Here at TPI we want to answer your questions large and small. Below are questions we've been asked that relate to practice.

Look through and you may find answers to your questions as well. If not, click here to send us your question. 

What should I charge the client for services that are not covered by their insurance?

If it is a non-covered service, you should get informed consent from the client in advance of the service, and charge your fee. If it is non-covered then I would think it would fall outside the scope of your contract with the insurer. You can also consult with you
attorney to get a legal opinion as to whether it is outside the scope of the contract if it is a non-covered service.

Do you have any tips for setting up my bookkeeping?

Your office financial records are in some way the life-blood of your practice. Being on top of your income and expense processes is key to running a successful practice from a business point of view. As an employer, a key best practice is to not have the same person manage accounts receivable as the person who manages the accounts payable. Additionally, you should have safeguards in place whereby you are able to oversee the bookkeeping processes and double check the data input processes as well as the payments. While no one likes to think about it, “Embezzlement Happens!” It is important to make sure you know how to use the software you choose for both your patient accounts and your accounts payable. Monthly reports and tracking your key monthly indicators are also crucial to help you monitor the health and well-being of your practice as well as to help you decide directional shifts. If you don't know the software you cannot oversee the data input. It is far too easy for your administrative staff to innocently make errors and for your key indicators and processes to become in disarray and misdirect you.

What is your feeling about giving out an email address on a business card?

Question Continued: A friend told me that he was advised in his grad school class to not give out an email  address to the public because of liability issues - in case someone writes to you that they are feeling suicidal. He said that I should just use a phone number. What do you think about this? Obviously many people now use email as their primary method of communicating.

Putting your email address on your business card is important. Generally, clinicians don't give their cards out to "the public". They give them to potential referral sources and to current patients. People may threaten suicide from seeing your email address on your business card, but they also may find your phone number or your email via your website or elsewhere on line  (which is much more public than your business card). If so, most clinicians, would probably not develop a doctor/patient relationship but would urge the individual to get emergency care. Either way, it is unclear what the faculty feared. Not putting one's email on your business card would not avert the issue. Perhaps someone contacting you (however they reached you) when suicidal could be looked at as a good thing (as they might get directed to the right level care) and not something to avoid. Lastly, now days, not putting your email on your business card is akin to not giving out key contact information.

What employee benefits should I give my staff?

Some benefits must be provided for employees (such as workers compensation insurance) and others are discretionary (such as disability insurance). Some benefits can be provided in a way that the employer receives a large share of the benefits (e.g., profit sharing contributions) and others must be provided equally to all employees (e.g., health insurance). To complicate matters a bit, there are benefits that some employees can refuse (e.g., health insurance) and others that they have to take (i.e., workers compensation). If you are considering offering a retirement plan to your employees we can’t underscore enough the importance of researching your options very carefully. There are many different types of plans with different features, obligations, and tax savings to the employer. Additionally, the fees for similar products can vary widely, so be sure to shop with great care. Recovering from a mistake can be difficult and costly.

It is important to think through the array of benefits you are going to provide very carefully. There are both financial and cultural considerations that are significant. For example, a practice that does not offer many of the discretionary benefits, may have difficulty recruiting good talent and be perceived as somewhat of a “sweat shop” where the owners simply want to take as much from the practice as they can get. Of course, this is not good for morale or employee retention.

On the other hand, offering a wide range of benefits can, over the long term, be quite costly and obligate the practice to fixed expenses that are not dependent on the practice’s success or productivity of the professionals receiving those benefits. This then can severely limit the compensation of the owners as the costs of these benefits come directly from the bottom line.

To mitigate some of these costs, employers can set policies that require employees to pay a percentage of certain benefits (e.g., disability and health insurance premiums). Additionally, before determining compensation budgets it is very important to figure in the real costs of benefits (and other expenses) so that you don’t arbitrarily fix a compensation level that can’t be sustained without severely cutting into your own personal income from the practice.

Remember too, that it is easy to offer benefits. Employees rarely refuse them. However, the slightest reduction in benefits over time can easily be perceived as a major slight and consequently have a negative impact on morale, productivity (there-by further complicating the financial issue), and retention. Some practices have had what might be termed “mutinies” where by a group of employees together all resign from the practice at once, form their own new practice in the same area, and leave the employer with all the fixed costs and a limited income stream. You don’t want to be in that position, so be thoughtful and careful when structuring your benefits package. We at TPI can help with a focused consultation on this issue.

Be sure to look at our Practice Guide entitled "Being an Employer" if you have other questions related to running a practice with employees.

Can I use the 1099 Independent Contractor (Subcontractor) payroll designation for a part-time position?

