Are you preparing to accept payment for your professional services by credit card? Before you decide which credit cards to accept in your private practice, check out Cracking the Code by Jennifer Gill. In her post, Jennifer lists 8 common credit card fees including skimming, debit cards (which are not always accepted), billbacks, and even hidden fees that you may incur and should be aware of when comparing costs.
Jennifer suggests that to determine what your merchant account is actually costing, you should divide your monthly credit card sales by the total merchant account fees.
Are you accepting credit cards in your practice? Got any horror stories or tips to share?
My lists of subscribers and readers are swelling! Thank you, thank you for passing along info about this blog to your colleagues and your professors (and to your massage therapists and your chiropractors and your physicians and all the other allied health professionals that you knew would be interested)!
If you are new to Private Practice from the Inside Out, I thought this post might be a really simple way to help you get to know me and start to get a a handle on the scope of information available to you right here.
My Very First Post
Working on Your Business – Working in your business is not the same as working on your business. Here’s the difference and why it’s important to do both.
I Enjoyed This Post the Most
You Know Your Private Practice is In Trouble When You Say . . . . – If you hear any of these lines start to come out of your mouth, it’s time to check in . . . with yourself, with a coach, with a seasoned colleague that can help you get back on track. Don’t let your practice suffer because you didn’t notice one of these 25 uh-oh lines.
A Post That Needs Your Input
Best and Worst of the Week -Need a place to vent and brag? Add your highs and lows in private practice here.
Clinical Supervision and ‘Money Gouging’ – What your professors may not have told you about your clinical supervision and why clinical supervision costs so much.
A Post I Wish I Had Written
How to Conduct Your Own Annual Review – Chris Gillebeau at The Art of Nonconformity speaks my language. This post talks about engaging in an annual self-review and goal setting.
If you are one of my regular readers and you missed some of these posts, subscribe to this blog (It’s FREE!) to receive email notifications of new posts.
Every mental health professional needs consultation on a regular basis. I wrote about that in my last post. If you work in an agency or organization, it’s likely that consultation is built into the system. However, if you have ventured out into private practice, you have to work a little harder to get your consultation needs met.
Many therapists choose to pay an individual counselor for their clinical consultation on a regular basis. If that is what you prefer, then you can expect to pay whatever that therapist’s usual and customary hourly fee is for his / her consulting and therapeutic services.
However, here are nine benefits to creating a peer consultation group to meet your consultation needs:
As a solo practitioner, you remain isolated most of the day except for seeing your clients. A peer consultation group allows you to meet some of your basic social needs.
It also exposes you to new / different ideas, perspectives, and energies.
It allows you to learn about other therapists’ business and clinical practices.
It may give you a broader range of professionals to refer to.
It exposes you to more professionals who may refer to you.
It exposes you indirectly to more resources in your community.
It can serve as a knowledge bank for clinical issues that you are not familiar with.
It can serve as a check point for potential ethical issues.
It’s free!
Have I convinced you yet of the huge benefits to participating in a peer consultation group? In my next post, I’ll tell you How to Create a Peer Consultation Group that ROCKS!
Colette Binger of Ridott, Illinois is expanding her practice to include consulting. She wrote in asking what should be included in her consulting contracts.
Here are the categories that I consider when I offer contractual services:
Services to be provided including specifications / proposal, if applicable;
Reports and presentations to be included;
Where services will take place i.e. on client’s premises or on consultant’s premises;
Any other special arrangements;
Beginning date;
Target completion date;
Fees specified per hour / day / other – consider including maximum number of individuals to be worked with;
Total estimated fee / cost;
Other costs (specify what for);
Amount of advance retainer amount;
Specify terms for balance to be paid;
Notes, remarks, and special provisions, if any;
A place for consultant to sign and date; and,
A place for client to sign and date.
After you develop your consulting contract, be sure you take your contract to an attorney for review. (I didn’t do this and unknowingly signed a non-compete clause that was perfectly enforceable – and not in my best interest – in the state of Colorado.)
Never sign a contract that has not been reviewed by an attorney in the state where your services will be provided.
