Sliding Scale
What is a sliding scale? If I am going to use one: How do I figure out what it should be? Who do I offer it to? If I am not going to use one: What do I do if someone asks me for it?
What is a sliding scale?
Offers variable fees for services based on a customer's ability to pay. Such fees are thereby reduced for those who have lower incomes, or alternatively, less money to spare after their personal expenses, regardless of income.
Why do people offer a sliding scale?
To be able to provide services and the same level of care across the board for those with fewer resources.
If you are going to offer a sliding scale…
What will it be?
A set fee (ex. $40 across the board for everyone)
Based on client’s household income (ex. annual income x .001 = fee)
Flexible (ex. more conversationally based with client on what they can afford for weekly sessions…may be $75 for one sliding scale client and may be $30 for another)
How will you determine who gets to use your sliding scale?
This is important to figure out before you start getting calls. If not you may just start offering your sliding scale to anyone who pauses after hearing your full fee.
If a client does meet your criteria for sliding scale or cannot afford your full fee or sliding scale spot it is important to have a handful of providers on hand that you trust and know will slide lower than you do.
Figure out how many sliding scale spots will you have in your caseload?
Some clinicians have an entire practice of sliding scale clients, and others set a limit on how many sliding scale clients they will take at a time (maybe 1, 2, 3 or 4 based on their caseload size).
If you aren’t going to offer a sliding scale…
Make sure you have a solid referral list for individuals that cannot afford your full fee or that you are not paneled with so you can point them in the direction of someone who might be able to meet their financial needs.
Having a hard time deciding?
Open Path Collective is a fantastic company for mental health professionals to use that streamlines the sliding scale process for you. Open Path generates referrals for your sliding scale slots, advertises your practice profile for free, and enhances your ability to serve your community.
If referring out because you don’t offer a sliding scale, or are full-- You can always refer prospective clients to Open Path Collective for affordable therapy. If clients meet the needs requirements set by Open Path, they can receive reduced rate therapy for a lifetime membership fee of $50! They can then log on anywhere nationwide and find a clinician through their directory.
Listen here to learn more.
Written by: Shannon Gonter, Founder, LPCC
Here at b.mindful Louisville, we not only provide our tenants with a comfortable, modern and safe space to practice out of but we also like to have an open dialogue around these topics and more. We have structured consultation hours to frame the conversation but also just find it beneficial to be open and transparent with one another about best clinical and business practices to assist each other in tackling the world of private practice. We are better together, if one of us succeeds we all succeed.
To learn more about the shared workspace of b.mindful Louisville click here, or call Shannon Gonter at 502-528-1363 to book your tour today.
Getting Paid In Private Practice
In graduate school we are told that we will graduate, get a job and then work for what we get hired for. If we are lucky, we will get a raise each year (to keep up with inflation), keep working our hours and getting our bi-weekly paychecks. In private practice getting paid looks quite different than it does within the employment model or at a hospital, or agency.
Here at b.mindful Louisville, we not only provide our tenants with a comfortable, modern and safe space to practice out of but we also like to have an open dialogue around these topics and more. We have partnerships with billing companies to provide our tenants with discounted rates and wide knowledge base of the best practices and systems to use in your practice.
We have structured consultation hours to frame these conversations but also just find it beneficial to be open and transparent with one another about best clinical and business practices to assist each other in tackling the world of private practice. We are better together, if one of us succeeds we all succeed.
In graduate school we are told that we will graduate, get a job and then work for what we get hired for. If we are lucky, we will get a raise each year (to keep up with inflation), keep working our hours and getting our bi-weekly paychecks.
In private practice getting paid looks quite different than it does within the employment model or at a hospital, or agency.
Side note: Being in private practice is a commitment to having inconsistent pay at times, and therefore it is suggested to have various streams of income. Some people create courses, workshops, groups, trainings, supervision, or other non-clinical income streams to assist with these inconsistencies. Learn more about that here.
