Tough Love: How to Be Firm About Finances

When you decided to go into the field of professional psychotherapy, it's likely that your reasons had little to do with money. Even as you first started, you probably didn't have dollars on the brain all the time (payments, insurance, fees, collections, etc.). Billing specialists deal with that stuff, not us, right? But those of us in private practice quickly discover how important it is to acknowledge and successfully navigate the financial aspect of our businesses. And resigning from managed care panels and switching to a fee-for-service model means that the responsibility to collect fees relies on the individual therapy practice; now, it's our job.

I certainly understand that it can be awkward. People get weird about money. I used to be uncomfortable asking clients for payment after they'd born their souls to me. But thankfully, there's a way to conquer money anxiety, serve your clients, and still meet the needs of your practice and of yourself. Here are some strategies I've discovered about how to be firm about finances and present your stated fees to clients with confidence:

(Re)Consider the Purpose of Money

Your own personal history may lead to your feeling anxiety about money. It may help to rethink the role it plays and the reason why we even have it in the first place: you are offering your time, energy, and skills to therapy, and in return, the client is offering you the resource of money. It's an energy exchange that can be emotionally neutral. It doesn't mean you are greedy or uncaring; not at all!

Value Yourself and Your Services

When I first started, I had a hard time seeing myself as a professional, which meant that I wasn't as confident or assertive about asking for money. But my supervisor helped me understand the training, skills, education, and experience I could offer. Remember what you're worth: you can provide valuable insight to those who are struggling, and you deserve to be compensated for your work. Keeping this in mind will help make it easier to accept payments and communicate about money issues.

Charge Before the Session

It works best to ask for payment at the beginning of the session before attempting to conquer tough emotional issues. This gets it out of the way right away and avoids the potentially awkward exchange at the end. There's no surprise, no uncomfortable conversation about fees owed. There's also something about being paid up front that is gratifying and enforcing for the therapist.

Use a "Money Script"

When possible, it's best to keep a separation between the therapist and the finances because it helps the client not associate his/her counselor with money. Use a planned and rehearsed script to communicate about payments. It may go something like this:

How would you like to pay for your session today?"

When potential clients ask, "Do you work with my insurance company?" I respond, "While we don't bill insurance directly, I'm happy to provide you with a receipt to submit for reimbursement from your insurance company. You may want to check with them and ask if you have out-of-network mental health benefits."

Have a Clearly Stated Payment Policy and Stick to It

Don't skimp on this. Take the time to develop and implement a carefully thought-out policy concerning payments, no-shows, cancellations, etc. By setting clear expectations, you can pave the way for an efficiently run practice with clients who attend sessions and take therapy seriously. Your actions and attitudes about finances will set the tone: if you feel anxious discussing money, your client likely will as well. But if you're professional, positive, and confident, a client will feel at ease.

My clinic policy is that if you are one session behind in payment your therapy is on hold until your account is up to date. Also, we charge full fee for no-shows and late cancellations, even on initial sessions, unless there is an emergency (read here for more about how to get paid for no-shows) . Therapist Leland Clipperton of Counseling & Mediation has a system in place where a client can actually receive a discount by pre-paying for 4 sessions in advance. Do some research, ask around, and get creative and innovative in developing a policy payment or tweaking your existing one.

You may find it helpful to have a system to notify your clients about their upcoming sessions. Making phone calls or using your EHR to send automated text messages or emails a day or two beforehand can serve as important reminders and reinforce the value of therapy. So if they're making the financial investment, we might consider making an extra effort to encourage them to be there.

In my 12 years in private practice, I've gotten extremely comfortable talking about financial issues with clients. With time, experience, and the use of these strategies, I am confident that the same can be true of you.

 How are YOU firm about finances?

What money tips and strategies that have benefitted your practice can you share?

Click here to access my webinar "How to Break Up With Managed Care" and learn more about how to improve your therapy practice.

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Choosing the Right Electronic Health Record (EHR) for Your Private Practice

The key to running any company smoothly is to keep meticulous and clear records, and psychotherapy private practices are no exception. Virtually all businesses today operate with an electronic data-keeping system; paper files don’t cut it anymore. More and more private practitioners are moving toward a paperless practice, which includes a professional Electronic Health Record. And advances in technology have created software programs designed for the unique needs of those in the mental health profession.

