[00:00:00] 

Intro

Amy Wonkka: [00:00:00] Welcome to SLP Nerd Cast. I'm Kate. And I'm Amy. And we appreciate you tuning in. In our podcast, we will review and provide commentary on resources, literature, and discussed issues related to the field of speech language pathology. You can use this podcast for ASHA 

Kate Grandbois: Professional Development. For more information about us and certification maintenance hours, go to our website, www.slpnerdcast.com.

LP Nerd Cast is brought to you in part by listeners like you. You can support our work by going to our website or social media pages and contributing. You can also find permanent products, notes and other handouts, including a handout for this episode. Some items are free, others are not, but everything is always affordable.

Visit our website www.slpnerdcast.com to submit a call for [00:01:00] papers to come on the show and present with us. Contact us anytime on Facebook, Instagram, or at [email protected]. We love hearing from our listeners and we can't 

Amy Wonkka: wait to learn what you have to teach us. Just a quick disclaimer, the contents of this episode are not meant to replace clinical advice.

SLP Nerd Cast. Its hosts and its guests do not represent or endorse specific products or procedures mentioned during our episodes, unless otherwise stated, we are not PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle.

That being said, it is always likely that there is an article we've missed or another perspective that isn't shared. If you have something to add to the conversation, please email us. We would love to hear from you. Before we get 

Kate Grandbois: started in today's episode's, financial and Non-Financial Disclosures, um, I am the owner and founder of Grand Wa Therapy and Consulting, LLC and co-founder of SLP Nerd Cast.

Amy Wonka is an employee of a public school system and co-founder of [00:02:00] SLP Nerd Cast. Uh, we are both members of ASHA's six 12 and both serve on the a a C advisory group from Massachusetts Advocates for Children. I am a member of the Berkshire Association for Behavior Analysis and Therapy, mass a BA, the Association for Behavior Analysis International and the corresponding Speech Language Pathology and Applied Behavior Analysis special interest group.

Hooray. So glad that's over. Moving on. Yeah. Um, so we are talking about legal and accounting considerations in private practice today. Uh, we decided to do this topic because it's a question that I get quite often. 

Amy Wonkka: Uh, it also seems really overwhelming and scary for some people. I am one of those people. Uh, there are a lot of moving parts to private practice and we didn't learn any of this in grad school.

At least I didn't learn any of this. Kate, did you have any business? 

Kate Grandbois: No, I had absolutely no business training or accounting train. I mean, I went to speech school [00:03:00] and BCBA school. I didn't get any of this training at all. Um, and I think, but I do, I will say that when I was a graduate student, I think there was always a draw to private practice or it was always something that was like, oh, maybe one day you could be in private practice.

There's something very, um. I think enticing about it for a lot of people. Mm-hmm. Because it's this mysterious sort of, I don't know how to do that. Um, and I, I have owned a private practice for about 10 years now. Um, and I have made a bit about a bajillion mistakes, and I've done it a thousand different ways.

I've taken insurance, I've done private pay, I've done, I have one employee sort of-ish. So sort of learning about all the business background, um, relating to private practice has been a long, a long and a long and interesting journey, put it that way. But I think you're right. There's a lot of concern out there and worry about liability.

Um. And all those [00:04:00] things. As a matter of fact, a little story, one of the reasons that I got more deeply into my private practice was because I was having lunch with an attorney friend of mine, uh, shout out to you, uh, tn out in Seattle. And, um, she was asking me all of these questions about my practice and what kind of clients I had, and she very casually was like, so do you think any of your clients would ever like, put something in their mouth or swallow it while you were working with them?

And I was like, oh, totally, because I work with, you know, more severe. Um, students and clients, that's always been my, my area. And as an attorney, she was like, oh, well you, you absolutely need, you know this and you need this and you need this. Because what I've learned is attorneys sort of set you up to prepared for your doomsday worst case scenario.

Um, so through that experience and through, um, a lot of way too many hours with, um, attorneys and accountants, I have sort of come to this, this [00:05:00] bank of knowledge that I'm hoping to impart into our listeners today. 

Amy Wonkka: Well, and I think, you know, we are, we are recording this in March of 2020. We are not sitting next to each other in a room like we usually are.

This is a first 

Kate Grandbois: distance recording. 

Amy Wonkka: Yeah. And so it's, it's a tough time. It's a weird time out there where a lot of us are. You know, minimizing or, you know, really eliminating our social contact with other people. And that has a lot of implications for folks in the field. It has a lot of 

Kate Grandbois: implications for employment.

I mean, I'm sure there are a lot of people out there who have very different, um, very different incomes, very different professional experiences with a lot of unknowns. And I know, I think I can speak for both of us where there's a lot of people interested in starting private practice through distance learning, um, and all of those kinds of things.

So there's a lot of, we have, we both have a lot of friends and colleagues whose employment is being affected [00:06:00] by this. Um, and there are a lot of people out there interested in starting private practice using modalities, modalities of technology and telepractice. Um, so hopefully this will be a nice piggyback onto, or at least will be helpful information to people out there trying to take on a private client or two, having never done it before.

Um, our episode today is gonna be broken up into three different parts. So first we're gonna talk about legal implications. So what are the legal considerations and responsibilities of owning and running a private practice? We'll go through, um, a few different components, um, related to that. Second, we're gonna talk about accounting.

What are the accounting considerations and strategies involved in owning and running a private practice? So when I talk, when I say accounting, I mean budget planning, considering what expenses you need to take on considering, um, how you plan for your income throughout the year. Um, [00:07:00] and I have spent way too many hours with my accountant, who is lovely.

Amy Wonkka: And that's also the taxes are different too. Yes. Taxes, you know, somebody who's paid as an employee, your employer kind of takes care of all of that. But when you're running your own business, that's. 

