1. So…You want to start a private practice.. Developed by Andrea Lary CCC-SLP Owner of Therapy Consortium Inc. & One Stop Therapy 4 Kids

2. DISCLOSURES I have the following financial relationship in services described in this presentation – 100% Ownership of the Private Practice, Therapy Consortium Inc, a case coordination and billing service for contractors performing PT, OT and ST services in the pediatric population – 100% Ownership of One Stop Therapy 4 Kids, a multidisciplinary pediatric therapy clinic. I have no relevant nonfinancial disclosures.

3. BACKGROUND

4. Purpose & Learning Outcomes The purpose of this presentation is to provide current SLP/As with a thought process and tools to equip themselves to move forward in creating a part time or full time private practice. Learning Outcomes: 1.List the differences between employees and contractors according to IRS guidelines. 2. List basic set up considerations, such as obtaining NPI, EIN and developing a business model/plan. 3.Use decision strategies to determine caseload type/focus, size of business, type of business, marketing and billing. 4.Develop resources to create a strong infrastructure: lawyer, accountant, mentor, SCORE, small business association, BBB, private practice associations.

5. Private Practice Myths 1.I will make more money in private practice than working for someone else. 2.I will have more free time. 3.I am so good that I will never have a shortage of clients. 4.My exceptional clinical skills will guarantee a successful practice. (PPE p. 1-2)

6. Models of Private Practice Contractor Office Based Client’s Home or Office Consultant Part-time vs Full-time

7. Employee vs Independent Contractor Common Law Rules Facts that provide evidence of the degree of control and independence fall into three categories: Behavioral: Does the company control or have the right to control what the worker does and how the worker does his or her job? Behavioral Financial: Are the business aspects of the worker’s job controlled by the payer? (these include things like how worker is paid, whether expenses are reimbursed, who provides tools/supplies, etc.) Financial Type of Relationship: Are there written contracts or employee type benefits (i.e. pension plan, insurance, vacation pay, etc.)? Will the relationship continue and is the work performed a key aspect of the business? Type of Relationship Businesses must weigh all these factors when determining whether a worker is an employee or independent contractor. Some factors may indicate that the worker is an employee, while other factors indicate that the worker is an independent contractor. There is no “magic” or set number of factors that “makes” the worker an employee or an independent contractor, and no one factor stands alone in making this determination. Also, factors which are relevant in one situation may not be relevant in another. The keys are to look at the entire relationship, consider the degree or extent of the right to direct and control, and finally, to document each of the factors used in coming up with the determination. from : www.irs.gov

8. Types of Business Entities Issues/Considerations Tax implications Management structures Personal liability exposure Flexibility of operation Size and scope of envisioned practice (PPE-p.5)

9. Types of Business Entities Sole Proprietorship Simplest No state filing requirements Report income on Schedule C of personal tax return Greater personal liability (PPE-p.5)

10. Types of Business Entities Partnerships General partnership: share in liability (financial and otherwise) Limited partnership Limited liability partnership (PPE-p.6)

11. Types of Business Entities Limited Liability Company Reduced liability to members Greater flexibility in structure and organization of company Requires articles of organization filed with state Greater protection of personal assets (PPE- p.6)

12. Types of Business Entities Other structures S-Corporation C-Corporation Not-for- Profit

13. Insurance vs Cash Only Depends on: Scope of practice Disorders to be treated Affluence of community State of the economy (PPE-p.7)

14. Developing your team Depending upon the size of your vision, you may need to develop a team to help you develop your practice: Accountant Business Lawyer Mentors

15. Free Mentors SCORE: Service Corps of Retired Executives https://www.score.org SBA: Small Business Association www.sba.gov ASHA www.ASHA.org

16. Key Elements of a Business Plan Business Description Vision Statement: Describes your practice’s plans for the future. Mission Statement: Why does your practice exist? Goals and Objectives for your practice Market Analysis/Competition

