Getting Paid In Private Practice
/Here at b.mindful Louisville, we not only provide our tenants with a comfortable, modern and safe space to practice out of but we also like to have an open dialogue around these topics and more. We have partnerships with billing companies to provide our tenants with discounted rates and wide knowledge base of the best practices and systems to use in your practice.
We have structured consultation hours to frame these conversations but also just find it beneficial to be open and transparent with one another about best clinical and business practices to assist each other in tackling the world of private practice. We are better together, if one of us succeeds we all succeed.
In graduate school we are told that we will graduate, get a job and then work for what we get hired for. If we are lucky, we will get a raise each year (to keep up with inflation), keep working our hours and getting our bi-weekly paychecks.
In private practice getting paid looks quite different than it does within the employment model or at a hospital, or agency.
Side note: Being in private practice is a commitment to having inconsistent pay at times, and therefore it is suggested to have various streams of income. Some people create courses, workshops, groups, trainings, supervision, or other non-clinical income streams to assist with these inconsistencies. Learn more about that here.
For this post we will be specifically focus on how we get paid for “butt in seat” clinical hours spent in our practices with our clients.
Easy break down, we get paid by our clients (private pay), or on behalf of our clients from their insurance companies.
Private Pay
Private Pay Benefits
You typically make more per hour
You see fewer people
Paperwork is easier
Immediate payment (cash/check/card from client)
Clients are often more dedicated and follow-through on treatment
Private Pay Cons
You should specialize and niche down more to bring in your ideal client
Marketing is key because you don’t have a provided referral network (insurance company)
You need to understand how to articulate your value and be confident in your hourly fee
Cash
Simple as it seems (set fee- exchange fee- done).
In today’s world, an all cash business isn’t the most convenient for your clients or yourself. This requires your clients to go to the bank and take out money each session and for you to go to the bank multiple times a week if not every day to deposit your earnings.
Also, you must have a safe space to keep your earnings in between sessions because you aren’t going to want to have wads of cash sitting or stashed around your office.
Some clients will prefer to pay with cash (for whatever reason) and if so, make sure to be specific with them about if you will or will not have change to provide them if they do not have the exact amount.
Check
Similar to above there are some implications that come with accepting checks as a form of payment.
Make sure you write down the check # before depositing
Actually make sure that the check doesn’t bounce, and it gets deposited
Make sure you deposit it! Have known several clinicians who have filed away checks without depositing them, therefore not getting paid!
Card (debit/credit or HAS/FSA account through clients insurance)
Your EHR may be integrated with a processing software (like Simple Practice and Stripe) but if you don’t have an EHR you can get a Square, Ivy Pay, Stripe or use WRS health for a card processor.
With whatever card processing system you use, you will have to pay a processing fee but to me it is worth it and I just count it as a cost of doing business and I also write off the card processing fee so that’s nice too!
Don’t use Venmo/Paypal/other money apps, because they are not HIPAA compliant and will not sign a BAA (yet…maybe one day they will…).
For all clients, it is suggested to keep a card on file (for no shows, and late cancellation appointments).
Make sure that the client is aware what this card will be used for and that it is listed in your informed consent and/or financial agreement and that they are initialing or signing to acknowledge agreement to card policy.
If it is an insurance-based client, you will need to check with each specific contract to see if you can charge a no-show fee or charge a client at all.
Insurance
Benefits of taking insurance
You have a built-in referral network (the insurance company)
People expect to use their insurance for medical purposes
Doctors refer more often to therapists that accept insurance
Cons of taking insurance
You don’t get paid right away because you have to file the claim, have insurance review it and then you get paid.
You need an EHR (electronic health record)
If your systems are off, you sometimes will lose money and not get paid
If you decide that insurance is something that fits your practice structure, do your research on what panels to get on before just getting credentialed with all of them. See what is popular in your area (talk with other therapists and see what they take, and if there are any gaps in the market…) and pick two or three that you feel are going to benefit your practices structure the best. Could be all Medicaid, all private, EAP or a combination.
If you get credentialed and sign a contract with an insurance provider, you are an “in network” provider for them.
In network Provider
You have to get credentialed and paneled with each insurance company (process can take around 6 months give or take).
While you are waiting for credentialing, you can see people at your private pay rate or at a sliding scale fee to build up your clientele and then switch them over to an insurance-based client once you are fully paneled.
You can take care of all things billing (credentialing, verifying, maintenance, claim filing…), or you can hire out for this. Bardstown billing is a Louisville local agency that provides affordable services for mental health professionals and Practice Solutions is a nationwide biller that could assist you getting paid by insurance companies.
If you do not get credentialed and sign a contract with insurances, you are an out of network provider with them.
Out of network Provider
Providers who do not have a contract with each insurance company but provide or file a superbill for client services so the client can get reimbursed for sessions at a later date.
I am a self-pay therapist and have some clients who use superbills and I always suggest that they call their insurance provider and inquire about out of network benefits and reimbursement to maybe get an idea on what they may be reimbursed.