An efficient EHR can reduce no-shows, provide instant and secure information to authorized patients, and overall contribute to a well-kept and professional business environment. In other words, a good EHR is nothing to skimp on!

The purpose of this post is not to provide a comprehensive look at every EHR on the market (as there are hundreds), but instead aims to identify important features and criteria in choosing a system and also to analyze some of the pros and cons of a few prominent brands.

Here are a few of the most important factors and features to consider when looking into a new EMH software for your therapy practice:

1) Basic features: these include to-do lists/ task management sub-systems, billing, scheduling, and patient appointment reminders

2) Price (many offer a free 30-day trial with limited features)

3) Client Portal (this would allow your clients to login to view their payment history, appointment history,  schedule appointments, or print out a superbill)

4) Data Reports (a detailed analysis of revenue, percentages, tracking referral sources and history, etc.)

5) Single Provider vs. Multiple Provider: (can multiple people or groups use the same system?  Can records overlap?)

Now let's look at a handful of some popular Electronic Health Record systems:

TheraNest

A major push for TheraNest is that it is workable for multiple providers in multiple locations. It also provides highly detailed analyzed reports to track data over time.

TheraNest does offer a client portal, but it's an add-on, so you have to upgrade and pay more for it. They offer a free 30-day limited trial (though it doesn't include client reminders during that time).

Simple Practice

Simple Practice is one of the most popular EHRs today, with most supporters praising its highly efficient and clear billing capabilities. Whether your customers pay full-fee or with insurance, Simple Practice can make it easy for you to keep everything in order.

While Simple Practice is top rated for a reason, a disadvantage of it is that it doesn't have a feature for multiple providers. And it's customer service reviews are relatively high, though some may wish they offered 24/7 technical support instead of just during business hours.

TherapyNotes

This system is known for its excellent and responsive customer support, user-friendly interface,  high security measures, and low cost. A possible downside of TherapyNotes is its limited billing features, including its inability to monitor secondary billing insurance. It also lacks a client portal.

Click here for a more detailed review of dozens of mental health software systems:  http://www.capterra.com/mental-health-software/

What are YOUR experiences with EHRs? What have you found that you like (and don’t like!) about different systems? I'd love to hear from you!

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Join my Private Practice Toolbox Facebook group and connect with 2700 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.

Webinar: How to 'Break Up' With Managed Care and Build a Fee-For-Service Practice

New webinar this Wednesday on building a fee-for-service private practice

I've written previously about my decisions to 'break up' with managed care and build a fee-for-service only practice. This topic comes up often in my Private Practice Toolbox Facebook Group. Group members often ask questions like:

• Is it really possible for private practitioners to build a cash-pay practice in our current economy?
• How do you find clients who are willing to pay your full fee at each session?
• How do I overcome the fear of losing all of my clientele if I resign from insurance panels?
• How do you address the needs of those in your community who can't afford your services if you don't work with insurance?

If you've ever wondered these questions, you may be interested in my upcoming webinar this Wednesday.

Date: Wed. Oct 10, 2014*

Time: 11:00 a.m. (PT)/Noon (MT)/1:00 p.m. (CT)/2:00 pm (ET)

Length: 90-minutes

*If you can't make the live webinar at that date & time, no problem! You'll receive a link to watch the replay video at your convenience, but you do need to register.

Reserve your seat here

Here's why I resigned from managed care:

• Excessive paperwork: I was spending almost as much time performing unpaid work (paperwork, phone calls, tracking authorizations, and billing) as I was spending seeing clients. I went into this field to do therapy, not paperwork.
• Reduced income: I resented writing off 40-60% of my fee upfront just to be placed on a list with dozens and dozens of other therapists. The managed care companies weren’t doing anything to market my practice, and yet I was being asked to take a huge pay cut to work with their clients.
• Mandatory diagnosing: I grew tired of having to diagnose every client who walked into my office in order to get paid. When I met with a client who didn’t have clearly diagnosable symptoms, I was faced with a dilemma. Do I stretch a diagnosis just so I can get paid, or do I do free therapy because insurance won’t reimburse without a diagnosis?
• Denied or delayed payments: Being denied reimbursement for a variety of reasons and receiving payment weeks or months after I had performed the service was extremely frustrating.

