HIPAA Security Rule Compliance for Private Practitioners

Guest Post by Rob Reinhardt, LPCS, Technology Consultant for Mental Health Professionals, CEO of Tame Your Practice

Wouldn't it be nice if someone would provide us with a brief checklist of things we need to do in order to comply with HIPAA (the Health Insurance Portability and Accountability Act)? I strongly recommend that you not wait for that to happen. HIPAA was purposely constructed to be flexible so that both large hospitals and solo practitioners would be able to comply. You wouldn't want to follow the same checklist as a hospital would you? Further, because HIPAA now covers electronic Protected Health Information (ePHI), it's important that it be flexible since technology continually evolves.

That said, there are some basic parameters and processes to be aware of. Once these concepts are understood, HIPAA no longer seems to be this overwhelming, unintelligible, monstrosity. It takes on a role similar to progress notes and other paperwork; that stuff that gets in the way of our client time, but we know we need to do it.

Here then, is a brief summary of the most important things to know about HIPAA:

It's More Than Just the HIPAA Privacy Notices

HIPAA started out in 1996 with the Privacy Rule, which regulates the use and disclosure of Protected Health Information (PHI) by Covered Entities (CEs). Protected Health Information is any data about health care that can be linked to a specific individual. Covered Entities are health plans/insurers, clearinghouses, and providers who engage in “Covered Transactions”. For most mental health clinicians, that means filing electronic insurance claims (even if you don't, be sure to read on). This is the part of HIPAA that brought us the HIPAA Notice of Privacy Practices, where providers detail for clients how and when they will use and/or disclose their PHI.

In 2003, the Security Rule was added in order to set standards for securing ePHI. It requires that CEs establish Administrative, Technical, and Physical safeguards to ensure the privacy of client data. This was further enhanced by the HITECH Act (Health Information Technology for Economic and Clinical Health Act) in 2009 and the Final (Omnibus) Rule in 2013.

I've found that most therapists have the Privacy Rule down pat, so in the following sections, I'll focus on clarifying information from the Security Rule.

HIPAA Security Compliance Is An Ongoing Process

One of the primary components of complying with the Security Rule is completing a Risk Analysis and Management Plan. This is a process of documenting reasonably anticipated threats to the security of ePHI (i.e. theft, loss, fire) and a plan for dealing with those threats. This is required to be reinforced through a documented set of Policies and Procedures (yes, even if you're a solo practitioner). Therapists wouldn't dream of assessing a client at intake and then never re-visiting that assessment. Similarly this Risk Analysis process needs to be re-visited on a regular basis. This ensures that new technologies and threats are addressed appropriately.

Software and Devices Can't Be HIPAA Compliant

If you listen to the marketing speak, you might get the impression that a CE can be in compliance as long as they choose software and devices that are “HIPAA Compliant”. The problem is that such things do not exist!

Only Covered Entities or Business Associates can be compliant with HIPAA by engaging in the processes described above. A Business Associate (BA) is any third party that a CE shares PHI with. This could be a billing agent, an EHR vendor, or a telehealth application vendor. In creating this relationship, the CE is required to establish a Business Associate Agreement with the BA, outlining the responsibilities of each. The good news is that, due to the Omnibus Rule, this requires that the BA is held to the same standards for compliance as the CE. To be clear, this doesn't release the CE from all responsibility. They still need to conduct a Risk Assessment. However, it's often the case (especially with EHR) that using a third party vendor will greatly decrease the scope of (read: amount of work involved in) the CEs process.

(Side Note: It's important to note that financial transactions are exempt from HIPAA, so typically financial institutions don't fit the definition of Business Associate. However, there are some circumstances to be aware of, such as some of the features offered by services like Square).

