1. So you want to start a private practice: some thoughts Judy Ripsch, Ph.D., L.C.S.W.

2. Intro ► Intro Self (Who made me the expert?) ► Why are you here? ► What do you want to know? ► Need to assess market and assess self

3. Assess Self ► Attitude ► Knowledge ► Skills ► Both as a practicing clinician and as a business person ► Let’s talk about the business person

4. Business Hat Exercise ► Write down all the words and phrases that you think of when you hear the word "business”. ► Share

5. Business Hat Exercise ► Does the word business make you feel uneasy, tense? ► Do you think someone may be taking advantage of you? ► Do you feel that you lack business skills?

6. Business Hat Exercise (Cont.) ► Do you believe that business people are: ruthless, money- hungry, without ethics, insensitive to others, a different breed from counselors and counselor educators, and from you?

7. Business Hat Exercise (Cont.) ► If your answer was "yes" to any of these questions, then you may have roadblocks that hold you back from deciding whether to start a private practice. ► Do you want to be a “business person”?

8. Attitude ► Your first step is to put on your business hat! ► The confidence it takes to put on this hat comes from your desire to not only help people, but also to make money. ► Can you bill? Can you collect? Are you worth your fee?

9. Attitude (Cont.) ► You must be comfortable with your need to make money and charge directly for your services—remember, making a living is not unethical!

10. Attitude (Cont.) ► You must be willing to take some risks financially. ► It often takes at least two years to build a successful practice; considerably more if it is planned and managed poorly.

11. Attitude (Cont.) ► (after 5 yrs IRS considers it a hobby!) ► You may lose money initially until a referral network and client base are established.

12. Knowledge ► You must become well acquainted with budgets, cash flows and business plans to evaluate the potential and ongoing viability of your independent practice. ► You must know about billing, coding, collecting. ► You must be prepared to market your skills to guarantee success.

13. Skills ► You must be able to attend to the minutiae of running an office as it is unlikely you will be able to afford to hire someone to do this initially. ► You must be able to perform in an ethical, competent, legal manner.

14. What do I need to start? ► License ► Malpractice Ins (1,000,000-3,000,000) ► Lawyer  Incorporate? LLC? ► Accountant  Taxes ► Business Plan ► Access to clients ► Access to payers

15. Business Plan ► A detailed and sound business plan plots your targets for your business and identifies how you will achieve them. ► Most business plans contain three standard elements:  Marketing plan.  Operating plan.  Financial plan.

16. Marketing Plan ► Your marketing plan should contain a detailed marketing analysis. ► How will you do this? (e.g. other professionals, customer/clients) ► Needs analysis.  What’s needed in the area?  What already exists?  Wait lists?  Other

17. Marketing Plan (Cont.) ► Analysis of your competitive strengths and weaknesses in ability to fill need. ► Identify the areas where you know you have an edge and those where you are less qualified. ► Finally, identify your sales strategy— the means by which you will make your services known.

18. Operating Plan ► Good business planning also involves the creation of an operating plan—one that attends to the "mechanics" of running a business. ► You must specify:  The location (building and equipment).  Management and staffing (as appropriate).  Administrative or professional procedures that you expect to follow (hours of work, scheduled services). (P+P manual)

19. Financial Plan ► Lastly, your business plan requires a financial plan component. Clearly identify startup costs, expected sources of funds, cash-flow forecasts, operating costs, and an initial profit/loss forecast. ► Your business plan must emphasize quantitative data to justify why your business will succeed.

20. Financial Plan (Cont.) ► Qualitative data can be used as well to help in identifying trends associated with the marketplace. ► Using quantitative and qualitative data to build your business demonstrates that you understand that the market truly requires your services.

21. Strategic Plan ► For most private practitioners, the business and strategic plan will be one and the same. ► Strategic questions to be considered are:  What are your long-term strategies to market the practice?  What are your long-term client and revenue goals?

22. Strategic Plan (Cont.)  What are your minimal profit margins/client retention rates required to maintain the practice?  What associations and networks are planned to promote practice growth?  What contingency plans have been created for times of illness or slowness in the marketplace?

