Private Practice quick questions

[smalltownpsych]

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Lol tbh I was using paper charts exclusively but then a patient was asking for invoices. I was like "WTF?" so I scrambled to get an EMR. I have folders with loose leaf papers in them. I call in prescriptions but I have one guy with one controlled substance I'm probably gonna end up discharging (he was referred to me). Some patients are on lithium and I have to check levels but I have no clue how to order labs without an EMR or fax or anything.

Bizarre: I made this post but I guess I didn't send it. You somehow touched upon a point that I raised but somehow the post didn't show up or maybe I missed it (very possible)

Few new things I'm running into:

1. Fax number. What do most people do about this?
2. Labs. How tf do you do this? I have to pay LabCorp and Quest to create accounts???
3. EMR. Still just puttering by with Charm. Sessions seems pretty nice though (from @lol.psych post above). Can you order labs through it? How do I do this? Can you order through SimplePractice? How do others do this?

I can't believe I didn't think about this crap before. I feel disheartened. I have a small practice

Good to learn this stuff when you are a small practice. I think @splik had a post that listed a lot of steps to starting a practice and as I recall it was like 20 items. Any of us who have done this recognize the challenge and are willing to help. This is a great site for getting this kind of info that wasn’t part of our clinical training. 😁

 

[Geraltofrivia]

Great point. I forgot about that thread. I will track it down. Thank you!

 

[minimooshie]

Hi everyone, got a question from a potential patient today about cash practices taking FSA/HSA - are there special requirements for me to go through to do this or is it just run as a credit card basically and they may need a superbill to prove to the account that they're receiving qualified medical services from me? Thanks! Happy Halloween!

 

[Sushirolls]

FSA/HSA usually issue credit/debit type cards.

Do you business as usual. Present your bill as usual. Run their card as usual.

If they want a superbill for whatever reason, provide it.

No need to overthink it.

*The issue with HSA/FSA, is for DPC practices by FM/IM, and a ridiculous gov laws not allowing them use those cards to pay for their monthly retainer fee.

 

[minimooshie]

Hi there! Another little question about cash and Medicare (Medi-Cal here in CA...). I have a patient saying he has a Blue Cross plan 'through' Medi-Cal. I'm not wanting to deal with Medicare and do not want to opt out, so I'm just explaining to patients I can't legally charge cash if they have those plans and cash is the only form of payment I'm accepting.

For this patient with a plan 'through' Medi-Cal, does that still mean I can't charge him cash and have to run it through Medi-Cal? Logically seems the answer would be 'yes' but I just wanted to ask in case others have more background on this topic. Also setting up my new med mal plan and may ask them about this soon, too. Thanks!

 

[Sushirolls]

I've defaulted to not charging cash for those with medicare advantage plans I'm not in network with, and simply saying we can't accept them.
Or we say we currently aren't accepting any new medicare patients, which is true.

I believe there is some debate on this issue, and other have posited that you may charge cash to medicare advantage patients who are OON, but you may not ever do so with true medicare.

I'm not willing to risk it, and simply say no.

 

[splik]

Hi there! Another little question about cash and Medicare (Medi-Cal here in CA...). I have a patient saying he has a Blue Cross plan 'through' Medi-Cal. I'm not wanting to deal with Medicare and do not want to opt out, so I'm just explaining to patients I can't legally charge cash if they have those plans and cash is the only form of payment I'm accepting.

For this patient with a plan 'through' Medi-Cal, does that still mean I can't charge him cash and have to run it through Medi-Cal? Logically seems the answer would be 'yes' but I just wanted to ask in case others have more background on this topic. Also setting up my new med mal plan and may ask them about this soon, too. Thanks!

You seem to be conflating medicare and medi-cal (CA medicaid). They are distinct. there is no opt out for medi-cal. There is only opt out for medicare.

The california medical association advises against charging medi-cal patients cash, but you can do so as long as you aren't contracted with their medi-cal plan. Do not give them a superbill.

If a patient has a medicare advantage plan, you can charge patients cash even if you haven't opted out of medicare. Basically, they've sold their medicare benefits and it's as if they don't have medicare at all. They can even get reimbursed potentially for part of the cost if you aren't opted out. If you had opted out, they can't get reimbursement. You would want to have a copy of their insurance card to double check they don't have original medicare w/ a supplemental (in which case you can't charge them) vs a medicare advantage plan.