But I Don't Take Insurance So I Don't Have To Worry About HIPAA

It's true that, if you (or your billing representative) are not filing electronic insurance claims, you likely don't fit the definition of Covered Entity. Technically then, you don't have to comply with HIPAA. You should be aware of and consider the following, however:

• Standard of Care - HIPAA is becoming recognized as a “Standard of Care” when it comes to Privacy and Security. If how you handle privacy and security ever comes into question, there's a solid chance that HIPAA will be the measuring stick for whether you're doing a good job.
• Ethics – Our codes of ethics require that we keep client information confidential. In line with the first point, what standards can we use to prove that we are doing so, especially with ePHI?
• State Law – Be sure to understand your state laws regarding client privacy. If you're in Texas, for example, your state laws are in some cases even more stringent than HIPAA.
• Best Practices – Similar to the idea of Standard of Care, the set of requirements in HIPAA are considered “Best Practices” for securing client data. While HIPAA may seem bloated and overdone in parts, the core requirements make sense and are a good path for significantly reducing the risks to privacy.

Rob Reinhardt is a Licensed Professional Counselor Supervisor in North Carolina and CEO of Tame Your Practice. In addition to helping therapists integrate technology into their practice, he is the column editor for Counseling Today magazine and creator of Describe, a therapy tool appropriate for individuals and families of all ages!

10 Reasons to Become a Media-Savvy Therapist

About 8-9 years ago, I felt a pull toward gaining media and social media skills and expertise. At the time, I wasn't sure why...or how. In hindsight, I now see the clear benefits of my media visibility for my private practice and for me as a professional. I also had no idea how fun it would be to build relationships (with producers, journalists, reporters, TV hosts, etc.), educate my community, and share my message and expertise with thousands of people. This decision to become media-savvy has altered the course of my professional life in exciting and new ways. Because my practice has grown so much (3 locations, 20 employees) and requires more management, because I'm increasingly involved in media work and content creation, and because it felt like the right thing to do, I have retired from clinical work. I now focus on writing, private practice business consulting, earning my PhD, and spending time with my family. These opportunities would not have been possible had I not acquired social media skills.

Reflecting on my career (thus far), I want to share with you some tangible benefits of becoming proficient with (social) media and maintaining an online presence. Here are 10 things you can do by becoming a media-savvy therapist:

1) Educate Your Community; Educate The World

The mental health field is by nature a helping profession. We became therapists to help people who are struggling in some aspect of their lives, right? One of the biggest ways to do is this by educating individuals. No matter your area of expertise (marriage therapy, addiction, depression, etc.), you have valuable insight that you can share with your community to serve them and better their lives. By embracing media (TV, radio, print) and newer technologies (blogging, podcasts, social media), your message can be amplified exponentially, causing you to reach a greater audience.

2) Grow Your Practice (even during an economic downturn!) 

I founded my private practice (Wasatch Family Therapy) in 2002 and consider myself an early adopter of technology. We created a website not long after we opened and have fully embraced and utilized social media as the years have gone by. To say that this has grown our practice is an understatement: maintaining a strong online presence has beenour number one strategy in acquiring new clients. What's more is that we now refer out over half of the individuals who seek our services (click here to read more about how our practice grew even in the economic downturn of 2008).

3) Increase Your Credibility Through Social Proof of Expertise

As you use your platform(s) of choice (blog, Facebook, Google+, etc.) to create content and build your body of work, you will in time gain followers who are interested in what you have to say. This will establish your social relevance and up your credibility. Others now view you as an expert and someone to be trusted. This can open up doors for you professionally, just like it has done for me! (read here about how gaining a social media following has brought me valuable career opportunities).

4) Employ a Fee-for-Service Model 

Because I am familiar to more people, I have been able build a fee-for-service practice. This has led to increased income and has kept my clinicians from having to deal with the stress and burden of insurance companies. A private pay model also helps provide better quality therapy for clients. And once again, it's due in large part to our strong media presence that we were able to "break up with managed care."

5) Raise Visibility For Your Profession 

We as therapists often lament the fact that mental health issues don't receive as much airtime as they deserve (though thankfully, this seems to be changing). Your media skills can help bring these topics to the forefront for your friends, family, and followers. For example, NASW has featured my work in their media news and even invited me to do national webinars. Good media interviews add visibility and educate the public about your profession in general and also about your specific expertise.

6) Create Additional Income Streams (book deals, paid blogging, consulting, etc.) 

There is so much more to being in this field than seeing clients. My online presence has afforded me the opportunities to write for major websites and blogs, consult others about how to best build their practice, and even write a book (currently working on my second one)! By growing your media skills, you too can diversify your professional activities and create multiple streams of income for yourself.