17. Key Elements of a Business Plan Target Market Products and services Organization and management Marketing Plan Financial Management Start up expenses (PPE – p.9-12)

18. Next Steps Develop a business name Obtain an NPI (National Provider Identifier) -Group -Individual https://nppes.cms.hhs.gov/NPPES Obtain an EIN (Employer Identification Number or Tax ID #) https://www.irs.gov/Businesses/Small- Businesses-%26-Self-Employed/Apply-for-an- Employer-Identification-Number-(EIN)-Online

19. An Employer Identification Number (EIN) is also known as a Federal Tax Identification Number, and is used to identify a business entity. Generally, businesses need an EIN. You may apply for an EIN in various ways, and now you may apply online. This is a free service offered by the Internal Revenue Service and you can get your EIN immediately. You must check with your state to make sure you need a state number or charter.apply onlineyour state

20. Insurances Professional Liability Car Commercial/Business Owners/General Liability Business interruption

21. Financial Considerations Cash Reserves - Cash is the Life Blood -Personal savings of the owners -Cash reserves in the business -Line of credit -Factoring -Credit cards (PPE- p.21-2)

22. Financial Considerations Determining charges -formula: cost/unit expected productivity profit margin In reality, you can set your charges, but oftentimes what you receive is preset by the payers that you choose to accept.

23. Primary Payers Private Pay Commercial Health Insurance Medicaid Medicare

24. Coding and Billing CPT Codes Defined: “a set of codes, descriptions, and guidelines to describe procedures and services performed by physicians and other health care professionals. (American Medical Association [AMA], 2014,p. xii) Owned, established and revised by AMA ASHA website and Coding and Billing for Audiology and Speech-Language Pathology reference book.

25. Payers independently determine the amount they will pay for each CPT code Medicare Physicians Fee Schedule Types : timed vs untimed codes Modifiers Bundled codes- Correct Coding Initiative

26. ICD-10-CM Reports diagnoses and disorders Developed by the World Health Organization Required by payers along with the CPT codes Resources: ASHA mapping tool

27. Other Billing Considerations Superbills Collecting Co-pays Sliding Fee Scales Cash Discounts Collecting balances Credit Cards

28. Contracting your services Schools SNFs Agencies Physicians ***Make sure the contracts specify every detail.

29. Developing Policies and Procedures Policy and procedures manuals describe how operations are expected to be conducted within that facility. Provides clarification and a specific response to situations before they occur. Examples of Procedures: – Caseload – Training – Timelines of documentation – Continuing education – Scheduling – Make up visits

30. Developing Policies and Procedures Sample client policies – Cancellation policy – No show policy – Overall attendance policy – Dismissal policy Sample employee policies: Labor laws are very specific with regards to enforceable /legal policies. A lawyer and/or a human resources specialist should be consulted.

31. Getting Credentialed CAQH stands for the Council for Affordable Quality Health Care. They host a universal credentialing database for health care providers. How it works is simple. A provider requests participation in a network that accepts the CAQH application. The health plan initiates an online account for the provider. We then complete the online application and submit several supporting documents to CAQH. Once the application is complete, any insurance company that accepts the CAQH application can access the provider’s information, expediting the credentialing process. The provider information needs to be updated every 120 days, and we handle this process for the provider as well. https://proview.caqh.org/Login/

32. Getting Credentialed Medicaid Enrollment- starting point- https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/ Credentialing into each Medicaid Managed Care Decide which insurance companies are commonly used by your population, e.g -Blue Cross/Blue Shield -Tricare -Aetna, United Healthcare, etc -Babynet

33. Automating your Practice: Factors to Consider How easy is it? Is it intuitive? Does it make sense? Can you easily navigate the system? How much training is required? Is there technical support? Is there mobile access? Is there offline access? Is it available on a variety of platforms?

34. Is it flexible? Does it do scheduling? Does it incorporate electronic billing? Does it work for commercial health insurance and secondary billing? Does it provide reports: clinical and financial? Can it integrate documentation from other sources? What is the cost?

