8 Deadly Private Practice Don’ts Ask anyone in private practice if they’ve made mistakes along the way, and you will most likely get a“Yes.” We've all made some bad decisions, but the key is we learned not to make that mistake again! Here are some lessons we’ve learned the hard way that can help ... Features
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Features  |   January 01, 2014
8 Deadly Private Practice Don’ts
Author Notes
  • Denise Dougherty, MA, CCC-SLP
    is past president of the American Academy of Private Practice in Speech Pathology and Audiology and the organization's liaison to ASHA's Health Care Economics Committee. She is also an affiliate of ASHA Special Interest Groups 13, Swallowing and Swallowing Disorders; and 15, Gerontology. doughterty1952@yahoo.com
Article Information
Practice Management / Professional Issues & Training / Features
Features   |   January 01, 2014
8 Deadly Private Practice Don’ts
The ASHA Leader, January 2014, Vol. 19, online only. doi:10.1044/leader.FTR4.19012014.np
The ASHA Leader, January 2014, Vol. 19, online only. doi:10.1044/leader.FTR4.19012014.np
Ask anyone in private practice if they’ve made mistakes along the way, and you will most likely get a“Yes.” We've all made some bad decisions, but the key is we learned not to make that mistake again! Here are some lessons we’ve learned the hard way that can help you avoid making them in the first place:
Don’t spend more than you can afford. Money will be tight, so spend wisely. Here are some examples of how some private practitioners didn’t: One person quit her job, rented an office and waited for business to walk through the door. After several months, her cash reserve ran out, and she went to work for another firm. Another example is a practitioner whospent money on costly practice software that she never used because all her contractors used their own paperwork. One practice remodeled and bought a building that took years to sell after the practice split up. 
You may not need an office or expensive practice software right now. Make sure you have only what you need to provide services. Always use “free” when you can—a press release is more budget-friendly than expensive advertising. Along the same line, “free” scheduling tools or a day planner may be just as effective as a front-desk person for your business right now.
Don’t assume the client’s insurance pays for speech services. Insurance plans are always changing and often speech services are considered “non-essential.” Always check with the insurance company on policy specifics. Remember that prerecorded message, “This phone call does not guarantee payment for services.” Create a phone log to record who you talked with at the insurance company, phone number and a summary of your discussion. Even if you have good communication with the insurance agency, don’t assume the patient understands his or her coverage. Add a statement to your intake sheet informing the patient/family that the patient is responsible if the claim is denied, and have the responsible party sign it.
Don’t expand too quickly. Even though it would be nice to have a support staff and fellow speech-language pathologists and audiologists to work alongside you, big does not necessarily mean better. Hiring additional staff creates other headaches, such as payroll and benefits. And if you do add extra people, don’t assume your SLPs or audiologists are independent contractors. The government may view them as employees, which means you would owe back taxes and fines on previous years’ income tax. Check with your attorney or the IRS to be sure. Complete IRS form SS-8, Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding [www.irs.gov/pub/irs-pdf/fss8.pdf], for an IRS ruling.
Don’t let someone else handle the money or books. I’ve heard numerous stories from private practitioners who trusted a staff member to handle deposits.All too often, funds were diverted into the staff member’s bank account. Some practices had bookkeepers using the business credit cards or writing checks for their personal gain and, because the owner trusted the person, the theft was not found for some time. Thousands of dollars later, the business owners dealt with continuing fallout. The practices had a hard time recovering. Consider background checks on potential employees to look for red flags. Your accountant can develop a system to track billings, co-pays and cash payments. Set up your checking account to require two signatures. Credit card alerts will notify you when purchases are made. Consider subscribing to companies that monitor your accounts for identify theft. Review your accounts regularly to monitor for fraudulent charges. Always know what revenues have come in and what expenses were paid. 
Don’t let a client run up an outstanding balance. Even though a client may claim to be in communication with the insurer to figure out coverage—which can sometimes take a while—don’t let the balance keep building week after week. If the services turn out to be covered, you can always reimburse the client. Be sure you communicate that payment is due at the time of service. A sign in the waiting room reinforces your policy. If you have a handout of the patient’s responsibilities (attendance and such), add a note about your payment policy.
Don’t rely on one referral source. Although your contact at the hospital was great at referring patients to you for about a year, what happens if that contact leaves or changes jobs? I know of cases in which private practices relied on Medicaid for referrals. Reimbursements were decent, business boomed and the practices expanded quickly. But when reimbursements dropped sharply, the business owners had to let staff go to remain profitable. Some business owners went back to solo practices to stay afloat. A good idea is to diversify, as referral sources can dry up quickly. Despite non-compete or compensation clauses, some contracts hire your staff rather than continue with your practice. It takes time to replace the lost revenues, and it will affect your profitability.
Don’t tolerate cancellations and no-shows. Your patients’ time is important, but so is yours—in fact, it’s money. Many professions have a no-show or cancellation fees for a missed session. You can’t keep your doors open long if clients are cavalier about attendance. Review your attendance policies with the family and have the responsible party sign the form. Some practices have a credit card number on file for this purpose. Review “In Private Practice: No More No-Shows,” by Robyn Merkel Walsh (The ASHA Leader, September 2013.).
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January 2014
Volume 19, Issue 1