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The Counselors Guide to Private Practice

Brian Mosley, MA, LPC

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How to establish your professional identity in private practice

Who are you in private practice?

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The identity of LPC’s in private practice.

How is it determined? What are the traits of a “good” LPC?

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What is “your” opinion of LPC’s

How was it determined? First impressions… Past experience…

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Imagine your ideal private practice

Who is your clientele? Where are located? What are your hours? What does your office look like? How much money are you making? Are you successful?

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We need help?

If the profession of Counselor/LPC came to you as a “client”, what issue do you think they would be dealing with?

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How did I get here? Why counseling? Why did I choose this field?

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How did I get here? Your personal journey..

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Where do LPC’s work?

Government Agencies Hospitals Psychiatric Practices Business Human Resources THE MENTAL HEALTH CENTER At the MALL: we all know an LPC working out of

their field

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Where is your place?

Substance Abuse Corrections Children's Services Aging Services Mental Health Schools Government

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Who do I want to serve in private practice?

Where are my interests? What am I best at? Do people need this? Can I get paid for what I do best? Does the public know they need what I do

best? Is it ethical?

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Who do I want to serve?

Socioeconomic groups Do I have a bias? Psychotherapy vs. Social “Work” Children Teens Elderly Couples Groups Individuals

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Who do I NOT wish to serve in my private practice??

Is it ethical?? What are my motives To answer these questions you must decide

what your goal for being in private practice is.

Its OK ..

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What are my goals in private practice?

Autonomy $$$$$$$$$$$$$$$$$$$$$$$$ Service Quality Can these be married?

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My ideal “patient”

Motivated Great Insurance Insightful and seeking answers Not mired down in “social problems”

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Who your market is, dictates….

Where you will set up your practice How you will market your practice How you will bill for your services When you will work. How you will present yourself

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Who your market is not also dictates…..

Where you will set up your practice How you will market your practice How you will bill for your services When you will work. How you will present yourself

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Where will my office be?

An office building Churches Clinics Community buildings Medical Practices Hospitals Home office Multiuse buildings

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Basic Requirements

Privacy Parking Waiting Restroom Handicapped accessible Safe for everyone

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Money Management

Business Account Pay you bills Pay your self Re-invest in your business

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“Tanning, Carwash , Live bait and Psychotherapy”

Meeting people where they are… Not just physical… We have separated ourselves…. Presentation… Casual, sloppy, unkempt. Too much… Business… Don’t make statements just dress well.

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Pros and Cons of renting/leasing

Leases Rent Owner stipulations Support. Staff and or

equipment Privacy

Taxes Separate from my “ life” Professional look Appearance is

everything in marketing Privacy

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Pros and cons of a “Home Office”

Convenience Taxes/IRS Privacy Safety

Safety Convince IRS Interruptions Zoning Privacy Separation between

work and home

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Components of a good home office.

Separate entrance Business is ALL it is used for. Restroom Easily accessible Parking Waiting Fully insured Private

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The most important component is you

Are you comfortable with your clientele, your marketing and your physical office.

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Steps to Private Practice

LPC State business Licenses http://www.wv.gov/business/Pages/

LicensesPermits.aspx City or County Business License Sole Proprietor Corporations LLC and PLLC

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Malpractice Insurance

Required by insurance companies, EAPS and most business you work with. Limits required.

DO NOT BE STUPID Sources APA ACC HPSO Your home owners policy provider “slip and fall”

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Insurance Companies

Who is the largest provider in your area to your market.

Call Provider Relations Get added to panels as the need arises.

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You must be credentialed for:

Insurance Companies Hospitals Organizations An easy way to do this and maintain it is. www.caqh.org

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Credentialing

Cumbersome Takes time Must be done Has been streamlined in some cases

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About CAQHCAQH, an unprecedented nonprofit alliance of health plans and trade associations, is

simplifying healthcare administration through industry initiatives that Promote quality interactions between plans, providers and other stakeholders

Reduce costs and frustrations associated with healthcare administration Facilitate administrative healthcare information exchange

Encourage administrative and clinical data integrationMission Statement

To be the catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for

patients and caregivers.

VisionA healthcare system in which administrative processes are efficient, predictable, and easily understood by patients, caregivers and providers. In this system, administrative

and clinical data are integrated to effectively support the delivery of care

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Billing

Hand billed Computer Generated Programs, soft ware and websites www.navinet/navimdex.com www.speedysoft.com www.notes444.com Insurance company websites

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HCFA 1500 Form

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Billing Options

Billing Companies/Electronic Clearing Houses

Office staff DIY Paper Electronic

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Billing Tips

Accurate Timely 24 hour turnaround Codes/authorization Will you be paid for what you are doing Do you have authorization Pre-Certification Deductibles

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Is it ethical

Did I do what I am billing for? I am qualified to bill for what I did?