7) Create Content For Your Blog

The information you access through your social media platforms can give you great inspiration for your blog. For example, when I do a TV interview, I then post it on my site, which improves SEO and provides new and engaging content. I've found that because of my technology connections, I never am lacking for material to blog or write about.

8) Reach MORE People With Your Message, Passion, & Expertise 

The power that social media provides to reach others is truly unparalleled. I can now talk with hundreds or thousands of people at one time with each interview, not to mention the many more who will watch, listen, or read it online later. You can infinitely expand your outreach and get your message out there by utilizing media and social technologies.

9) Add Incentive for Additional Clinicians To Join Your Practice 

My media presence and relationships have given other clinicians a reason to work for me instead of opening their own practice. So individuals who potentially may have been my competition are now on my team! Your media presence (blog, interviews, Facebook, etc.) can attract new therapists who know about your vision, values, and niche from what they've seen online.

10) Gain Recognition by Professional Organizations

My media appearances and online presence has garnered the attention of reputable organizations, and I'm grateful to have received some notable accolades. For example, I was named #1 online influencer for depression, and #2 mental health online influencer by ShareCare (a social media health company founded by Dr. Oz, Discovery Communications, and WebMD's Jeff Arnold), and received the 2015 National Association of Social Worker Award for my website JulieHanks.com.

How can YOU improve your media-savviness?

And what great opportunities await you as you do? 

Join my upcoming media training. Click the graphic below to get on the list!

Visit the new PrivatePracticeToolbox.net for webinars and consulting services

FREE Download Get 52 Blog Post Topics & prompts when you sign up for PPT list

Join my Private Practice Toolbox Facebook group and connect with 3200 therapists around the globe in 2 simple steps: 1) Click request to join the group and 2) Fill out this brief questionnaire before you’ll be added to the group.

8 Steps to Launching or Relaunching a Psychotherapy Practice

In this guest post, Miranda Palmer LMFT and Kelly Higdon share eight ways to thrive in the current private practice climate. The process of building a successful private practice has changed considerably over the last twenty years. Most therapists we speak with who have been in practice for a few decades started by getting their credentials from an insurance companies. Reimbursement rates were relatively high for the cost of living from the 80s into the early 90s. Things flowed. Maybe they had a listing in the phone book, but back then there was no need for websites, Facebook pages, or Twitter accounts!

Fast forward to now: the financial picture for therapists in private practice has drastically changed, as we are in a time of low or stagnate reimbursement rates combined with an increase in cost of doing business and living.

The old model is simply that, old. It doesn’t work for today, and thus we find experienced therapists with a full practice that isn’t profitable enough to prepare for retirement, and new therapists often feel lost when they ask their mentors for direction and get answers that don’t resonate with the current economy.

We want to simplify the steps required for launching and successfully running a private practice in 2014. Whether you are starting out fresh, have moved to a new city, or need to make some significant changes in your business foundation, these steps will help you get things on track!

1) Develop a clear vision of your life

We tell our clients to do this regularly. We help them reassess and ask them to be accountable for the choices they make that lead them toward or away from that vision becoming a reality. This is your road map. When you begin with a plan for your life, your business can be formed to support that plan. So before you come up with an awesome group therapy curriculum or some other great idea, write down a super clear vision for your work AND home life.

2) Take that vision and break it down into pieces

Having a simple vision, with no basis in reality, can be difficult. How much money do you need to make that vision come to life? What would it take for you to go home at that time each day? Are you preparing for quarterly taxes? Are you realistic about how many clients you can see regularly while avoiding burnout? Are you leaving time for networking and marketing your practice? Leaving time for going to trainings? For being sick? Are you leaving enough time to return client phone calls and be available for crisis situations?

This is where people can get stuck in magical math. If I see 20 clients at $100/hr, that is $2,000 per week for 50 weeks – that’s six figures! YET there are expenses, taxes, real life stuff that happens. Be honest with your capabilities and your needs. Also, be open to the idea of reaching your goals in different ways. You might discover that face-to-face sessions is only a part of the plan. Now go crunch numbers, write down the schedule, and look at the specific pieces that are needed to fully form your vision.