If you are just getting started in private practice, don’t forget that you will need receipts. Here is the information that you will need to include on your receipt:
You can go to office supply stores like Office Depot, to have three-ply copies of receipts made. Or, you can order large quantities through online suppliers like Medical Art Press. If you use other suppliers for printing your receipts for professional services, feel free to suggest them below!
How Does Your Reduced Fee Reflect on Your Overall Reputation?
Are you thinking about advertising the fact that you offer a sliding scale fee? I strongly discourage mental health professionals from doing this and here’s the reason why . . . .
Once referral sources discover that you routinely provide services for a reduced fee, that is the idea that becomes attached to your name i.e. you provide the cheap stuff.
That’s NOT what you want to be known for even if you run a non-profit and routinely charge less than the Usual and Customary Fee for your services.
Your reputation should be based on the services that you provide and what differentiates you from your peers . . . not on having the lowest rates in town.
If You Choose to Provide a Reduced Fee, How Long Should You Do So?
I’ve had clients who were unemployed when they began working with me, so I offered my services at a reduced fee. Later, when they secured six figure incomes, they continued to pay the reduced fees.
Lesson learned? Yep . . . .
Lesson #1
My own issues with money got in the way. Otherwise, when it came to my attention that my clients were in better financial situations, I would have addressed it directly with each of them rather than feeling taken advantage of. If that is true for you, you have some work to do and a good therapist can well be worth her full fee to get that cleaned up early.
Lesson #2
What is understood to be “less than enough” by one person may appear to be “more than enough” to another . . . and vice versa. Get really clear about the circumstances under which you are comfortable providing reduced fees.
Lesson #3
Reduced fees need to have time limits. Unless you are operating as a charitable organization, consider how long is “long enough” to help someone access your professional services. Limits are good for your client and they are good for you.
Lesson #4
If you offer anyone a “good deal,” they’ll probably take it. Make sure to think through the offers you want to make before you make them.
Drop me a line and let’s talk about if / how you provide services to clients at a reduced fee. What does that look like in your practice? Is it working well for you and your clients?
I don’t know anyone these days who isn’t looking for a bargain – including me. It’s important to determine ahead of time if your client really needs a reduced fee to access your services.
I learned this lesson when one of my clients
(who was receiving a substantial discount on my fee) mentioned that he would be out of town the following week. He was vacationing at a rather pricey resort. That was a clue . . . .
Then, I decided to walk him out to the parking lot where he proceeded to get into his shiny, late model car . . . that cost about twice as much as my car.
Of course, most of us need a break and most of us need reliable transportation. However, my goal was not to fund those needs for my client before I could fund them for myself. It’s important to determine how you will decide who needs the reduced fee and who does not.
Do you have similar stories that you can share? If so, drop us a line below so that we can chuckle at your lessons learned, too.
This is the 1st post in the series
Reduced Fees, Sliding Scales, and Lessons Learned
When I first went into private practice, I tripped over several issues when offering my services for a reduced fee. Before you begin advertising that you reduce your fees for clients, there’s a few things you may want to take into consideration to avoid the same mistakes that I made. Here’s the first one . . . .
Are You Meeting Your Own Financial Needs?
Generosity is certainly admirable . . . if you can afford it. Airlines tell you to put your oxygen mask on before you try to help someone else with theirs. And, you cannot afford to give your services away if you cannot afford the rent and electricity for your home and your office.
There are other ways to do good in this world and hopefully you are doing them. But make sure that you are financially sound before you go trying to meet your clients’ financial needs.
And, if you are out there already doing good in this world without or in addition to reducing your fees, why don’t you take a moment to let us know about your good works!
One of the choices every practitioner in private practice has to make is how to set your fees.
Karlaye from Arizona writes . . .
. . . I set my base fee at $ 125 per hour . . . but the insurance companies that I work for set it at $85-95. If I have a private patient, its fine, but when I have a client that wants to use their insurance, I can only set it at that price. Is that correct?”
And, Jason from Colorado asks . . .