Many practices hire employees on a part-time basis. Frequently, the question arises about whether to pay them as Independent Contractors. This is sometimes appropriate and can save the employer from paying certain employee taxes. However, the appropriateness of this designation is not simply up to the employer and employee. Rather, it is based on many factors specified by the Internal Revenue Service (IRS) which include among others whether the employee has other sources of earned income and whether the employee sets their own hours, work strategies, etc. In short, the more structure the employer imposes on the employee, the less likely it is that the designation of Independent Contractor is appropriate. For example, the practice may not be able to require the clinician to dress in a certain manner, see certain types of clients, attend specific meetings, chart in a certain way as some examples. According to the IRS, "The determination is complex, but is based on whether the person for whom the services are performed has the right to control how the person performs the services. It is not based merely on how the person is paid, how often the person is paid, or whether the person works part-time or full-time." See the IRS  for more specific information on the regulations. Making an error in this regard can be quite costly if the IRS requests payment of all the back payroll taxes and perhaps adds fines and penalties. Our advice is that you exercise extreme caution before using the designation of an Independent Contractor and by all means check with your accountant before doing so.

I have been an independent contractor within a group practice and am now preparing to move out to open my own clinic. I want to know the ethical way to handle my clients. I am sure they will want to go with me, as they are invested in the work we are doing together and have good rapport with me. How do I tell the director I am going and what should I say about the clients, etc.?

Thanks for your very good question. The first step is to look at your
agreement with your current practice and check to see if there are any
clauses that discuss your exiting from the practice and possible
restrictions. If there are, you might want to check with an attorney
to see if the clause is indeed backed up by state statute and what
your options are. In general though, patients are free to seek
treatment where they so desire.

Perhaps the easiest way to leave is to give notice to the practice,
discuss a process and understanding with the director and then begin
to inform your patients. A friendly and diplomatic approach can be to
reach an understanding with the director that you will tell patients
that you are leaving and that the patients can continue treatment at
the current practice if they'd like (and if indeed the practice can
provide the service) or they can continue with you if they'd like.
That way it is the patient who is making the decision.

If a patient continues with you and you want to copy their file, be
sure to get a release from the patient authorizing the release from
the current practice to you and then copy the file before you leave.

Also, when you meet with the director be sure to talk about the
financial side of things. For example, get a clear understanding about
what will happen to your accounts receivables that are outstanding. It
is best to also write a letter of resignation and then also a memo
about the termination agreement which documents all the specifics
after the discussion with the director. Certainly, seek legal advice
if any legal questions arise.

As an aside...if you are on any managed care panels do not assume that
your participation as a provider will be transferrable. Each company
may handle it differently.

Good luck with your transition and be sure to check out our practice guide on Leasing Office Space.

What is marketing?

Marketing is about locating people who are likely to need and want your services, finding out what is important to them, and demonstrating to them that you can be of service.

Marketing focuses on creating and cultivating relationships with your potential clients and referral sources. It requires listening to others and learning what their needs are – all this before giving them details about the services that you provide.

Why? Because for the kind of work you do, people need to feel a connection with you prior to engaging your services.

Marketing is different from selling

The focus of marketing is to understand your target audience and the types of problems that they are looking to solve.

The focus of selling is to “close the deal” – to get people to spend their money with you. Selling is the goal of every business. After all, you could not make a living if you didn’t get paid.

Here’s an example to illustrate the difference between marketing and selling:

Carol is a psychologist who specializes in treating anxiety. As part of her marketing plan, she subscribes to a few online forums dedicated to anxiety problems. She reads the postings, which reveal the types of questions and challenges people have around the issues of anxiety.

Occasionally Carol replies to postings where she can provide some helpful information such as a link to an article or online resource. Her goal is to build relationships with other forum members, and to get them to regard her as an expert on anxiety. This is marketing.

As she becomes more known and respected as an expert, someone might contact her privately to ask about working with her. At that point, she would mention her methods and fees, and invite the person to set up an appointment – which is part of the selling process.

Only a fraction of the people to whom you are marketing will purchase your services. That’s because people are in different stages of decision-making. Some are more ready to take action than others.

However, if you keep your name out there, and you continue to be helpful, those people who are not ready to take action today, may be ready in a few months. The “sale” is much easier when you already have a relationship established. People like to buy from those whom they know, like and trust.

What can marketing do for you?

Marketing helps brand you as an expert and an authority. Think about some experts that you know. How did you come to view them as experts? Most likely, it was not from their telling you that they were experts. You probably read their work, saw them in action, or heard about them from others.

And most likely it was not just from one contact or encounter that you came to regard these people as experts. Their name became associated with their area of expertise over time.