3) Develop a business plan based on your vision and those realistic pieces

Every therapist in private practice needs a written business plan. He/she must know exactly how the fee was developed, how many sliding or pro bono slots there are, how much money is put toward retirement, etc. There is also a bit of research to be done here. Surprised? Sure, people need mental health services, but who and where are they, and what are the holes in the market in your area? Have a clear idea of who you want serve and how you plan to serve them. Write it down; be accountable to yourself.

4) Develop a sustainable plan to let your community know who you are

Notice I didn’t say develop a sustainable plan to let people know your business exists. People decide to work with therapists they know, like, and trust. Being authentic in how you present your private practice to the public doesn’t have to mean complete self-disclosure. Maintain professional boundaries, but don’t be afraid to let your personality shine!

The beauty of our current world is that people can advocate for themselves by choosing a provider who they believe is prepared to help them heal. If a potential client doesn’t get a chance to hear your “voice” and how you practice, how can he/she determine if you are a good fit? How hard is it for you to choose a therapist for yourself? Can you imagine how much more difficult it would be without an advanced degree and a deep knowledge of psychological theory?  Make sure to clearly communicate what unique things you can offer as a therapist.

Be aware of your insecurities and how you demonstrate those to the world. Now is the time to believe in yourself and honestly take stock in what you bring to the table. It is not prideful to share your craft with others. It is necessary in order to build relationships and instill hope in members of your community.

5) Develop and maintain clear business boundaries

Your business is your service to your clients. You may think that the things you are doing on a daily basis are serving your clients, but you need to be honest with yourself. If your business is struggling, it will impact your clinical work. What would happen if your clients talked to one another? Do more assertive clients pay a different fee than passive clients? Do clients with poor money management skills pay less than a client who has better budgeting skills?

Stick to your plan. Go back, and if you start to waver, remember #1 – why you are doing this in the first place? What is the life you are seeking to create? Who are the clients you are seeking to transform? When you break those boundaries, you are holding yourself back from the dreams you have for yourself and from helping your community in a profound way.

6) Streamline your business processes

The best way to do great clinical work is to free yourself up to do great clinical work. Whether this means transitioning to a paperless office to reduce late cancellations or no shows and decrease unpaid balances, or outsourcing your insurance billing so you never have to sit on hold with insurance companies again, find a way to make the business process work efficiently. If you feel like you can’t afford to streamline your process, you need to look at return on investment and/or whether you have set a fee that fully integrates business and overhead costs.

7) Streamline your marketing process

It takes more energy to start from a stopped position. The start of launching or re-launching your practice takes a LOT of energy, gusto, and enthusiasm. Know that it won’t always be as hard as it is in the beginning. Watch what works for growing your practice most effortlessly, and make a way to continue the bare minimum even when you are full with clients to keep things flowing. Maybe that is blogging once a month, speaking a few times a year, or monthly lunch dates with new contacts in your area. If you don’t have time to do some minimal tasks to keep things moving, you need to reassess if you are being honest with yourself about the time it takes to run a business.

Your marketing must align with who you are and your core values. If you don’t want to write a blog, don’t. If you don’t want to speak, don’t. BUT, do something and analyze if it works. If it isn’t working, then tweak it until it works, or let it go and move on to other options. Just because your neighbor gets referrals from Psychology Today doesn’t mean that is what YOU should do. You must only do what is best for your business, not necessarily what is best for others.

8) Celebrate your accomplishments!

Be good to yourself; kind to yourself. There is a lot to learn when starting a private practice. Know that everyone has a learning curve, and seek out a supportive community. However, no matter how awesome your community is, you will be struggling to stay energized and enjoy private practice if you are being unkind to you. Start from the inside out! And don’t be afraid to celebrate all the great accomplishments you’ve made in your private practice.

Miranda Palmer is a Licensed Marriage Family Therapists who is passionate about teaching and empowering other clinical counselors to successfully run a private practice. Visit her site www.zynnyme.com to learn more. 

Kelly Higdon wants to make a difference by sharing her expertise to help clients and business owners reach their full potential. Check out her Business School Bootcamp to learn more.   

