Tools for starting a private practice

Discussion in 'Psychiatry' started by Doctor Bagel, Aug 2, 2015.

  1. zolof

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    Great list. What about all of you who are doing PP part time (weekends, evenings, etc)? I have a spot that offered me including overhead , part time office, etc, that includes NHome work as well that was able to negotiate to 20%. Are any of you doing Private practice part time only in addition to inpatient work and are you doing everything yourself or using colleagues space?
     
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  3. rollercoaster

    rollercoaster Junior Member

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    Please post Recommendations for billing companies and any experience with practicefusion EMR. Has anyone worked out of shared office space viz Regus ?
     
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  4. carlosc1dbz

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    I was wondering, for people that are doing these concierge type practices where they are trying to have that personal/available practice model? Are there any legal issues that psychiatrist have to keep in mind when seeing patient's, lets say in their home or over the internet? What about meeting in public places like a coffee shop?

    I heard that some people use Skype for Telepsych and that it is encrypted so that it is HIPAA compliant. I am not convinced.
     
  5. splik

    splik Professional Cat at Large
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    skype is absolutely not hipaa compliant

    it's not uncommon in some models to meet people with serious mental illness or disturbed youth who are hard to engage in public settings. However it is asking for trouble doing so in a concierge model - you are more likely to find these patients attractive, the boundaries are more likely to get crossed/violated, their expectations and level of entitlement will be higher, your capacity to manage the transference will be impaired, and they are more litigious.
     
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  6. CAPsychiatry

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    Any input about networking and how to increase your referrals if you are new in a city? I recently started my private-pay practice (no insurance) in an affluent area where most psychiatrists/therapists are cash pay, but I am not certain whom I should approach to get referrals from beside psychology today and networking with other therapists. I read here that PCPs are a good source. My hesitation with PCP has been that most PCP see insurance patients and they get disappointed to hear that you do not accept insurance. Do you just show up at PCPs offices and request to see the doctor? Or do you try to get connected through phone/email?
     
  7. hamstergang

    hamstergang may or may not contain hamsters

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    Disclaimer: I'm making this all up but it sounds good to me.

    They're busy so likely wouldn't really appreciate you just showing up. I'd call in advance, tell them you're new to town and want to take them to lunch to get to know those in the area better. If they sorry of know you they'd be more likely to recommend you.
     
  8. digitlnoize

    digitlnoize Rock God

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    FaceTime is, according to the VA however. http://www.va.gov/trm/ToolPage.asp?tid=7953
     
  9. TikiTorches

    Physician Gold Donor Classifieds Approved

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  10. Indodo

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    The part about PCPs and insurance is absolutely true. They don't like it when you don't take insurance. Generally the PCP referral source is really better for those taking insurance.
    I do it face to face. You can just show up but it is better to make an appointment, bring lunch etc. (enough for the secretaries/MAs).
     
  11. Ahamis

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    Is it true that with inpatient contract you can round with your patients and once you are done you can go to your second job?
    If yes, that would be a good way to start a private practice gradually.
     
  12. TexasPhysician

    Moderator Physician

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    A lot of people do exactly this. The downside is long days and call at 2 places.
     
  13. michaelrack

    michaelrack All In at the wrong time
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    I am often on call for 3 places at once
     
  14. stat777

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    I have a question about directly billing patients in a private setting. My practice will be rented space at an substance use treatment facility. I do some work for them where I will occasionally see admissions. To further complicate the situation I will also be do some part time outpatient work through a hospital organization in another state. If I'm required to take insurance through the hospital position do I have to take it through my private practice as well? Someone told me that if I did not take insurance one place but I did at another location that would be fraud.
     
  15. TexasPhysician

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    Insurance contracts are typically location specific, but certainly read yours thoroughly.

    A problem may occur if you are renting space at the same location where you accept insurance for the treatment center.

    I would get space elsewhere.
     
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  17. Gavanshir

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    Really? The pharm rep thing? D:
     
  18. carlosc1dbz

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    The APA website has some good information for starting a private practice. I suggest you guys check it out. One things that I am curious about is the legal paperwork associated with a private practice. The paperwork patients sign when entering a patient doctor relationship with you. What kind of lawyer should one seek out to get all this done? Anyone even doing this?
     
  19. carlosc1dbz

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    I was wondering if anyone has any recommendation or can share their experience about finding a good small business bank?
     
  20. JustAGuy

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    Part-time private practice after a day job - do you rent your own office for X and try to rent out rooms, or rent a small room from an established provider for 0.75X? I know it probably varies by geographic location, but what do you guys spend on rent each month?
     