23. Strategic Plan (Cont.) ► While business and strategic plans are to be written, they are not carved in stone. ► Each is to be treated as a tool—a fluid document—that you can adjust and reevaluate as necessary. ► Think Treatment Planning!

24. Budgeting ► Your budget will be a key feature of your business plan and is updated annually. ► A budget outlines expected sources of income and expenses and results in a projected income or loss for the year.

25. Budgeting (Cont.) ► Your budget for your first year of practice will include start-up costs in addition to ongoing expenses. ► When budgeting, it is useful to overestimate costs and underestimate projected income so as to increase the realistic nature of your expectations.

26. Budgeting (Cont.) ► Developing a "worst case" scenario will result in more careful planning of budget categories. ► Your budget and your financial statement—produced at the end of the fiscal year—permit more accurate planning of your budget for your second and subsequent years of practice.

27. Budgeting (Cont.) ► A financial statement is the summary of actual income and costs incurred for the fiscal year and shows either a profit or a loss on the balance sheet. ► It uses the same categories as those used in your budget and includes various depreciation schedules. ► See Accountant!

28. Expense categories ► Expense categories in a budget can vary, but common ones might include:  Office space—rent, furniture, cleaning, upgrades and painting, utilities, parking.  Telephone—phone lines, computer access, fax line, long distance charges, cellular phone service, answering services.  Machine—computer, server, fax, copier, printer, answering machine

29. Expense categories (Cont.)  Office supplies and materials—basic office supplies, ink, paper, stationery, specialized supplies, test materials, reference materials, coffee.  Postage.  Bank charges—for checks, accounts, deposits, NSF checks written by clients, credit card fees.  Billing program/service (clearing house)  Business program (Quicken?)

30. Expense categories (Cont.)  interests on loans.  Insurance—professional liability, general office liability, health care, disability, office expense (e.g. unemployment ins.), accidental death and dismemberment.  Salaries and benefits paid to staff (self).  Retirement savings  Pro Bono work

31. Expense categories (Cont.)  Licenses—professional licenses, business licenses, registration fees, listing fees.  Income taxes—payments are computed based on your income or loss for the year and are not a budget category per se. You will however, need to plan on accumulating enough cash to pay your taxes on a quarterly basis. (Double FICA)  Business and other taxes—as may be required locally.

32. Expense categories (Cont.)  Bad debts—unpaid invoices that are written off.  Bookkeeping and accounting fees.  Legal fees.  Outside professional services—case consultants, supervision, holiday cover- off.  Professional development—conferences and workshops, supervision. (CEU’s)  Professional dues and membership fees.

33. Expense categories (Cont.) ► - Play therapy materials—stocking a play therapy room can be very costly. Depending on the complexity of the materials offered, costs can run to several thousand dollars. ► - Biofeedback materials—again this specialized equipment can be very costly. Often a specialized room and chair for sessions will further add to cost.

34. Expense categories (Cont.) ► - Professional journals, reference materials and memberships—in order to keep current with emerging research findings regarding theory and clinical practice, it is convenient to subscribe to various professional journals and to buy essential reference materials. ► - Locked fireproof filing cabinets (At lease two locks between files and intruder)

35. Expense categories (Cont.)  Sales promotion—open house, special mailings, phone book, internet presence.  Vehicle and travel expenses—travel logs of business and personal use, vehicle charges, mileage paid, airfares, metered parking  Depreciation of furniture, business machines and any large purchases.  Collection fees  Software (client records)  Others

36. Simple principles can guide early budgeting ► Be realistic and estimate costs carefully. ► Practice austerity and shop around. ► Balance cost, durability and quality of materials. ► Start basic.

37. Simple principles can guide early budgeting (Cont.) ► Underestimate income and overestimate costs. ► Accumulate operating capital prior to opening your office. ► Avoid large loans as you will need considerable income to service the debt. ► Expect some payment lag. (Depends a lot on payor)

38. Simple principles can guide early budgeting (Cont.) ► Obtain partial guaranteed funding. (part time, consultant, services for hosp/court/etc.) ► Maintain a block of funds to cover at least six months of operating expenses in case of various emergencies. ► Review your budget regularly to gauge your financial performance.

