I get a decent number of people asking me about my private practice and for some tips on starting a small private pay (out of network) practice. This is definitely not my area of expertise, but I have put some time and effort into it, and have discovered a few things that seem to have worked better for me. To make the discussion easier I have decided to write this brief post.

First a major caveat: This is not intended as legal, professional, or medical advice. Spend time talking to those who are invested in those realms and get their advice on what you are doing. A good accountant and lawyer will be absolutely essential. Hopefully reviewing this will help with the discussion you have but it SHOULD NOT be your source of advice on these topics. Also since I am US based I have no idea how this applies to other countries if at all.

Again, take anything below at your own risk…

General structure

It is probably a good idea to get a LLC or an S corp. Whether Professional LLC or just LLC will depend on your state. Discuss this with a lawyer. There are tons of articles online that go into the advantages and disadvantages. Discuss with your accountant whether to get this as an S corp or if you should elect to be recognized as one. This seems to largely depend on how much you will earn.

Get your federal EIN. Clicking on THIS LINK will take you there. It is also suggested that you get your business NPI number after it is established.

Open a business bank account. Many options but you need the EIN first. If you switch (from sole proprietor to LLC for instance) you will need to shut down your old account and get a new one. Chase has been a pleasure to work with for me but many of your local credit unions may offer excellent options.

I would suggest also getting a business credit card. The two most highly recommended from my research are Chase and Capitol one. Look into them and determine which works best for you.

Get liability insurance. HPSO insures many of those in the APTA and has specific offers for them. They are very easy to work with. If you have proof of a certain amount of con-ed in the last year and mention this they also offer a small discount.

Payroll: If you go with an S corp then payroll software makes the process a lot easier. I prefer ease to saving a little money while burning time. I have found wagepoint to be very easy to use and it makes quarterly taxes etc much easier to pay. There is a 30 day free trial if you want to explore it. ADP and Intuit also offer this option as do many others. Do your research.

Documentation:

You should have a consent to treat form, a HIPAA compliance section, an explanation that you do not accept insurance, and the various other legal statements that most clinics have available. (I suspect there’s only one that was written decades ago and has been modified by everyone else ever since.)

Intake Forms:

• Patient Information: Get a sheet with whatever information you need from the patient.
• Waiver and Consent to treat: Here is the form I use. Modify to reflect your services and have your lawyer look at it.

Treatment Documentation

• Evaluation – This is what I use but you are free to do whatever you wish
• Soap notes – again this is the form I use but modify as you wish
• Exercise Flow sheet – this is very basic and I am constantly tweaking other versions but it works as a starter template.

Email:

This should be via a secure server and a waiver should be included at the end. I have a waiver in my patient consent where they sign to allow electronic communication. Otherwise various portals and tunnels are available.

This is mine

CONFIDENTIALITY NOTICE:
The contents of this email message and any attachments are intended solely for the addressee(s) and may contain confidential and/or privileged information and may be legally protected from disclosure. If you are not the intended recipient of this message or their agent, or if this message has been addressed to you in error, please immediately alert the sender by reply email and then delete this message and any attachments. If you are not the intended recipient, you are hereby notified that any use, dissemination, copying, or storage of this message or its attachments is strictly prohibited.

Superbill:

In order for your patient to be able to submit their services for reimbursement they will need a superbill. I made a custom template in my invoice service. You must include the diagnosis code, treatment codes and units billed at a minimum.

Here is an example of what I use

Apps:

The following apps have been ones that I have found very beneficial

• Quick books self employed
  • Tracking income
  • Tracking expenses
  • Invoices
  • Tracking mileage
• Invoice2go
  • Great customizable invoice app that lets you accept payment via credit card and paypal. Tracks income and outstanding balances etc.
• Sfax
  • Online fax service that is HIPPA compliant. They also offer a EMR option that I looked at but haven’t used.
• Google Suite Email option
  • Can be used for documentation
  • Can be made HIPPA compliant with a BAA See HERE and HERE
• PDF Expert
  • Can be used for PDF management, signatures, etc.