35. Sample of Vendors WebPT.com CentralReach.com Clinicsource.com Fusionwebclinic.com Talktrac.com Therabill.com Officeally.com (Practice Mate)

36. Billing How are you going to do your billing? -Paper -Clearinghouse -Billing service

37. Documentation Types of forms – Referral – History – HIPPA/ Consent forms – Evaluation – Visit notes – Discharge summaries

38. General Principles of Documentation If it isn’t documented, it didn’t happen. Oftentimes, guidelines are really mandatory expectations! Documentation is an integral part of a visit and is actually included in the payment for the visit.

39. Elements of Documentation Is the service medically necessary? Are the services requiring the skills of an SLP? Are the goals and treatments functionally relevant? How did this service add value to the patient’s overall treatment and health outcome? (PPE-p. 57)

40. Marketing Defined: Marketing is about identifying and understanding the customers’ needs and problems and providing a service to address their problems and concerns. “Word of Mouth is the most valuable tool and it costs nothing.” (PPE-p.71)

41. Market research: -Who are your customers? -What are their needs? -Are their current services meeting their needs? -What is the difference between your service and those of the competition? -How many competitors and what types of competition exists? -How can you differentiate your service from your competition? -How large is the population of people will to be referred for your service? -How do clients access your service, and how do you facilitate the process? (PPE-p.72)

42. Marketing Plan 1.Describe services in tangible terms. 2.Explain how you differ from the competition: Knowledge Specialized services Prompt scheduling Related services Good outcomes

43. Digital Marketing Websites Blogging Search Engines Email Marketing Social media: – Facebook – Twitter – Linked In – Pinterest – Instagram – YouTube

44. Publicity Give free lectures Write articles Write editorials Sponsor at events Offer free screenings Hold informational open houses

45. Compliance, Ethics and Quality “Your reputation as an honest and ethical business person is one of the strongest endorsements your practice can have.” “Whether you are a solo practitioner or have a large practice, you hold the ultimate responsibility for compliance, ethics and the quality of your business.” (PPE- p. 117)

46. Compliance: adhering to business policies as well as state, national and professional laws and requirements. Ways to stay in compliance: – ASHA Leader – Newsletters – Online blogs & forums for Private Practioners (PPE –p.118)

47. Ethical Practice Adhering to ASHA and State Licensure Codes of Ethics Ethics Statements from ASHA  Client Abandonment  Professional Competition  Conflict of Professional Interests  Obtaining Clients for Private Practice from Primary Place of Employment  Public Announcements and Public Statements (PPE-p.121-122)

48. Resources and References 1. Checklist for Starting Your Practice  Choose your business name.  Develop your business plan.  Work with and attorney to establish your business entity.  Have business cards made.  Obtain a loan or line of credit.  Find an accountant to set up and manage your accounting system.  Rent or sublet office space; furnish space.  Apply for liability insurance and other insurance coverage.  Obtain necessary licenses, permits and clearances.  Get your EIN and NPI.  Build your community networks for referrals. (PPE-p. 137) 2. Practice Management Tools for Speech –Language Pathologist (ASHA bookstore) CD for forms and guidelines

49. Books 1.Brown, J.E., & Dougherty, D. (Eds.);(2016). Private Practice Essentials: A Practical Guide for Speech- Language Pathologists (PPE). Rockville, MD: American Speech-Language-Hearing Association. 2.Golper, L.A.C., & Brown, J.E.(Eds.);(2005). Business matters: A guide for speech-language pathologists. Rockville, MD: American Speech-Language-Hearing Association. 3.American Speech-Language-Hearing Association. (2015). Coding and billing for audiology and speech- language pathology. Rockville, MD: Author

50. Resources Associations 1.ASHA: www.asha.orgwww.asha.org 2.American Academy of Private Practice in Speech Language Pathology and Audiology: www.AAPPSPA.org