Is it OK to charge my cash-paying clients $85 / hour and charge my insurance- paying clients $100 / hour? It’s the only way I can see surviving in this economy.”
When setting your fees, you need to be careful. Health care providers are the most common perpetrators of insurance fraud. Sometimes such fraud occurs out of greed; however, it is much more likely that you may be engaging in fee-related practices that are illegal and not even know it.
If you have chosen to work with insurance companies, make sure that you are not charging you cash-paying clients a different rate than those who are filing on their insurance. Regardless of your intent, charging different clients different fees for the same service (based only on whether or not your client pays cash / uses insurance) is not OK.
Look for a future post when I discuss reduced fees and sliding scale fees.
If you are a regular member of our community here, you already know that my practice is a
"Money Fight" by HikingArtist.com
fee-for-service-only practice. However, if you are a provider who bills insurance companies for your services and you are having difficulty recouping your fees, check out this post about a doctor in Florida who got his money back by taking an insurance company to small claims court.
And, if you have had success in working with insurance / managed care companies and recouping your fees, I hope you’ll drop in here to share your insights / experiences.
I have made the choice not to contract
with managed care companies
for my professional services.
Here’s the 8 reasons why . . . .
Conflicts of Interest
As a Licensed Professional Counselor, I am required to avoid potential conflicts of interest. My primary concern is for my client’s well-being. Therapists working under the constraints of managed care companies are sometimes put in the position of having to choose between what is in their own best interest and what is in their client’s best interest. I do not want to be put in that position.
Managed care companies were created to “manage” and contain escalating health care costs. Their bottom line is to reduce costs and raise profits; it is not to increase the quality of care or quality of life for my client. In many cases, therapists who contract with MCC are actually paid to NOT see clients.
Restricted Choice
Often managed care companies restrict the client’s choice of therapist by offering only short term / brief therapy that I refer to as “drive-by” therapy. Such therapy meets the financial criteria of managed care companies but may fail to afford my client the opportunity to get the information / therapy that s/he wants / needs. It is my belief that this often results in my client’s quality of care being compromised. And, this, of course, can result in the possibility of my client’s needs going unmet.
Managed care companies often choose to limit what therapies are offered, can restrict what is discussed in therapy, and decide which clients can be seen and for how long. Some managed care companies have even included “gag clauses” in their contracts to prevent therapists from suggesting more effective treatments.
Professional Expertise
I believe that my client should be able to access the full range of mental health professionals according to client needs. Often managed care companies restrict the professionals that clients are allowed to work with – preferring to refer clients to therapists who have a record of providing short term therapy rather than to other therapists who may provide better results or offer a different packaging of services.
Contractual Limitations
I believe that a client has the right to full disclosure of any arrangements, agreements, contracts, or restrictions between any third party and me that could interfere with or impact your treatment. Managed care companies may label counselors’ choices to advocate for clients in this manner as “Managed Care Unfriendly Behaviors” and take such actions as they deem fit. Typically “violations” such as these result in therapists being removed from provider panels or censured in other ways.
Privacy / Confidentiality
By contracting with managed care companies, it is likely that I would be required to share my client’s deeply personal information with gatekeepers and utilization review professionals; it would mean potentially allowing literally hundreds of other to have access to my client’s personal information.
Medication
Research has consistently shown that medication for problems with mood is most effective when combined with psychotherapy. Nevertheless, managed care companies frequently approve medication only for their members rather than permitting them to also work with a mental health counselor. Again, the appearance is that of being more concerned about money rather than my client’s needs.
Time
Managed care companies usually require therapists to justify and convince Utilization Review professionals before treatment is approved / continued. This is time consuming for the therapist and for the client who is required to continue his / her therapy in “fits and starts.”
Diagnosis and Stigma
Managed care companies typically cover only those services deemed medically necessary which is defined as being literally about life and death and the treatment of illness. This means that they require a diagnosis of mental illness for my clients.
My practice is solution- focused on quality of life and personal goals. My work with clients focuses on prevention, exploration, and personal growth rather than simply survival. We typically talk in terms of possibility and resourcefulness, gratitude and integrity, commitment and personal responsibility. Working with managed care companies is not a choice that I can ethically make.