39. Accounting and financial records ► As an independent practitioner and business person, you will need to keep accurate and detailed financial records. ► Not only does this allow you to track and manage your finances, but such records are necessary should you ever be audited by federal tax personnel. ► Consultation with a business accountant is essential in setting your accounting system and financial records.

40. Accounting and financial records (Cont.) ► Your accountant also may suggest a user-friendly accounting software package that enables you or your support staff to enter basic data and even produce a financial statement. ► You should consult a licensed accountant to determine the need for a formal audit or financial review of your business. ► If you incorporate you may require a formal audit—a statement that ensures accuracy and appropriateness of all expenses and income claimed by your business. Check with lawyer.

41. Accounting and financial records (Cont.) ► If you plan to depend on support staff to be responsible for record- keeping, ask detailed questions during their initial interviews about their experience with financial record-keeping, get references!!! ► Institute checks and balances.

42. Accounting and financial records (Cont.) ► Even so, it is very worth your while to be well aware of the income and costs in your business and review them regularly. ► You are ultimately responsible for the success or failure of your business and cannot make informed business decisions unless you are indeed informed.

43. What else? ► You are your own business manager/CEO. ► You may also be your own bookkeeper!

44. Basic necessary financial records include: Receipts for all money received from direct, uninvoiced payment. (e.g. Co-Pay) Receipts for all money received from direct, uninvoiced payment. (e.g. Co-Pay)  Number these sequentially; provide one copy to the client and keep one for your records. Invoices for services. Invoices for services. Number these sequentially; provide two copies to the client—one to be returned with payment, one to keep—and keep one for your records. ► Open a separate account solely for your business, record all deposits/checks and balance all statements on a monthly basis.

45. Basic necessary financial records include: ► Use of a separate bank account assists in the ongoing management of your finances and saves you time when preparing financial statements and tax returns ► Bank deposit slips. These are provided by your bank; number them sequentially. ► Use sequentially numbered, personalized business checks. ► Record the name of the payee, the reason for the payment and the amount of the check on the check stubs.

46. Basic necessary financial records include: ► For services invoiced to you, note the check number and the date paid on your copy of the invoice. ► Always check and balance statements of credit cards and checking accounts used for your business. ► Maintain a petty cash fund and accurate records (receipts) of expenses paid with these moneys.

47. Basic necessary financial records include: ► Keep a log of all mileage driven for your business so that you can either claim mileage or a portion of your vehicle expenses. ► Consult your accountant on the best strategy. ► Keep a log of all pay telephone and parking meter cash payments for later claims ► My Accountant gave me a book!

48. Basic necessary financial records include: Keep records of pay issued to people in your employ. If not “contractual”, you will need to make deductions for them and submit the Income Tax and FICA. Keep records of pay issued to people in your employ. If not “contractual”, you will need to make deductions for them and submit the Income Tax and FICA. Regular monthly remittances reduce penalties. You will also need to decide what pay schedule to use to pay employees (e.g., monthly, biweekly, etc.). You will need to pay them regularly and to pay them prior to paying your own salary if cash flow is low.

49. Basic necessary financial records include: ► While these records are detailed and laborious to keep, they are worth the effort as every penny is accounted for and you can see clearly how your business is functioning and can then plan accordingly. ► As an independent practitioner, you will be responsible for paying and collecting various taxes. (e.g. Fed + St. Income Tax, HICFA, Unemployment tax) ► Electronic billing/banking will make some of these suggestions archaic.

50. Office Space ► You will need to find or develop office space. ► One way is to contact existing practitioners in your area and sublet space from them. ► Most private practitioners have open times in their offices where, for a fee, you may be able to use the office when they do not.

51. Office Space (Cont.) ► The difficulty with this plan is that you are at the mercy of their schedules. ► Another creative way to obtain office space is by contacting your local pediatricians, general practitioners, gynecologists, or other doctors.