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RECORD KEEPING: Another In-Service

Informed consent. Disclosure Statement Release to treat, bill and refer if needed. Demographics. History. Medical. Progress Notes. Treatment Plan Correspondence

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Forms and charts

Forget the mental Health Center and Hospital Model.

What works for you and your “client” What stratify who is paying you.

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Electronic and Paper record keeping

Your records Security Access Who is the guardian of my records if something

happens to me. Paper or electronic What is practical for you? What can you afford?

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No code , no cash…

How do you learn about coding.

CPT Codes CPT (Current Procedural Terminology) codes are numbers

assigned to every task and service a medical practitioner may provide to a patient including medical, surgical and diagnostic services. They are then used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer. Since everyone uses the same codes to mean the same thing, they ensure uniformity.

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Coding

Mental Health CPT Codes (for Professional Reference)

Below are some commonly used CPT codes for general reference. You will want to check whether these are billable codes before submitting them for reimbursement to the client’s insurance provider.

90801Psychological Diagnostic Interview Examination (Includes report prep time 90885)

90804 Individual medical psychotherapy, 20 - 30 minutes

90806Individual medical psychotherapy, 45 - 50 minutes

90808Individual medical psychotherapy, 75 - 80

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Codes Continued

9084790847Family Psychotherapy with patient PresentFamily Psychotherapy with patient Present

9085390853Group psychotherapyGroup psychotherapy

Source: “AMA and CMS 2011 Coding for Offices”

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Diagnosing for billing

Yes you can. Accurate Impression Fluid Do not fence yourself in If in doubt get more training

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Insurance Companies

Actually want to serve their members Provider Relations. They dictate what you can do and get paid for doing. They have requirements we must fulfill in order to be

paid. Most will allow a certain number of sessions and

then will ask for a treatment plan. Sometimes you can get more sessions on the phone

or electronically.

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Marketing your practice

Advertising Yellow pages Internet Flyers and signs Business cards Media

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The best source of referrals?

Word of mouth

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Marketing to referral sources

Physicians Schools Businesses Other healthcare professionals General public

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Marketing to referral sources

Physicians “Here is what I can do for you and your

patients”. Diagnosis to justify treatment.. Counseling Crisis services “I can make your job easier”

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Schools

Difficult at best in my experience.

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Businesses

I can help you keep good employees and save you money.

Fast turn around with results. Education to prevent further problems Crisis Debriefing

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Marketing to community

More open to counseling than in the past. Flyers Signs Advertising Word of mouth works best.

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Sources of new business in the community.

Support Groups Substance Abuse, Parenting, Grief, special

topics, health issues, etc… “Back to School”, “Off to College”. Get together with other healthcare

professionals who can help with these groups.

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EAP“Employee Assistance Providers”

Promise you access to a pool of employees by “agreeing:” to their terms.

Federal Government USPS Manufactures Minning Chemical Industry

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EAP

Other sources of income from EAPS are Speaking engagements, health fairs,

informational events.

Downside ½ the pay

Upside quick to pay, easy to work with.

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Hospitals

You can contract with a local hospital or be credentialed to join the staff and provide consultations services to the ED and in-patient populations under the supervision of a staff member, you can then bill for the consult or the hospital will pay you directly for each encounter.

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Local Law Enforcement

Contract to provide services to police and fire personnel , training, crisis debriefing, employment selection.

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Local companies

How you can assist them in keeping good employees

Education Counseling Consulting

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The business of local businesses

City licensing County licensing State licensing Zoning

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TAXES

City State Federal Health Care Provider Tax???

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Marketing Tools

Signs Flyers Internet Commercials Yellow pages News papers Cards

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Taxes

Keep everything Education travel Office supplies Utilities Furniture , equipment Advertising Books, literature Fees Pro bono

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Taxes

Pay quarterly Keep great records

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Be a professional

Appearance Communication Style Business manner Your not just representing yourself , you are

representing me and all LPC’s.

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References

Billing www.speedysoft.com www.navinet.com www.cms.com/hcfa1500 www.cms.gov

http://www.navinet.net/

http://www.counseling.org/

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References

http://www.samhsa.gov/healthPrivacy/

http://www.hipaatraining.com/mentalhealth.aspx

http://www.allthingsprivatepractice.com/do-you-need-to-be-hipaa-compliant/