I Know Better
I have mental health professionals declare on a regular basis that you “can’t survive in private practice without participating in managed care.” But, I know better. What I know is that you can’t thrive – both personally and professionally – while participating in managed care.
Once I realized the ethical implications of working with managed care companies, I terminated all of my contracts with managed care. It’s not a decision that is right or necessary for all therapists but it was the best decision that I’ve made to date.
I am now celebrating 10 years of being an insurance-and- managed-care-free private practice. I’m thriving and you can, too! All it requires is courage.
If you, too, run a practice without managed-care, I hope you’ll drop in here to chat about your experiences. And, if you have yet to make the choice to opt out of managed care, I would be happy to help you find your courage and to help you create a path to a fee-for-service only practice.
Early in my career,I naively believed that the way to build a strong and independent practice was to contract with both insurance and managed care companies. I spent hours filling out the lengthy applications for each company. I followed up with phone calls and sent in supportive documentation just trying to get on the companies’ panels as a provider.
"Paperwork" by Luxomedia
Once I was approved to get referrals from the managed care companies, I had more paperwork to do and more phone calls to make. And, did I mention that the fee that I contracted for was significantly reduced from my usual and customary fee?
When counseling was not deemed medically necessary by the Utilization Review professionals, my reimbursement was abruptly cut off. My clients were unprepared to suddenly be financially responsible for my full fee. And, neither were they prepared to discontinue treatment with me.
As a therapist in private practice, you have many potentially practice-altering choices to make. Deciding whether or not to contract with managed care companies is one of them.
Make sure you take the time to consider the implications of working with managed care before you ever contract to do so.
If you market your services via the internet, television, radio, in print or face to face . . . even if you volunteer to man a booth for your community expo . . . you are engaging in direct marketing. Ken McArthur has just posted new guidelines for direct marketing in the United States. Tempted to put your head in the sand and ignore the guidelines? Really??
"Apple Planet" by Jorge Elias
Here are some snippets from Ken’s post:
Terms like “Free,” “Free Trial,” and “Risk Free” are to be avoided.
So are potentially misleading offers.
Don’t offer ‘false sense of urgency’ i.e. “Last Week to Purchase at This Price!” if the offer will continue.
Endorsements must be honest and accurate depictions of likely use of your services / products.
Affiliate marketing programs must make concerted effort to track participating marketers and minimize fraud.
Opt-out procedures need to be written in 12 point font or larger.
. . . Has anyone customized a general billing software like QuickBooks?”
[Update 01-28-09] Another reader, Sandy Jardine, in Phoenix, Arizona also wrote in asking for help.
I am a long-time user of Therapist Helper software. I have just been informed that when I switch to Windows 7 my ancient version of Therapy Helper will be useless. I need to get new software. I am looking for something SIMPLE. I have a completely self pay practice, do no direct billing to insurance, submit no electronic claims and need no scheduler. I provide my clients statements they can submit directly to their insurance for reimbursement. I also use it for keeping track of my income receivables, client lists, etc.
Can you please recommend what you have found helpful, affordable, simple and windows 7 compatible.”
If you have experience and opinions about billing software, please introduce yourself, tell us what you’ve used (and for how long) and let us benefit from what you know!
Tamara G. Suttle, M.Ed., LPC has maintained a private clinical practice since 1991 and founded Private Practice from the Inside Out in 2003. She has spent almost 20 years consulting and teaching marketing strategies to health care professionals like you. You can learn more about her clinical practice at her website.
Email Tamara
common credit card fees including skimming, debit cards (which are not always accepted), billbacks, and even hidden fees that you may incur and should be aware of when comparing costs.
on a regular basis. I wrote about that in 
contracts.
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=03faddb0-2e81-4185-bd49-f658841e3a50)
becomes attached to your name i.e. you provide the cheap stuff.
theirs. And, you cannot afford to give your services away if you cannot afford the rent and electricity for your home and your office.