52. Office Space (Cont.) ► You might offer a service to them in exchange for space in their office when they are not using it. ► You could offer to do parenting groups, marriage enrichment groups, weight loss help, divorce recovery, or stress management, all in exchange for office space.

53. Office Space (Cont.) ► The idea here is that even a busy doctor's office has times where it is not in use. ► Also, a pediatrician may relish the thought of having a licensed mental health professional in the office, available to see his/her patients.

54. Office Space (Cont.) ► There are many options with which to negotiate. If the doctor or the office manager seems interested, but suggests some payment for office space, and if the cost is reasonable, you may ask to have your name put on the door with the other professionals.

55. Office Space (Cont.) ► The cost of using the office is offset by the invaluable publicity, creditability and access to clients. ► If you follow this plan, it is best to target a doctor's office that fits your niche. (C+A/Pediatrician, Women’s groups/gynecologist, etc.)

56. Office Space (Cont.) ► If this seems to difficult to do, remember that you are a business person and that the worst thing that they could say in answer to your offer is “no”.

57. Office Space (Cont.) ► Sharing office space holds down cost. Another mental health professional, a friend, may be interested in opening an office and all expenses would be shared. ► Finally, there's always the possibility of finding a small office in your target area that may fit your budget.

58. Office Space (Cont.) ► Be sure the office is accessible, clean, private, confidential, professional, has a waiting area, has accessible bathroom, etc. ► Depending on your area/nitch/comfort level, you may choose to provide home visits. (Not N.H. in IL as yet.) ► Be creative!

59. Forms ► Forms: ► Clinical records (notes, plan, soc. Hx, diag.) ► Consent to treat, Confidentiality/HIPPA Statement ► Consent to bill ► Demographics, referral source ► Complete, organized and proper clinical records enhance service provision and also serve to protect the practitioner in the event of a malpractice allegation or later subpoena to court.

60. Core contents of clinical files ► Identifying data: name, birth date, address, phone numbers, gender, responsible payor. ► Intake form identifying presenting problems. ► Record of appointments, no- shows, cancellations.

61. Core contents of clinical files (Cont.) ► Any assessments undertaken and interventions recommended, formulation and treatment goals. ► Description of the types and dates of the services provided, record of cancellations and no-shows. ► Periodic description of client progress. (Justify continuing service.) ► Copies of any formal service agreements.

62. Core contents of clinical files (Cont.) ► Copies of signed releases of information and of the information released. (Make note on release.) (Needed info is based on State Law. May include: the names of any persons you expect to be contacting, the reason for the contact and the kind of information you will be discussing, purpose, expiration date of consent, signature, witness, etc.—Check your state law!)

63. Core contents of clinical files (Cont.) ► Copies of any release forms for taping, training, etc. ► Copies of any written correspondence and record of phone calls.

64. Key elements to be addressed in effective clinical record-keeping include: ► Date all reports only on the day they are completed. ► Reports are to be signed by the practitioner providing service. (Name, License) ► Notes must be accurate and specific— these are vital to help follow the progress of a client. ► Include a mechanism for regular file review.

65. Security of information ► All records, regardless of whether they are on paper or electronic, must be kept securely. ► Must use appropriate firewalls if using electronic submissions. ► Choose fireproof cabinets and locations away from general traffic areas.

66. Security of information (Cont.) ► Keep files and records under lock and key at all times—secured from public access. ► Keep public areas of the practice— particularly the reception area—free of personal or financial information. (e.g. Don’t call client by name!) ► Shred all recordings or client documents that are no longer needed. ► Minimum of two locks between file and access..

67. Fees ► How do you set a fee schedule?  (Find out “usual and customary” in area, may check insurance or Medicare payment schedule, consider your experience and skill level…) ► The issue of payments is very important.

68. Fees (Cont.) ► Be sure the client (AND YOU) understand that payment is made at the time of the appointment, and that any insurance consideration will be worked out in advance. ► Deductables/copays, EOB’s

69. Fees (Cont.) ► Accepting payment for your services may make you uncomfortable at first. Do not be. You are a valuable professional who is licensed, and remember: you are solid, knowledgeable, and effective.

