somebody put a TMS and other interventional bugs in my ear. Is it possible to do a cash only practice with PRN insurance (for things like TMS)? eg do TMS evaluations and also offer TMS for patients that need it, taking insurance ONLY for these patients? Or is that not possible? Does anybody have any experience with anything like this?

If you are doing cash only, please don’t do TMS. There are exceptions to every rule, but this is how you lose money. People try to sell these used all the time when they realize they don’t have the volume. TMS is a consideration if you have a high volume insurance practice with likely multiple clinicians.