  21. TexasPhysician

    Moderator Physician

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    What do you need a small business bank for? I use WF for a free business checking account.
     
  22. TexasPhysician

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    If private practice is planned to be part-time only, I would sublease from another clinician. No need to add extra hassles on top of a part-time job.
     
  23. michaelrack

    michaelrack All In at the wrong time
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    Most banks will be able to set up a lockbox account which you can have checks/payments/electronic fund transfers sent to. The cost is $100-$200 per month, depending on how many deposits you get
     
  24. Notyetaphysician

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    What would the average overhead cost be? What should it be with a physical office? Is it any different for telepsych only?
     
  25. medium rare

    medium rare Psychologist & Psych NP

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    We charge $450/month to rent office space for one day/week. This includes the office space and full secretarial/administrative support (reception, billing, scheduling, phone calls, etc.).
     
  26. Notyetaphysician

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    Thanks! Where are you located? What part of that is the rent vs the overhead?
     
  27. medium rare

    medium rare Psychologist & Psych NP

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    Southwest. About 60% rent, 40% overhead.
     
  28. carlosc1dbz

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    One thing that I did that I thought was really helpful was going to the website of the local psychologist association in my city. There you can see who is renting their office space for anywhere from 1-4 days per week on a month to month basis. It is really affordable that way. You will also likely be surrounded by psychologist and have access to easy referrals.
     
    #76 carlosc1dbz, May 24, 2017
    Last edited: May 24, 2017
  29. carlosc1dbz

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    You are right, I did not need that type of bank. I opened up a Chase Business checking account. I used their partner in house partner ADP to set up my own payroll and tax related things. It is going pretty smooth.
     
  30. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    For 1 day/week? That's fairly expensive. You can get full-time access to an office with support through Regus for a similar amount in most cities.
     
  31. carlosc1dbz

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    You can get a virtual office with x hours per week for a pretty good price. Virtual offices are good so that at least you can have a business address, set up your DEA, get mail, your prescriptions with an address and then transition to a full time office on a lease. I am using Premier Business Centers and they have their own receptionist that is included in the price, they answer phones and can even take calls and make appointments for patients. They have places all over the country.
     
  32. carlosc1dbz

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    Great advice. Where can I find out what forms I legally need to give to my patients if I start a private practice? Do you need to display the medical board's phone number?
     
  33. aa1984

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    Was hoping to get this thread going on - specifically if you are using EMR, and how you are scheduling for part time practice if you don't have staff yet. Any phone services (internet based) that you recommend, or is it better to get a land line? I am looking to sublet from another physician for a few months before transitioning so its murky. Thanks in advance!
     
  34. RomanticScience

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    I graduated from residency in July and I went right into full-time private practice. It's a solo psychotherapy-focused practice with very low overhead (~1k/mo). I take two local insurances which pay fairly and I do all of my own billing. I'm able to be efficient because I rely heavily on tech. Granted, this limits my patient population to those who are technologically literate.

    I use 8x8 virtual office (virtual fax, phone w/ auto-attendant--rings to iPhone), OfficeAlly EMR Suite (PracticeMate [Scheduling, Accounting, Claim Submission], EMR 24/7 [Charting, E-Rx, E-Labs], PatientAlly [Patient Portal]), Google Business Apps (Docs, Sheets, Drive, Sites; all HIPAA compliant), and Doxy.Me (tele-psych platform; HIPAA compliant).

    PM me for any questions!
     
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  35. aa1984

    Physician

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    SO helpful, am going to PM you.
     
  36. zolof

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    Hey had a question. They are able to make appointments ? What about taking patients insurance information and entering them into your emr?
     
  37. zolof

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    Where I am at this is a steal, is 450 for just office space here, no support from reception, scheduling or billing. But then again these are the nicer looking offices,
     
  38. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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  39. Mastac741

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    Hi Guys - I've been out of residency for 2 1/2 years. Was actually a tough transition (I was surprised - you always dream of being an attending). Residency had a lot of comradery; job not so much. Most relationships are at a strictly professional level and at arms-length. Anyway, I've been daydreaming of starting a private practice; though nervous because I have a family who is dependent on me. A few questions for the veteran private practice people:

    #1 - Am I crazy to consider taking Medicare? Reimbursement rates seem alright if done correctly. Here's my calculation.

    see 10-12 patients a day - 2 new patients 10 follow-ups: (Pulled data off CMS website)

    2 x new intakes (90792) $148.97 = $297.94
    5 x 99213 followups /day $74.65 = $373.25
    5 x 99214 followups /day $109.75 = $329.25
    50% of visits I will do supportive or other psychotherapy (90833 add on code) $67.07 = $335.25

    If I work 221 days/year = 1335.69 x 221 assuming 90% fill rate = $265,668

    Please prescribe me an antipsychotic if I'm not thinking about this right. I've never billed Medicare - does it take forever to get reimbursed? Do they reject your claims a lot?