70. Fees (Cont.) ► If you consider sliding fee, be fair to yourself. Remember: It is also a reflection of your vision, your self-worth and education. Many clients will see your fees as a gauge of your value as a professional. ► Pro-Bono

71. Marketing ► Provide good service. No network can compare to the one you create through the excellence of your work. Referrals from satisfied clients may not generate immediate referrals, but over time increase your client base. (After 30 years in Pontiac, I am seeing 3 rd generation, presently WOM and EAP are my client base!)

72. Building a Client Base ► Provide personal contact and immediate responses to inquiries from both referral sources and potential clients to demonstrate your interest in meeting their needs. ► Maintain goodwill with potential referral sources and other professionals in the community.

73. Building a Client Base ► Realize that various other professionals besides psychologists may be valuable referral sources, including: medical professionals, educators, social workers, general counselors, employee assistance programs, lawyers and social service personnel, to list a few.

74. Building a Client Base (Cont.) ► NETWORK, NETWORK, NETWORK ► Refer clients elsewhere if you do not have the specific skills they require, or provide an option of an alternate referral if your waiting list is very long. Maintain a referral list of other professionals whose work you respect.

75. Building a Client Base (Cont.) ► Distribute your business cards freely. Make them easy to read, attractive and professional. Include your name, degrees, license, certificates, address, and phone/fax/e- mail numbers. (e.g. mine) ► Send a thank you letter to the referral source once you have seen a client and received their written consent to do so.

76. Building a Client Base (Cont.) ► Send an announcement mailing when you first establish your practice, or add another practitioner to your practice. Realize that this may result in very few referrals, but will still make your availability known. ► Contact local business reporter to do a piece on something special you are offering. (Horse riding therapy)

77. Building a Client Base (Cont.) ► Hold an open-house to make your availability known, thank the people who have supported you, to establish a practice, and generally establish goodwill. ► Join the local Chamber of Commerce.

78. Building a Client Base (Cont.) ► Place your name and perhaps an advertisement in the Yellow Pages. Some people look there first. ► Realize, however, that some people may not select a psychologist through the Yellow Pages. Know that having your name there indicates that you are a bona fide practitioner and provides phone numbers and addresses to facilitate contact with you.

79. Building a Client Base (Cont.) ► Be willing to accept interviews from the media on general topics in psychology. ► Have your name placed on a list for speakers' bureaus indicating your willingness to give presentations and workshops. This makes your name known. ► Volunteer to speak at service clubs, church groups, women’s groups, etc.

80. Building a Client Base (Cont.) ► Give your practice a name and a logo. Again, this makes your name stand out and is likely to be most useful if you are in a joint practice with several other practitioners. ► Serve on various community boards for either profit or non-profit societies. ► Become adjunct faculty for universities, community colleges, etc.

81. EAPs ► Employee Assistance Programs (EAPs) are employee benefit programs offered by many employers, typically in conjunction with a health insurance plan. employee benefithealth insuranceemployee benefithealth insurance ► EAPs are intended to help employees deal with personal problems that might adversely impact their work performance, health, and well-being. ► EAPs generally include assessment, short- term counseling and referral services for employees and their household members. assessment

82. EAPs (Cont.) ► Employees and their household members may use EAPs to help manage issues that could adversely impact their work and personal lives. ► EAP counselors typically provide assessment, support, and if needed, referrals to additional resources.