Get practice tips and blog updates in your inbox. Sign up for the Private Practice Toolbox Newsletter here.

Join my Private Practice Toolbox Facebook group and connect with nearly 2000 therapists around the globe in 2 simple steps: 1) Click request to join the group & 2) Fill out this brief questionnaire before you'll be added to the group.

Need help blogging? Join my ongoing therapist blog challenge!

10 Ways Blogging Transformed My Private Practice

Jodie Gale MA built a thriving practice through online presence, blogging and social media. Read about her journey in this inspiring guest post.

When I returned home from the UK several years ago, I was shocked at the state of psychotherapy in Australia. There was, and still is, a lack of understanding about what psychotherapy is and a lack of promotion regarding the benefits of psychotherapy from our professional associations. Frustratingly, it is rare to find a psychotherapist (or a family/play/art therapist) working as part of a multidisciplinary team in private or public health.

There is also a deeply pervasive myth that it is impossible to fill a ‘full fee paying’ private practice as a counsellor or psychotherapist because of the mental health plan insurance system which only provides rebates to psychologists and a small number of social workers. Trying to persuade clients to engage in weekly, depth psychotherapy (without a rebate) literally felt like mission impossible. My private practice reflected this and was sporadic to say the least. Desperate and down hearted after 8 years of Master’s training to become a psychotherapist – I found myself smack bang in the middle of a major career crisis.

At the beginning of 2013, I built a strong online presence through blogging and by taking the Julie Hanks LCSW's Private Practice Toolbox Blog Challenge.  Since taking the blogging challenge I am now described by my colleagues as a prolific blogger and I credit creating online content as the foremost reason for my practice growth and success.

10 Benefits of Blogging Regularly on my Private Practice Website

1) I have more than enough clients

A great deal has changed since then! My practice is out of control busy and I have literally had to take my phone number off my website because I couldn’t keep up with the high level of phone inquiries. Last count, I have referred 50+ clients to other therapists in my local area and beyond.

2) Networking with colleagues

The initial benefit of blogging specifically through taking the blog challenge was networking with colleagues from around the world and building ongoing personal and professional relationships. Connections are crucial, especially when working from a home office, private practice as I do.

3) Keeping current on research

Writing one-two times a month has kept me up-to-date with the latest research and news within the therapy field.

4) Building writing confidence

Initially terrified of putting myself out there, I found that my confidence and writing improved with every blog post.

5) Increase in client inquiries

After about four – five months of blogging, I noticed a significant increase in client inquiries. One client specifically mentioned finding me through the ‘Top 10 Books’ blog challenge post. She had Googled one of the book titles, then ‘counsellor’ and I ranked first in the google search.

6) Provides resources for current clients

A blog is a great resource centre for my clients and I often send them links on a specific topic. Once my blog is written, I share it on Pinterest as my boards are the ultimate resource centre for clients and therapists alike. Whenever I choose an image for my blog, it is with Pinterest in mind as I find my articles are shared more frequently on Pinterest than on other social media pages.

7) Higher ranking on Google searches

Six months into the blog challenge, I started to rank on the front page of Google Australia and I often rank at number one for my local area, key word searches. My practice has been full since then. When I reply to inquiries, I let the prospective client know that my practice is full, I offer to make a referral and ask if they would like to go on my women’s workshop mailing list.

8) Professional credibility

Historically, psychology articles were limited to journals or written by journalists for popular magazines. As therapists, we have a wealth of knowledge to share. Blogging helps to raise the profile of our profession.

Blogging has raised my profile as an expert in the field and the go-to professional for women’s psycho-spiritual health and well-being. I have been interviewed, written guest posts and featured on Private Practice Toolbox, The World of Psychology , About.com, ABC Radio, Australia Counselling, The Manly Daily Newspaper, The Morning Show and Australian Well-being Magazine.

9) Job opportunities

Blogging helped me to land the job of my dreams. Late last year I attended a two-day workshop and I was approached by the two directors who offered me the position of Assistant Clinical Director of an eating disorder unit. Having written about eating disorders from a soulful and psycho-spiritual perspective, they loved my blog and felt that I would be a good fit for their team.