Here's what has happened since 'breaking up' with managed care:

• Exponential growth: My private practice grew from a solo practice to a clinic of 20 providers and 3 locations in a fee-for-service model during an economic downturn.
• Immediate payments: We get paid our full fee at each session (including late cancellations and no shows)
• Streamlined paperwork: We do assessment, case notes, and discharge summary.
• Motivated clientele: We work with clients who value our time and expertise because they are more financially invested in the therapy process.
• Diagnosis has become a tool, not a requirement for payment: We don't have to diagnose anyone.

In this webinar, I'll show you how to:

• Identify and attract your ideal clients.
• Demonstrate the value of your services to your community through building a strong online and media presence so clients will be willing to pay your full fee at each session.
• Wean off of managed care contracts and smooth this transition for your current clients by offering many options.
• Talk confidently about your services, your fees, and financial policies.
• Provide options for potential clients who can not afford your full fee or who want to use their insurance benefits.

The decision to resign from manage care panels and build a fee-for-service practice is not the right path for every practitioner. However, there are some private practitioners who want to go this direction but lack the knowledge, skills, or confidence to implement their desired changes. If you fall into this second group, this webinar is designed for you.

I hope to see you on Wednesday!

Here's the link to reserve your spot for the webinar and access to the replay video

Oh, and if you have any specific questions you'd like me to address in this upcoming webinar, contact me here with "Managed care webinar Q" in the subject line.

The Power of Online Presence: Blogging Brings Training Opportunities for Art Therapist Lisa Mitchell LMFT

Discover how some very successful mental health professionals use blogging, social media, and other technologies as powerful tools for their therapy practices.

Lisa Mitchell MFT, ATR, LPC, is director of The Art Therapy Studio in Sacramento, CA and owner of InnerCanvas.com. She helps teens and adults use their creativity to heal from trauma, depression, and anxiety. Read here about how Lisa's online presence grew her outreach exponentially:

When and how did you first start putting time and effort into maintaining a strong online presence?

I started 13 months ago with my blog at InnerCanvas.com. I do have a small website for my local private practice, and I wrote an online newsletter for 5 years, but my serious efforts are with my blog.

I first had to commit to the writing schedule. Weekly content is not easy to come up with, and I had to really give myself space to create. I got support from a business coach who helped me know how to engage the readers I did have and how to interest new readers.

As an artist, I love to make things. So, I’ve used this love as a way to create things I know my blog readers and potential blog readers would love to receive as gifts. I’ve created a music playlist, several videos, art invitations, and a quiz. These were fun for the recipients and for me as well. Each time I offer something like this, my email list numbers jump considerably.

While other platforms have been important to growing my audience, I think of my blog as the thing that everything else pivots around. It has become a community that I love and am proud of.

Please describe what social platforms you currently use.

Facebook has been a wonderful place to meet colleagues and make connections. I use it to post blog entries and also get ideas from like-minded therapists.

LinkedIn has been incredible for connections that I couldn’t make on Facebook. I’ve messaged professionals in our field with questions, comments, and gratitude for their work and have engaged in some valuable conversations. The therapist groups on LinkedIn are very active, and I find that I can engage in some really good dialogue around my blog posts and others’ blog posts there.

I’m also on Twitter and Pinterest, but putting energy into these spreads me really thin. I’m thinking of hiring a social media person to cover this for me, but haven’t gone that far yet.

About how much time do you devote to your online presence? How do you balance it with your other work responsibilities?

I have to be really careful about the time I spend online. It is really seductive because I love learning and reading other people’s perspectives so much, so it would be easy to get carried away. I devote about 4 hours a week to blogging, posting, and generally updating my online presence.

I tend to integrate my art and creativity with my online presence, so it doesn’t feel so separate from my other work responsibilities. If I come up with a cool new art invitation, I will share it. If I am experimenting with a new art technique or medium, I’ll share that as well.