83. The issues for which EAPs provide support vary, but examples include ► substance abuse substance abusesubstance abuse ► safe working environment safe working environment safe working environment ► emotional distress emotional distress emotional distress ► major life events, including births, accidents and deaths ► health care concerns health care health care ► financial or legal concerns

84. The issues for which EAPs provide support vary, but examples include (Cont.) ► family/personal relationship issues ► Partner relationship issues ► work relationship issues ► concerns about aging parents ► An EAP's services are usually free to the employee or household member, having been pre-paid by the employer

85. +/- of working with EAP ► PLUSES ► Easy to collect from Contractor ► Less paperwork ► Source of referrals ► No deductibles/co-pays to collect (no out-of- pocket for client) ► Does not require “major” (reimbursable) diagnosis

86. +/- of working with EAP (Cont.) ► MINUSES ► May be required to share client’s info with employer (with client’s permission) ► Can not charge a no show fee ► May not be able to self refer ► Eap company is “Keeper of the Records” ► Must be able to function in “brief model” ► Some EAP companies have questionable “fee arrangements”

87. Insurance ► Some insurances require that you be “on their panel” ► Some will pay at lesser rate if you are “out of network”, some not at all. ► Can often apply through web site (look for “provider relations”) ► Find out who insures most people in your area ► BC/BS is usually big

88. Insurance ► May check with other providers (hospital?) to see whom they bill ► Will need copies of current license, malpractice, certifications (e.g. CADC) ► Medicare is “special” insurance with own process: see on line, all electronic billing (central management service)

89. +/- ► PLUSES ► Some referrals if persons covered are seeking someone in network ► Can be reliable source of income ► You maintain your own records ► Many accept multiple billing methods

90. +/- ► MINUSES ► May have to get “preapproval” ► Deal with deductibles each year and copays ► May pay reduced rates to “covered” therapists

91. Coding Info Needed for Billing ► The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals.

92. Coding Info Needed for Billing (Cont.) ► These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. ► Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. ► The CPT codes are republished and updated annually by the AMA.

93. Coding Info Needed for Billing (Cont.) ► Because these particular codes mean so much income for the AMA, it is difficult to find lists of them that are accessible to the public. In fact, groups that have tried to make them public have been cited for violations and fines by the AMA and have been forced to remove them from the Internet. Many groups license the lists of codes from the AMA, however, and then publish them online or in books. They are allowed to charge for access since they are also paying that licensing fee.

94. CPT (Current Procedural Terminology) ► Billing service may have them ► May buy a book from AMA ► May pay for list on line ► Most common: 90801-intake, 90806-45 to 50 minute session.(90804, 90808) ► Helpful to have the resource for parameters of what's included ► New “Health and Behavior” codes presently can be used by Psychologists

95. “Health and Behavior” ► CPT Code ► (15 min – 1 unit)(1 hr – 4 units) ► 96150 Assessment – initial ► *96151 Re-assessment ► 96152 Intervention – Individual ► 96153 Intervention – group ► 96154 Intervention – family w/ patient ► 96155 Intervention – family w/o patient

96. ICD-09 ► What Do the Numbers Mean? ICD-09, ICD-10 and Others? ► ICD codes were first developed in 1893 in France by a physician, Jacques Bertillion. They were called the Bertillon Classification of Causes of Death. In 1898, they were adopted in the United States, and were considered, in effect, ICD-1 because that was the first version of code numbers.

97. ICD-09 (Cont.) ► Since then, as medical science has progressed and new diagnoses have been developed, named and described, the code lists have been updated. The number designation changes when the updates are so extensive that a wholesale change needs to be made. There may be annual updates, too, but those are considered to be relatively minor, and the basic code set doesn't change. ► For example, the upgrade in 1949, ICD-6, was the first time mental disorders were added to the code set.

98. ICD-09 (Cont.) ► Most of the codes we see in the United States today are version 9, called ICD-9-CM codes. With few exceptions, the paperwork we receive when we leave a doctors office will contain both CPT codes (Current Procedural Terminology) to describe the service that was rendered for billing purposes, and ICD-9-CM codes to describe why that service was provided. Further, most death certificates filed since 1977 will have an ICD-9 code on them. CPT codesCPT codes

99. ICD-09 (Cont.) ► The most current list of codes in use is ICD-10. This list was first used in the United States in 2007. Minor revisions added to ICD-10 codes were made available in early 2009 by the NCHS. Globally, most other countries in the world have implemented the ICD-10 codes. There are some major differences between the two code sets, the transition is very expensive, and most American providers have not yet upgraded to the ICD-10 system.