For this post we will be specifically focus on how we get paid for “butt in seat” clinical hours spent in our practices with our clients.
Easy break down, we get paid by our clients (private pay), or on behalf of our clients from their insurance companies.
Private Pay
Private Pay Benefits
You typically make more per hour
You see fewer people
Paperwork is easier
Immediate payment (cash/check/card from client)
Clients are often more dedicated and follow-through on treatment
Private Pay Cons
You should specialize and niche down more to bring in your ideal client
Marketing is key because you don’t have a provided referral network (insurance company)
You need to understand how to articulate your value and be confident in your hourly fee
Cash
Simple as it seems (set fee- exchange fee- done).
In today’s world, an all cash business isn’t the most convenient for your clients or yourself. This requires your clients to go to the bank and take out money each session and for you to go to the bank multiple times a week if not every day to deposit your earnings.
Also, you must have a safe space to keep your earnings in between sessions because you aren’t going to want to have wads of cash sitting or stashed around your office.
Some clients will prefer to pay with cash (for whatever reason) and if so, make sure to be specific with them about if you will or will not have change to provide them if they do not have the exact amount.
Check
Similar to above there are some implications that come with accepting checks as a form of payment.
Make sure you write down the check # before depositing
Actually make sure that the check doesn’t bounce, and it gets deposited
Make sure you deposit it! Have known several clinicians who have filed away checks without depositing them, therefore not getting paid!
Card (debit/credit or HAS/FSA account through clients insurance)
Your EHR may be integrated with a processing software (like Simple Practice and Stripe) but if you don’t have an EHR you can get a Square, Ivy Pay, Stripe or use WRS health for a card processor.
With whatever card processing system you use, you will have to pay a processing fee but to me it is worth it and I just count it as a cost of doing business and I also write off the card processing fee so that’s nice too!
Don’t use Venmo/Paypal/other money apps, because they are not HIPAA compliant and will not sign a BAA (yet…maybe one day they will…).
For all clients, it is suggested to keep a card on file (for no shows, and late cancellation appointments).
Make sure that the client is aware what this card will be used for and that it is listed in your informed consent and/or financial agreement and that they are initialing or signing to acknowledge agreement to card policy.
If it is an insurance-based client, you will need to check with each specific contract to see if you can charge a no-show fee or charge a client at all.
Insurance
Benefits of taking insurance
You have a built-in referral network (the insurance company)
People expect to use their insurance for medical purposes
Doctors refer more often to therapists that accept insurance
Cons of taking insurance
You don’t get paid right away because you have to file the claim, have insurance review it and then you get paid.
You need an EHR (electronic health record)
If your systems are off, you sometimes will lose money and not get paid
If you decide that insurance is something that fits your practice structure, do your research on what panels to get on before just getting credentialed with all of them. See what is popular in your area (talk with other therapists and see what they take, and if there are any gaps in the market…) and pick two or three that you feel are going to benefit your practices structure the best. Could be all Medicaid, all private, EAP or a combination.
If you get credentialed and sign a contract with an insurance provider, you are an “in network” provider for them.
In network Provider
You have to get credentialed and paneled with each insurance company (process can take around 6 months give or take).
While you are waiting for credentialing, you can see people at your private pay rate or at a sliding scale fee to build up your clientele and then switch them over to an insurance-based client once you are fully paneled.
You can take care of all things billing (credentialing, verifying, maintenance, claim filing…), or you can hire out for this. Bardstown billing is a Louisville local agency that provides affordable services for mental health professionals and Practice Solutions is a nationwide biller that could assist you getting paid by insurance companies.
If you do not get credentialed and sign a contract with insurances, you are an out of network provider with them.
Out of network Provider
Providers who do not have a contract with each insurance company but provide or file a superbill for client services so the client can get reimbursed for sessions at a later date.
I am a self-pay therapist and have some clients who use superbills and I always suggest that they call their insurance provider and inquire about out of network benefits and reimbursement to maybe get an idea on what they may be reimbursed.