The more you talk and write about a subject, the more that you will be viewed as an authority – assuming, of course, that you communicate your ideas well.

Being perceived as an expert can increase your income. Experts generally charge higher fees. It’s a simple matter of supply and demand. There are fewer specialists than generalists. If the specialty is something that people want, they will travel and will pay more – because they place greater value on the service.

Not everyone seeks out an expert, of course. If you need to replace a light switch, you can either do it yourself or find a generalist, like a handyman. But if your dishwasher starts running when you turn on your ceiling fan, it’s time to call in a specialist – an electrician.

When it comes to dealing with life problems, experts and specialists are more important than ever. Everyone feels that their own problem is very important. If they can’t figure out their own problems, they assume that their problems are complex. And when a problem is complex, you need an expert!

Marketing helps create the kind of practice that you enjoy. When you market your services to the kinds of people whom you like to work with, you will derive more satisfaction from your work.

Think of your ideal client. There are probably hundreds or thousands that are similar. Imagine setting up your marketing to attract those people. As your practice begins to fill with the kinds of clients you feel most successful with, you will be energized rather than drained by your work.

Why is marketing an uncomfortable experience?

If you’re like most professionals, it’s difficult for you to promote yourself. That’s understandable. For decades we were discouraged – even prohibited – from advertising our practices in the same way that other businesses might do – billboards, TV and radio ads, etc.

Direct advertising was considered undignified and, well…”unprofessional.” In the halls of academic training we were assured that if we mastered our skills, a lucrative career would naturally follow without the need for self-promotion. Those who did advertise were viewed as crass and commercial.

It’s hard to shake that image, even today, when there is no restriction to advertising as long as it conforms to your professional association’s ethical code.


Think about marketing as your professional duty

Whether you market your services or not, people will seek help for their problems and answers to their questions. They may well end up with a less experienced professional, or even with an unlicensed charlatan who is good at marketing.

Wouldn’t you rather be the one they find when they’re searching?

Get rid of the notion that marketing is distasteful. Instead, think of marketing as a way to inform and educate people in terms of how you can help them. Consider marketing as your professional duty. You’ll be giving people an opportunity to avail themselves of competent professional services, which they might otherwise not know about.

For more information about marketing check out our Marketing Tools and Tips tab.

We do a lot of psychological testing at our practice and we typically store the test protocols in a separate testing file from the actual patient chart. A copy of the final psychological report goes in the patient's file as well as the separate testing chart. Do you know the standards of keeping the protocols? It would be nice to get rid of old protocols. Any thoughts on this?

It is my understanding that the protocols are part of the patient's record and therefore must be treated like the rest of the record. Therefore, whatever record keeping guidelines are in place in your state are the standard for you to follow. It is important that these be retained. At a later date a client may need these for clinical reasons or forensic reasons. For example, if you are testing a six-year old child, someone else may re-test them later at twelve years old and may want to look for similarities/changes in test responses. As another example, an adult that you may see in 2011 may become involved in an automobile accident in 2015. As part of their forensic case they are claiming PTSD and your entire record may be helpful in someone else conducting the assessment in 2015.

Now with that being said I certainly understand storage of records being a difficulty or annoyance. I have "boxes and boxes" of test protocols because my busy practice  has had a large assessment focus the past 10 years. However, I believe that I have come upon a solution. While visiting my CPA this year she told us that her office is now going entirely paperless. That is, she purchased a high powered scanner (I think she paid $1200 or so for it) that is capable of scanning 40 pages per minute. You have to check your State laws about record keeping but I believe you may not have to have the actual protocols but be within Standards if you can reproduce the protocol if requested. 

This is one of my projects for this year that I will be doing in my practice in order to reduce the annoyance of having all of this paper to store. If you do go electronic be sure to have adequate backup systems in place. The records are still your professional responsibility to maintain, even if you go paperless. If you do not have a large volume of protocols to archive you may be able to purchase a less expensive scanner. The task is also made easier if you make an electronic copy for each new protocol as soon as you have completed the assessment. It is always easier to do one at a time than to take the time and energy to do 10, 20, 50 or hundreds/thousands at a time. Thanks and please let us know at TPI if you have any follow-up questions.

I need to add a 1099 employee. S/he will be a licensed psychologist. Here is my question: I'm wondering if I can bill their work under my insurance stuff or if they need to be credentialed themselves?

You need to check with each insurer. Most contracts (unless you are licensed as a clinic) require that each provider be separately credentialed. One other important point...before you hire the person as a 1099 employee click here. You don't want to make a mistake in this area as you will not be happy when the IRS comes knocking for their money.