In Private Practice: What Would You Do? Solo practitioners and practice owners may face ethically tricky situations related to billing, accepting patients, discharging patients and other issues. Consider these typical scenarios. In Private Practice
In Private Practice  |   November 01, 2013
In Private Practice: What Would You Do?
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 a member of ASHA Special Interest Groups 13, Swallowing and Swallowing Disorders; and 15, Gerontology.
Article Information
Practice Management / Professional Issues & Training / In Private Practice
In Private Practice   |   November 01, 2013
In Private Practice: What Would You Do?
The ASHA Leader, November 2013, Vol. 18, 30-31. doi:10.1044/leader.IPP.18112013.30
The ASHA Leader, November 2013, Vol. 18, 30-31. doi:10.1044/leader.IPP.18112013.30
As solo practitioners, we commonly face situations in which we walk a fine line with ethics, or perhaps even in which we have crossed into unethical business practices. When red flags pop up, we need to step back, analyze the situation and think, "Is this good business practice?" or "Is what I'm doing ethical?" Speech-language pathologist Lisa Milliken, in her video seminar "Ethics, Compliance and Consequences," is very clear: "Be true to yourself, your client and code of ethics."
Those new to private practice often call on more experienced practitioners for advice. All of us—new and veteran clinicians—can turn to ASHA's Code of Ethics to guide us in our decision-making. In these real-world scenarios, what would you do?
SCENARIO: Your private practice has more empty slots than you'd like. A potential client wants to come to you for treatment, but you haven't had experience with this type of client, the client's disorder or the treatment technique the condition requires. This client will bring in much-needed revenue from the evaluation and treatment. Is it OK to schedule the client and the figure it out as you go along?
Our code of ethics clearly states we should "provide all services competently" (Principle I, Rule A) and "shall not misrepresent competence, education, training, experience" (Principle III, Rule A). These rules lead us to the obligation to refer to another practitioner "when appropriate, to ensure that high-quality service is provided" (Principle I, Rule B). Many other rules discuss competence, training and experience—such as engaging in "only those aspects of the professions that are within … level of education, training and experience" (Principle II, Rule B) and engaging in "lifelong learning to maintain and enhance professional competence and performance" (Principle II, Rule C).
SCENARIO: Your client's insurance covers therapy services, but reimbursement for the procedural code that corresponds to the client's disorder is substantially less than your hourly rate. Your practice is "in network" and must accept the contracted rate. But, if you use different procedural and diagnostic codes, reimbursement is higher. Should you bill the other codes, collect higher fees, and keep this client?
One area in which we should never get "creative" is billing. Our code is very clear, stating that clinicians "shall not misrepresent services rendered" (Principle I, Rule O); "shall not defraud or engage in any scheme to defraud in connection with obtaining payment, reimbursement" (Principle III, Rule E); and "shall not engage in dishonesty, fraud, deceit, or misrepresentation" (Principle IV, Rule C). ASHA's Health Care Economics Committee has noted that some professionals are serving prison terms for fraud.
SCENARIO: The client's insurance reimbursement is much less than your hourly rate. You're "in network" and have agreed to the insurance company's reimbursement rate. So, to make up the difference in the hourly rate, you could bill the client, correct?
If you sign a contract to accept an insurance company's reimbursement, you may not collect anything from the patient other than the copayment. Ethically (and legally) this practice constitutes fraud. If you aren't willing to accept the contract rate, complete the paperwork to change your provider status to out-of-network provider.
SCENARIO: You accepted a client and now regret it for many reasons—the client makes inappropriate demands, constantly reschedules and cancels often. You've made up your mind—you will tell the client you can no longer work together and that today's session will be the client's last.
It is unethical to terminate a client without "providing reasonable notice" (Principle I, Rule R). If you want to end treatment, inform the client of the end date for services—giving "reasonable notice"—and provide names of other facilities for treatment. Follow through with records transfer, and make sure to document the transition to protect yourself against a claim of patient abandonment.
SCENARIO: You have several employees in your private practice, whom you equip with the most recent editions of assessments and plenty of equipment to use in evaluations and treatment. After a staff member leaves to work elsewhere or to open a practice, you look for—but can't locate—a particular assessment tool or treatment aid that costs several hundred dollars. You can't be sure when it disappeared, but no one knows where it is.
Theft of equipment, protocols, tools and other materials is a real concern in private practice. Employees should understand that they should not "engage in dishonesty, fraud, deceit, or misrepresentation" (Principle IV, Rule C). Without proof, however, employers have little recourse. To protect yourself, you might want to develop a sign-out system for equipment and materials, and address the issue of theft in your employee handbook.
Business owners and employees in any work environment will face ethical issues. But just as we spend a great deal of effort maintaining a profitable business, we need to be vigilant about maintaining an ethical practice as well.
1.American Speech-Language-Hearing Association. (2010). Code of Ethics [Ethics].
1.American Speech-Language-Hearing Association. (2010). Code of Ethics [Ethics]. ×
2.Milliken, L. Ethics, Compliance and Consequences. Home CEU Connections Video Seminar, June 13, 2012.
2.Milliken, L. Ethics, Compliance and Consequences. Home CEU Connections Video Seminar, June 13, 2012. ×
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November 2013
Volume 18, Issue 11