10) Sense of power and effectiveness

Finally, I have found a sense of personal power due to taking responsibility for the growth of my practice and career progression. I was filled with a sense of hopelessness regarding our field and often envied other therapists who appeared to have more clients and success than I did. When my practice was sporadic and slow, I was working from a place of lack. Now I work from a place of generosity and abundance. And… most importantly, I have realised that there are enough courageous, ideal (and full fee paying) clients out there for everyone!

Jodie Gale MA is a leading specialist in women’s emotional, psychological and spiritual health and well-being. She is a qualified therapeutic counsellor, a psychosynthesis psychotherapist. Jodie lives on the Northern Beaches of Sydney where she currently balances being a stay at home mother with her part-time position at EatFed and a part-time private practice.

How to Create and Sell Your First E-book (part 2)

In this guest post, counselor and consultant Clinton Power share how to put the finishing touches on your E-book and how to get the word out and sell your book. (Read part 1 how to create your first E-Book)

Use a graphic designer to make your E-book stunning

If you're planning on creating a PDF version of your E-book to sell through your website, you definitely want to get it professionally designed. Your designer can then employ visuals, highlight quotes, and use attractive fonts and graphic design elements to draw the reader in and make reading your E-book a pleasure. Your designer will also create a compelling cover page, which is essential as it will make a big difference whether people are attracted to your E-book or not.

If you're going down the Amazon route, you won't need a designer to design the inside, but you will need an awesome cover design so you stand out from the thousands of books in Amazon.

One other consideration is to make sure you have your e-book proof read once it’s complete. I employed a professional copy editor to make sure my book was grammatically sound with no spelling errors. This was a good investment.

Create a dedicated landing page for your E-book

It's worth creating a dedicated landing page on your website for, or creating a stand-alone website just for your E-book.

Even if you're selling it through Amazon, it's helpful to direct people to this page to read more about your book.

Include attractive images of the cover (3D preferably), testimonials and a bio of you, the author.

Options for selling your E-book

I chose the Amazon route and more specifically, a product called KDP Select. If you use KDP Select you have a 90-day agreement with Amazon that you won't sell your E-book anywhere else on the internet.

KDP Select also allows you to have up to 5 promotional days within the 90 days where you can give your book away for free on Amazon. This was a great strategy for getting more exposure, and helped me get over 2000 downloads. In fact, over 1,800 downloads happened in one weekend during one of my free promotions when my book went to the top of the free list for its category.

If you want more flexibility, you can just join KDP and then still sell your E-book in other places.

If you're selling your E-book through your website, I recommend using E-Junkie or Gum Road. E-Junkie will allow you to have affiliates so other people can sell your book and earn a commission, and Gum Road is very simple software where a beautiful pop-up appears on your website and guides the purchaser through a checkout.

Begin promoting your E-book

Now your E-book has been created, it's time to start promoting it. That's probably a whole other post on it's own, but one tip I'll share is I sent advanced copies to readers on my newsletter list for free, in exchange for Amazon reviews.

This was very helpful in getting reviews on Amazon just as I started to make sales. And the more positive reviews you get, the more Amazon will promote your book in its marketplace.

Don't forget to talk about your E-book on a regular basis on social media and get creative about sharing your message.

Another strategy I used was I created attractive images in PicMonkey with tips from each chapter and shared them on social media and on my blog.

Track your results

Finally, you want to track your results to see how you're doing with your sales.

Amazon makes this easy through Author Central, so make sure you create an account there. You can track the ranking of your book in the Amazon Marketplace and read all your reviews, as well as edit your author profile.

If you're selling your E-book on your website, use Google Analytics to see where traffic is coming to your landing page, and then increase your marketing efforts in those areas.

Creating an E-book has never been easier, so what's stopping you? Get writing!

Clinton Power is a Gestalt therapist and the owner of Clinton Power + Associates - a private practice dedicated to helping singles and couples move out of relationship pain in Sydney, Australia. Clinton is the author of the E-book 31 Days to Build a Better Relationship, which is available in the Amazon store. He is also the founder of Australia Counselling Directory, a free directory for finding counselors and psychologists in Australia. Follow him on Twitter @sydneytherapist