Voicemail Script For Your Mental Health Or Wellness Private Practice
Your voicemail can often be your first interaction with clients and making a good impression is key. In this post we are going to focus on formulating the most efficient and effective voicemail for you to use so you can spend less time on the phone and more time working with your clients.
As mental health and wellness professionals we are busy people and what busy people need in their lives is highly efficient processes. In this field, on top of efficiency, we also need to be able to exude confidence, competence, organization and professionalism all without seeming fake, rushed, cocky or robotic.
“So…how does this pertain to my voicemail message?”
Having a solid voicemail message that is clear, concise and natural sounding can significantly lower the number of hang-ups you get, wrong number voice messages you receive and help you turn more of your calls into new clients.
Majority of healthcare professionals don’t answer calls unless they know the number, therefore sending the bulk of calls to voicemail. For some, your voicemail message may be the first time a prospective client hears your voice and forms a connection with you. So, you want to make sure you are coming across as welcoming, professional and natural (no pressure). For those of you who write blogs or do videos already, your prospective clients may have some formation of who you are and what you do so your voicemail prompt will just be an added impression to that.
“How is reading off a script going to make me sound more natural?”
By using a script and rehearsing it, you will build confidence and the flow will become more and more natural with time. At first you will just be reading it, but once you get used to how the words string together you will be able to tweak it, add in pauses and your own personality.
Scripts to be altered to fit your practice’s needs:
Solo Wellness Practice:
“Hello. You’ve reached Molly Hill, Licensed Massage Therapist with Healing Touch. I am currently unavailable to take your call, so please state your name, phone number, and a detailed message after the beep and I will get back with you within two business days”
Solo Mental Health Practice:
Those of you coming from an agency or hospital that are used to saying “Hello you have reached the confidential voicemail of …” be aware that agencies and hospitals pay BIG money to have secure phone lines and neither your iPhone or Android is. Be mindful of the wording you use for your private practices voicemail and maybe try something like this:
“Hello. You’ve reached Shannon Gonter, Licensed Professional Clinical Counselor with Therapy by Shannon. I am currently unavailable to take your call, so please state your name, phone number, and a detailed message after the beep and I will get back with you within two business days. If you are wanting to learn more about my services, please visit www.therapybyshannon.com and schedule your free 15-minute phone consultation online. If this is an emergency, hang up and dial 911 or go to your local emergency room. If you’re not in immediate danger, but you would like to speak with someone, you can reach the National Suicide Prevention Lifeline at 1-800-273-8255.”
Group Practice:
It is highly beneficial in a group practice office to get a voicemail system that allows the caller to leave a private voicemail for each clinician. For example, a client calls, listens to general voicemail message, selects a number, listens to their clinicians voicemail prompt, leaves a private voicemail message, then the clinician can sign in to listen to their messages.
“Hello. You’ve reached Therapy Specialist of Louisville. We are currently unable to take your call. If you’d like to leave a message for Brad Morris, press one. For Joanna Smith, press two. For Emily Hopkins, press three. If this is an emergency, hang up and dial 911 or go to your nearest emergency room. If you’re not in immediate danger, but would like someone to speak with, you can reach the National Suicide Prevention Lifeline at 1-800-273-8255.”
Before recording:
Alter the script with your practices name and contact information
Rehearse your message before recording (maybe even audio record yourself first and play it back to make sure you sound how you want to)
Find a quiet place to record, with no echo
Make sure you are holding the phone close to your mouth
Take a deep breath
Record
Be patient with yourself
For some it will take more recordings than others, and that’s okay. It may be helpful to read it out loud to a friend or loved one before recording. Then after recording ask another friend to call as if they were a client and listen, providing you with feedback. If you are having a hard time sounding natural, it may help to record yourself with a friend present. Have them stand in front of you during the recording so you can act as if you are just talking to a friend.