I do have a new rule for myself regarding how I use my time in between sessions. I decided that I couldn’t engage in my online activities during the 10 minutes between clients. Instead, I keep my creative process going by making art and/or staying present with real, non-digital activities. I wrote a blog post about it called "Five Ways to Limber Your Thinking Between Sessions" and got some really great responses from my tribe there.

What kinds of things do you use to inspire your content creation; what do you write about?

My focus in writing is to explore the parallels between the creative process and the therapeutic process. The two are beautifully linked, actually one in the same, and I love to think up new ways to teach and inspire therapists about creativity.

I am deeply reflective about my experience as a therapist, and I like to share these reflections in my writing. So my inspiration comes from my work as a therapist and my daily practice as an artist. I have a little list of criteria that I use when I write. I ask myself, Is the piece moving or inspiring? Does it share something meaningful or thought provoking? Is it ethically sound? These questions ensure that my content is not just a journal, but comes full circle and actually makes a point or teaches something.

How do you best balance personal and professional in your online activities? Please give examples.

Because I want to invite therapists to value their work and see it as a creative art form, I do include quite a bit of my own self-reflection in my online activities. I’m very cautious that I don’t violate client confidentiality in the process. Many of my blog posts are pieces that are about real experiences with clients, but I’ve changed much of the information and context in order to adhere to ethics.

I wrote “Sometimes there’s too much sadness....” and “The Art of Permission: What an artist can teach us about therapeutic use of self” in response to my own experiences. In each post, I share some personal thoughts, and then I link these thoughts to a broader, creative view that can apply to being a therapist in general.

What is some tangible evidence that your online presence has grown your business?

My online presence has been invaluable to the growth and expansion of my business. Not only have I met people from all over the world, I’ve also been approached and hired by multiple organizations. My training revenue has increased this year by 175%. My online course for therapists, Artfix, has filled every time I’ve offered it by therapists all over the world!

I’ve also been commissioned to write a book, “Creativity as Co-Therapist: The Practitioner’s Guide to the Art of Psychotherapy." It’s my dream to write this kind of book, and the editor found me first as a faculty member of the Psychotherapy Networker Symposium, read my blog all the way through, and emailed me asking, “Do you have an idea for a book? We’d love to publish it.” The book will be out in the Spring of 2016.

Besides attracting clients, what other ways has your strong online presence helped you?

I was asked to develop a seminar for Cross Country Education as a result of the trainings that I had advertised on my website. Now I travel across the country offering these seminars to professionals who want to learn to use art in therapy safely and effectively.

This might sound silly, but it’s powerful: After my last speaking tour, I had a nightmare of a time flying home from the East Coast. I missed 4 flights, and it ended up taking 29 hours to travel across the county. I decided to post my frustration and sadness on Facebook. The support and well wishes I got from folks who had participated in workshops and follow my blog was touching. I really felt as if the community was there for me when I needed a pick-me-up.

What have been some of the biggest challenges you’ve encountered creating and maintaining your online presence?

The learning curve for me was overwhelming. Four years ago, I had no idea what an autoresponder or an opt-in box was. I am not someone who loves to figure details out, especially on a screen. Because I didn’t have the financial means to hire someone right away, I had to learn. So I took it very slow and gave myself a whole lot of room to experiment and make mistakes. I used to tell myself that I was just slower than everyone else, but I knew I could do it.

I also had to beef up my business marketing skills. My mentor Lynn Grodzki was very helpful and encouraging. I've learned a lot from Casey Truffo about how to earn a significant living through being a therapist. And I’m now part of an ongoing business coaching group with Andrea J. Lee. I learned that I couldn’t scrimp on coaching support. So rather than pay for the technical part to get done for me, I invested heavily in business strategy coaching. It’s really paid off.

What tips or resources can you recommend to help therapists who are new to the online world of blogging, social media, SEO, etc.?

Be kind to yourself and go at your own speed. Don’t invest big dollars until you are somewhat knowledgeable about being online. First, sign up for as many free and low cost opportunities as possible, just to get a feel for what this online world is all about.

We therapists are seldom in the limelight and are used to not being very visible. Check in with your feelings about this. If it feels very scary to show up and be seen by complete strangers, do some work and identify a reason why you want to get online. If you can find a way to turn the fear into excitement, you will do great. If you have a powerful WHY, you will do even better.