100. But I use DSM-IV-TR to diagnose! ► Covered Diagnoses & Crosswalk of DSMIV ► The crosswalk is a document designed to help you determine which ICD-9-CM diagnosis code (1977) corresponds to a particular DSM-IV-TR diagnosis code.

101. Do I need to use it? ► YES! ► Under the Health Insurance Portability and Accessibility Act (HIPAA), insurance companies who accept and process insurance claims electronically are only required to accept ICD-9-CM diagnosis codes.

102. Do I need to use it? ► Because there is no HIPAA requirement that insurance companies also accept DSM-IV-TR codes, insurance companies are likely to only accept electronic claims that use ICD-9-CM diagnosis codes, and which will require psychologists who are only familiar with DSM-IV-TR to convert their DSM- IVTR diagnosis codes into ICD-9-CM diagnosis codes.

103. Where do I find it? ► http://www.apapractice.org/apo/insider/pra ctice/pracmanage/practice_management/ds m-9. http://www.apapractice.org/apo/insider/pra ctice/pracmanage/practice_management/ds m-9 http://www.apapractice.org/apo/insider/pra ctice/pracmanage/practice_management/ds m-9 ► GenericArticle.Single.articleLink.GenericArticl e.Single.file.tmp/Download_the_Covered_Di agnoses_&_Crosswalk%20of_DSM- IV_Codes_to_ICD-9-CM_Codes_chart.pdf ► Or Google: Covered Diagnoses & Crosswalk of DSMIV Codes to ICD-9- CM Codes

104. Mentor/supervision ► If you decide to start a business one of the most important components is finding a trustworthy reliable mentor/supervisor who is successful. ► Can supply needed expertise in business and psychotherapy. ► Can provide needed supervision.

105. Mentor/supervision (Cont.) ► Can provide access to assessing the current professional standard of care. ► It is also helpful to: networking with other entrepreneurs/therapists, join in- person and virtual entrepreneur/therapist support groups, take classes and workshops.

106. Ways to start ► In the beginning opt for full-time work in an agency or institution, but take on a few clients privately. ► This augments income and helps determine if there is a market for your skills. ► This provides guaranteed income and benefits.

107. Ways to start (Cont.) ► Spend time learning the policies and procedures of the entity, including billing. ► Note: you must be careful to avoid any conflict of interest, perhaps best achieved through completely different referral sources from those of the agency. It is also important not to use agency time to build your practice.

108. Ways to start (Cont.) ► Another alternative is to join a functioning professional practice as an associate to gain awareness and experience prior to establishing an independent practice. ► This also provides a safety net of sorts. ► Exercise the same care regarding conflict of interest as you would if working in an agency or institution.

109. Ways to start (Cont.) ► Opt for a clearly delineated part- time role—working half-time at an agency and half-time in your own practice. ► This is advantageous, as you have some guaranteed income, but can have more energy available to devote to building your referral network. Again, take care to avoid any conflict of interest.

110. Ways to start (Cont.) ► Opt for full-time practice, while understanding the financial risks involved. ► Perhaps the best way to ensure viability is to ensure that you have some guaranteed funding, such as obtaining a contract for a block of service provision, or a part-time teaching position.

111. Ways to start (Cont.) ► Guaranteed funding ensures that bills will be paid during the time that you are building your referral network and a steady client base. ► Be creative in developing an option that best suits your skills, strengths, energy, need for security and present circumstances. ► Have a clear idea of anticipated costs and potential income.

112. My Advice ► Don’t quit your day job!!! ► A new business can take up to 5 years to turn a good profit!

113. My Advice ► Expect to spend a great deal of time developing and running a private practice—both in serving clients and in marketing and running the business. ► Careful planning and preparation is crucial and takes time. ► Have financial resources available to your business.

114. My Advice ► Be prepared to work hard at getting started, getting known and encouraging referrals. ► As your practice enlarges, decrease your other commitments. ► GO FOR IT! YOU CAN SUCCEED!!!!! ► Q/A