 

[Geraltofrivia]

I have a new problem now: I believe I've gone as far as I can with one of my psychotherapy patients (my only patient). How do I go about finding a good supervisor? Thank you

 

[ObsequiousAplomb]

I have a new problem now: I believe I've gone as far as I can with one of my psychotherapy patients (my only patient). How do I go about finding a good supervisor? Thank you

Easiest: reach out to a former supervisor from residency and offer to pay their usual hourly rate for supervision

Still easy: reach out to a local institute or training program in the type of therapy you are interested in and ask if they have people they would recommend

A little more but still easy: ask local AMA or APA chapter or list-serv

Not as easy: go to a conference and schmooze a bit until you find someone interested

Harder: find a therapist you really like in your area either by word of mouth or from reviewing their websites, then cold-call or cold-email them and ask.

 

[minimooshie]

Hi everyone! 2 months into my private practice and I am chugging along. Thanks to all of you for your constant support and tips for success.

I have a question about transferring between jobs, for anyone who has navigated that.

I am getting faxes from CVS for refills and PA's from my old job. Seems all my old patients are just saved under my name as their prescribing physician instead of being tied to the facility I used to work for. Now that CVS has my new fax number for my current patients, all the other requests are getting passed along. I created a letter stating "Mrs. blah blah birthdate is no longer my patient, please cease communication about this patient and forward all requests for medication refills and PAs to my old job at fax number". It's tedious to have to fax this every time, but that's what I'm doing.

Any other suggestions or experience with this? Feels like a HIPPA violation waiting to happen.

 

[splik]

Hi everyone! 2 months into my private practice and I am chugging along. Thanks to all of you for your constant support and tips for success.

I have a question about transferring between jobs, for anyone who has navigated that.

I am getting faxes from CVS for refills and PA's from my old job. Seems all my old patients are just saved under my name as their prescribing physician instead of being tied to the facility I used to work for. Now that CVS has my new fax number for my current patients, all the other requests are getting passed along. I created a letter stating "Mrs. blah blah birthdate is no longer my patient, please cease communication about this patient and forward all requests for medication refills and PAs to my old job at fax number". It's tedious to have to fax this every time, but that's what I'm doing.

Any other suggestions or experience with this? Feels like a HIPPA violation waiting to happen.

just ignore. As long as you have formally terminated these patients and they aren't under your care, you have no obligation to respond.

 

[minimooshie]

just ignore. As long as you have formally terminated these patients and they aren't under your care, you have no obligation to respond.

I just talked with the pharmacist, they said the patient's app where they can request refills is tied to my name, not the practice location - so this isn't going away until a new doc writes for them. I'll just hope my fax subscription can handle this wave and it'll go away within a couple months! Thanks

 

[Geraltofrivia]

Hey guys just wanted some advice.

I am having a hard time generating business! My website ranking is improving (I'm up to page 3). Not on psychology today though. Haven't gone to PCP offices or anything or to the District Attorney/Public Defender's office (for forensic work). Are business cards important? I've been relying basically entirely on my website. I've had a few patients inquire as to whether I was taking patients, but my practice at that time was not approved by the state (I got approval like two weeks ago). I haven't been getting emails or real phone calls lol.

I'm open to taking literally any suggestions. Thank you guys

 

[brosa]

Hey guys just wanted some advice.

I am having a hard time generating business! My website ranking is improving (I'm up to page 3). Not on psychology today though. Haven't gone to PCP offices or anything or to the District Attorney/Public Defender's office (for forensic work). Are business cards important? I've been relying basically entirely on my website. I've had a few patients inquire as to whether I was taking patients, but my practice at that time was not approved by the state (I got approval like two weeks ago). I haven't been getting emails or real phone calls lol.

I'm open to taking literally any suggestions. Thank you guys

I don't have a private practice, but I have experience working with other things related. Anyway, being on page 3 is basically useless because no one goes there. Shouldn't be a difference between page 3 or 300. You will need to do more hands on marketing, such as going to PCP offices, therapists offices, Facebook groups (see what is available about your city, something like Therapists at X town would be great), even a reddit post in the subreddit of the city would likely work (ofc create a user for that lol). Reaching out to older psychiatrists who may be filled can also work sometimes. People do say good things about psychological today as well.

Another advice that I saw in a NP forum was to go UPS and buy mass delivery of business cards. It may not be at UPS and that may not be the name, but there is a system where they will mass delivery something based on the zip code. I never saw anyone here trying that, but the NPs loved it. They would spend like $500 and everyone in their area would get their card in the mail.

Once you start, patients will recommend you to other people, but the initial influx can be challenging.

 

[hamstergang]

Not on psychology today though.

Why not? It's cheap and definitely effective.

Otherwise, going to PCP offices with business cards is probably best. That way, your name stays behind on something they can easily access. After they refer you a patient, definitely follow up with them so they'll remember you as a good psychiatrist. PCPs see more patients than therapists, so they tend to make great referral sources.

 

[SakuraBloom]

I get most through psychology today