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THE KEYS TO STARTING A PRIVATE PRACTICE Part III THE NITTY-GRITTY A Presentation of the AACAP Member Benefits Committee John E. Dunne, MD 16040 Christensen Road, Suite 217 Tukwila, WA 98188 [email protected] INITIAL START-UP Opening your office Medical and business licenses Telephone and fax/copier Emergency contact system Scheduling process Intake form listing pt. name, address and BD; parents’ names and addresses; insurance information Office policy and HIPPA privacy statements Charting system (paper vs. EMR) Prescription pads and DEA registration Stationery, business cards Checking account Billing system PRACTICE MANAGEMENT TOOLS Appointment system Credit card processing Billing system Accounting system recording charges and payments tracking insurance claims Paying bills Paying employees, if any Calculating, paying local, state and federal taxes Medical record system Transcription service Banking services Credit card Line of credit Reserve fund Medical Records Paper charts Inexpensive Easy to handle and review Handwriting may be easier than typing Storage is a problem Electronic medical records Expensive, long term costs Purchase in-house system vs. secure hosted EMRs Critical questions re. costs, updates, transferability, long term storage Easier to handle ROI requests, share info Storage is easier, cheaper May eventually be required Practice Website Helps people looking for help find you Can post intake forms and information FAQs Post patient information and links to helpful websites Can post emerging information: e.g., out of office dates, who is covering for you, rate changes E-mail link Creates additional expense and time commitment SETTING FEES Dunne’s Rule for setting fees, negotiating contracts and just about everything else in life “If you feel resentful about providing the service at a certain rate, you are not charging enough. If you feel guilty about how much you are charging, you are charging too much.” Usual and Customary fees Sliding scale, discounts and surcharges Handling fee increases Differentiating services Intake appointment Psychotherapy Medication management Forensic Consultation Reports, school forms, telephone consultation, prescriptions INSURANCE AND MANAGED CARE It’s not all or nothing How quickly do you want to fill your practice? Selection criteria Large insurers and large employers Allowed amounts Hassle factor, i.e., the effort required to get authorizations for treatment, medications Negotiating with contracting companies Remember Dunne’s Rule “Negotiating with Managed Care Companies”, Healthcare Access and Economics Committee BILLING HCFA (“hic’va”) Health Care Finance Authority, standardized form 1500 Electronic billing Billing services Payment at time of service vs. balance billing Contract restrictions on balance billing Coding, DSM vs. ICDM MANAGING YOUR SCHEDULE Set your work schedule and stick to it Not all hours are created equal Designate time for certain activities Dealing with emergencies and urgent issues How busy do you want to be? Maximize service? Maximize income? Maximize flexibility? TIPS AND TRICKS Create forms that gather routine information or serve administrative functions Sample practice forms are posted on AACAP website Use handouts, e.g. medication info, Facts for Families Create shortcuts Use stickers, labels and ink stamps Program commonly called numbers into your phone and fax In private practice you are a part of your community. Find a way you can make it better. REFERENCES Entering Private Practice: a Handbook for Psychiatrists. Jeremy Lazarus, ED., APPI, 2005 Money and Outpatient Psychiatry: Practice Guidelines from Accounting to Ethics. Cecilia M.Mikalac, MD, Norton & Co., 2005 References provided by Jill Carlson, MD 2010 AACAP Meeting Programs “The Transition to Practice” symposium sponsored by the Early Career Psychiatrist Committee “Starting a Private Practice” workshop sponsored by the Member Benefits Committee “Private Practice 101: Strategies and Tips for Running an Efficient Practice” workshop sponsored by the Member Benefits Committee