Like scripts and templates and want more? Check out our office rentals at b.mindful Louisville. With each fully furnished office rental our tenants get full access to all our amenities and our practice building courses. Jam packed with tips and tricks to assist you in building your business including but not limited to detailed scripts and templates for your email and phone calls. Learn more here.
Must Have Paperwork For Your Mental Health Private Practice?
Are you wondering if you have the right documentation practices in place and more importantly, if they are set up correctly? Having the right paperwork documents protects and establishes your most important private practice principles. Today we are going to discuss the essential paperwork for your mental health or wellness practice in order to ensure compliance with your state board and HIPAA, protect yourself and your business and maintain transparency with your clients.
With every job there seems to be more paperwork involved than necessary and for mental health professionals that is definitely true when it comes to client documentations and insurance paperwork. Are you wondering if you have the right documentation practices in place and more importantly, if you are doing them correctly? Today we are going to discuss the essential paperwork for your practice in order to ensure compliance with your state board and HIPAA, protect yourself and your business and maintain transparency with your clients.
Let’s dive right into it. Below are the necessary paperwork items you need for your mental health private practice.
Informed Consent
A document outlining your practice policies, expectations and practices. If your current informed consent is only one page, that isn’t long enough. Check with your board on the exact must haves for your specific state and license. Some of the most common items you will need are: limits to counselor/client confidentiality, benefits and risks to counseling, practices around medical records, fees, electronic communication, appointments and cancellation policy, phone contact and emergencies, structure of therapy, and dual relationships.
Check out Kate and Katies video on the 13 must haves.
Financial Agreement
This can be rolled into your informed consent, but I prefer to have a separate document for agreeing to the fees associated with therapy. We’ve all got money issues and either brush over it or don’t mention it at all but we need to be setting firm limits and expectations for our clients and holding true to those (so if you’ve agreed on a fee for a session, charge that fee at the beginning of every session, hold true to your agreement). This form should state your professional fee for services (all services), as well as cancellation charges, policy for if payment was not accepted, authorization to charge card on file, etc.
HIPAA Statement
This can be added to your informed consent if you prefer or can be a separate document. You can download and edit this form using these instructions.
Release of Information (ROI)
So you can talk with your clients current and past providers in order to collaborate and do the best work possible for your clients. Remember to get a ROI signed to talk with ANYONE other than your client and to keep them up to date when they expire.
Intake Paperwork
Paperwork that you want your client to complete prior to the first session with you. Can include: Demographic information, Relevant history gathering, Relationship information, Clinical information, Preferred contact method, etc.
Extras:
Superbill
This is typically only used if you are an out-of-network provider with someone's insurance company and they are wanting to file for possible reimbursement. Typically provided to client on a monthly basis so they can file it with their insurance company. Most EHR platforms will generate this automatically for you but if you are creating your own it needs to have the following: your practice name, address, contact information, NPI #, License #, and Tax ID #, Clients name, address, contact information and DOB, Diagnosis Code, Date of services, service code, description of services and total amount paid to you for services
*Connect your clients with Get Better to assist them in getting reimbursed for services they have paid out of pocket for.
Invoice/Receipt for Services
You should provide your clients with a receipt for their payment. You can easily do this on Canva or with a template from Microsoft Word.
Letterhead
Good to have on hand so when you need to write a formal letter you don’t have to take the extra time to design it then. You can easily do this with Canva or with a template from Microsoft Word.
*All paperwork should be looked over and approved by a business attorney*
At b.mindful Louisville we provide each tenant with full access to our practice building resources. Within the paperwork section we provide detailed information for what needs to be in your informed consent, templates you can alter for your financial agreement, HIPAA statement, ROI, superbill, intake paperwork, scripts and more.
Shannon Gonter, LPCC, Owner and Founder of b.mindful Louisville
If you want to learn more about our rentals, don’t hesitate to reach out to Shannon at Shannon@bmindfullouisville.com or call 502-528-1363. Click here to learn more.