Lisa Mitchell, MFT, ATR, LPC Licensed Family & Marriage Therapist, Registered Art Therapist Facebook Page: www.facebook.com/InnerCanvas Blog: www.innercanvas.com Website: thearttherapystudio.com

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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!

The Power of Online Presence: Viral Blog Post Brings Book Deal for Amy Morin, LCSW

Amy Morin, LCSW could never have guess that one viral blog post could lead to a national book deal!

Today, we continue with our series "The Power of Online Presence." Amy Morin is an LSCW specializing in adolescent depression, anxiety, and behavior disorders. Her now famous article "13 Things Mentally Strong People Don't Do" has been viewed millions of times and recently was made into a book. Learn more about what Amy does to build her online presence.

1) When and how did you first start putting time and effort into maintaining a strong online presence?

I started blogging a couple of years ago. Initially, I set out to create a simple blog that would attract people to my website. Then over time, I began getting paid to write articles for other websites and media outlets. I started to realize how important social media was to getting noticed online.

2) Please describe what social platforms you currently use. 

I use Google+, Facebook, Twitter, and LinkedIn. I use them all to share articles, quotes, and other newsworthy information.

3) About how much time do you devote to your online presence? How do you balance it with your other work responsibilities?  

My online activities have essentially become another job for me. I write articles for other therapists or provide content for college websites, etc. The two biggest sites I write for are About.com and Forbes. As a freelance writer, I can decide which jobs I want to accept and which ones I want to turn down. I spend maybe 30 minutes each day sharing those articles and other information on social media. Fortunately, having a smartphone makes it easy to use social media wherever I am, so I find that it really doesn't take up too much of my spare time. If I have an extra couple of minutes here or there, I can easily connect on social media.

4) What kinds of things do you use to inspire your content creation; what do you write about?

I mainly write about parenting teens and child discipline on About.com. I write about psychological aspects of business on Forbes. I never know when an article idea will come to me, so I keep a notebook handy and am always jotting down my ideas. Sometimes I interview other people, and that often spurs new ideas for me to write about in the future.

 5) How do you best balance personal and professional in your online activities? Please give examples.

I mostly keep my personal and professional social media activities separate. I use Twitter and my professional Facebook page to promote my articles, and I have a personal Facebook page that I reserve for close friends and family.

6) What is some tangible evidence that your online presence has grown your business? 

I live in a rural area, so my online activities don’t necessarily attract new clients for me. Instead, my online presence provides new income streams for me altogether. I generate enough revenue through writing and speaking that I’ve drastically cut back on my therapy practice, and now I only see clients two days per week.

7) What other ways has your strong online presence helped you?

I have been able to land interviews with major print media outlets like NBC.com, Time, Parenting, and Success. I’ve also done national radio shows and have appeared on news programs like Fox News and Glenn Beck. People discover me through online searches, and I’m often invited for speaking engagements.

Last year, I wrote an article on mental strength that went viral and received millions of page views. A writer at Forbes picked it up, and the article attracted almost 10 million more views. Not long after, I was contacted by a literary agent who suggested I write a book. I was offered a book deal with William Morrow (an imprint of HarperCollins), and my book is scheduled to hit the shelves in January of 2015.

8) What have been some of the biggest challenges you’ve encountered creating and maintaining your online presence?

The internet is constantly changing. What is considered good practice one year is outdated and can even lead to search engine penalties the next year. It’s been a challenge to try and keep up with the latest changes to ensure that the content I write gets discovered and shared on social media.

 How have you overcome those challenges?

 I spend time each week educating myself about the recent online changes. That means reading about the latest social media trends and actively engaging in conversations with other people about strategies to maintain a strong online presence.

 9) What tips or resources can you recommend to help therapists who are new to the online world of blogging, social media, SEO, etc.?

I recommend taking it one step at a time. Initially, the online world can seem quite confusing and overwhelming. But compared to the DSM and the insurance world, blogging and social media are relatively easy to navigate. There are lots of basic tutorials for people looking to get started. Focus on one strategy at a time, and don’t be afraid to ask for help.

Amy Morin, LCSW 

Website: www.amymorinlcsw.com

Visit her Facebook Page

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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!