    #2 - Thinking about doing TMS treatments - there has been other forms about this, but they are old. Insurance and Medicare now covers this, so times have changed. Can anyone with experience with this PM me? I would greatly appreciate it.

    #3 - Does billing and getting reimbursed take a lot of time? I was thinking of billing myself and if it gets rejected, then hand it over to the billing and collector people who take a cut. Anyone do this?

    Thanks for reading.
     
  40. nitemagi

    nitemagi Senior Member
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    I think this is going to be regional as to medicare. If you can get by without it, I'd say do so. At minimum talk with a billing company and get their estimates on how much to expect in receivables and the turnaround time.

    TMS is a massive upfront investment. Neurostar was $1M previously (I'm sure it's come down). But in a field where overhead can be quite minimal, I wouldn't go for that unless you're in a totally saturated environment.
    1. Get a PT gig so your bills are paid. 1-2 days a week. Always good if they have additional per diem work if you need it.
    2. Start the practice, get all your logistics set up, including billing, office, phone, fax, and make a list of referral sources.
    3. Start getting the word out and accepting patients.
     
  41. Mastac741

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    Thanks for the advice. I've got some thinking to do...
     
  42. zolof

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    Billing, coding, How much lately if anyone is utilizing a company or individual doing this ? I cannot find less than 7 to 8 percent, in my search. Anyone else?
     
  43. michaelrack

    michaelrack All In at the wrong time
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    Medicare is a pain to sign up for/add a practice location, but once you do the $ comes in fairly regularly. I believe that the reimbursements above are for medicare allowables, meaning you will have to collect the 20% copay (and deductibles) yourself and/or bill their secondary insurance. you aren't going to get all of it, so that will bring the $265,000 down to $230k at best, and then you will have expenses including your billing company, malpractice, etc. You will likely end up netting in the 175-200k range
     
  44. boogaaloo

    boogaaloo Banned
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    Facetime definitely is. Everyone knows that!
     
  45. gebor

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    Is it legal/possible to do a mix of cash/insurance patients? Example having 4 appointment slots insurance and 6 slots reserved for cash only on a given day at the same location?
     
  46. splik

    splik Professional Cat at Large
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    not sure what your question is but it is of course common for people to take a few insurances and then see other people as cash (because they don't have insurance you are contracted with). what you cannot do is charge cash to patients who have insurance you are in network with. if you are a medicare provider you cannot charge cash to see medicare patients.
     
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  47. hamstergang

    hamstergang may or may not contain hamsters

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    I think the real question being asked is if you can section off your schedule. That is, you contract with some insurances but only make certain intake and follow up slots available for those with those insurances, and then make your other intakes and follow ups for those without the insurances you take.
     
  48. Nitya2

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  49. Nitya2

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    Thank you. How is your experience using OfficeAlly EMR so far? is it time consuming or expensive? How much time does it take to enter an initial assessment? Have you looked into other EMrs before joining them....AdvancedMD, Kaero, NueMD, Tharepy Notes?
     
  50. zolof

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    I have used a couple different therapy notes and office ally. I didn't really like either but thats my preference I use my own modified template when I can. It doesn't take too long to do an assessment, just about 5 to 10 min for me. I think kareo and some of the others were too pricey. therapy notes and office ally were less exp. How did your friend in NJ find a company that takes 2to 3 percent billing? If you know any names please PM me.
     
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  51. Mastac741

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    Hi, still mulling over starting my practice. I think I'm getting close to making the dive. Just another insurance question: Is it true that once you take one Medicare patient that you have to take all of them (if you're accepting new patients)?

    Is this true for Blue Cross/Blue Shield or UnitedHealthCare? If you are contracted with them in-network, can you refuse to see nightmare patients who have their insurance?

    I would like the ability to fire patients if it's not working out.

    Thanks.
     
  52. PistolPete

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    Curious about this too. My understanding is that yes, you can most definitely fire your patients, whether they’re paying cash or on United/some other insurance if they’re not following your prescribed treatment plan.
     

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