Kate Grandbois: How could I forget taxes? That was on purpose. I must have blocked it out because taxes are horrible. But yes, one, one of the biggest things we're gonna talk about today is taxes.

Oh, thanks Amy. Um, and the last bucket that we're gonna talk about today is revenue and income. So should you take health insurance? How do you set up your private practice to take health insurance? What are other revenue options that you have? Um, and so those are the three. Those are the three main points that we are gonna go over.

And as we already discussed, um, we get topics, we get, I get questions related to this all the time. So if at any point through this episode there is a question that you still have, please feel free to email me and reach out to me. Um, [00:08:00] this is, there's a lot of topics I don't like to talk about, but actually I find this really interesting.

So, um, please feel free to reach out anytime. Um, first legal. So as I already mentioned, attorneys really exist to, um, help prepare you for your worst case scenario. Um. Yes. And this to me is one of the, she's facing her hand at me through the screen. 

Amy Wonkka: We're, we're trying really hard to get our remote, a remote podcasting flow down.

Um, it's working. Yeah, it's working. We're getting there. We're there, we're doing a good job. This is the scariest part for me, the legal piece. Like what are all the pieces that I need to think about and plan for? And I don't even have, you know, a rubric in my mind for all of those different components.

Like I think of liability insurance, but beyond that. 

Kate Grandbois: Well, right. And I mean, based on the little vignette that my, I told my friend, she was like, well, would you ever, would you one of your clients ever swallow something or, you know, accidentally do something dangerous? I was like, oh, totally. They do dangerous stuff all the time.

I mean, I How many times in [00:09:00] your work setting have you seen something that made you a little uncomfortable or had a question like, uh, not sure if I'm allowed to do this, and then you just, you go ask your administration, but what if there is no administration? Right? Like, who do you turn to? And attorneys are expensive.

Yeah. Um, so there are a handful of things that you can do to protect yourself, um, without an attorney. And we, so we're gonna, I'm gonna go through and list some of those things. And I think the first thing to consideration, the first thing to consider is mitigating your risk. So considering how risk, how at risk are you of being sued?

And I think there are a couple of factors that go into that. So first and foremost, first and foremost, um. What kind of clients are you seeing? So if you're a speech pathologist who is in private practice and you have an accent modification practice and you're working with neurotypical adults who are at very low risk for injuring themselves, [00:10:00] then you would probably have less risk than someone who is a feeding.

As we had a whole discussion yesterday about feeding and swallowing, about a feeding and swallowing case where they're at risk for aspiration and possible loss of life, right? Like there's a huge spectrum there between how much risk you actually have. Um, so you know, thinking about your, what level of protection that you want is really rooted in how much risk you think you are, you know how at risk you actually are.

Amy Wonkka: And does that, does that also change depending upon, like, I know you used to have an office, like you had an office that you were maintaining and clients were coming to your office. Mm-hmm. And then you've also worked in places where you've contracted out and kind of worked in some other environment.

Mm-hmm. Is that a variable there? 

Kate Grandbois: That is a variable and I, I don't know a ton about that. Um, but you have certain different kinds of, there's all kinds of insurance. Everyone out there can probably hear my children screaming in the background. We all [00:11:00] work from home, so apologies. But, um, there are different kinds of insurance that you can get.

There is, um, employment liability insurance. There is, um, or like workers' comp related insurance. There is your malpractice insurance. I believe there are some umbrellas of, of malpractice insurance that would cover. Like if you have a private practice, brick and mortar and there's ice and someone slips in your office and hurts themselves, um, I would definitely, when you get malpractice insurance, I would definitely look into some of those things.

That's a really good question. Um, there's also cyber insurance so that you, you can get an insur if you store all of your, your documentation electronically. You can purchase cyber insurance to make sure if you get hacked, your information is, um, you know, not going, is gonna be protected in some encrypted military grade situation.

Amy Wonkka: Well, and that was sort of when I, [00:12:00] when I tapped out of doing any form of private practice in the past, in the dinosaur ages, um, before all the web-based, the web-based features, and it's changed 

Kate Grandbois: so much in like five years. 

Amy Wonkka: Right. And so when that happened for me, I felt like then it became too many variables to keep track of.

Like, I, I got the liability insurance through ASHA back in the day, and they ask you a lot of different questions and at that time I did a very small amount of private practice and it was typically, you know, going into somebody's home, um, for a limited time basis. And the rules around records and all of that have changed so much that I felt like I can't keep on top of it and do a good job with it, so I'm just not going to do it.

And 

Kate Grandbois: I think this comes back to volume. I mean, if you're a clinician who wants to pick up one client, then you're, the amount of protection you feel like you need is totally different than managing documentation for, you know, 20 clients. 

Amy Wonkka: You know what I'm saying? 

Kate Grandbois: But 

Amy Wonkka: on the [00:13:00] flip side, there have been.

Changes too. You know, way back in the day when I, when I was doing that type of service, there weren't products out there that were designed to help with that flow too. I mean, I know, I don't know what you use for your tracking, but there are, you know, there are web-based platforms that you could Oh yeah.

Subscribe to practice 

Kate Grandbois: software. Yeah, there's a bunch of that. Um, and we, I have a whole, we're gonna go over different kinds of record, um, keeping and HIPAA compliance and that kind of stuff a little bit later. Um, but sort of looping back to the different kinds of protection. And consideration, um, for how you wanna protect yourself.

So there is the malpractice insurance that has different levels of insurance. So it's a different cost if you're a single provider, so just Amy going out and seeing one client. But if you decide to incorporate or become an LLC, then you have a different level of coverage because you're considered a group.

[00:14:00] Um, so there's a, a bunch of different, um, resources on our website for the different kinds of malpractice insurance that you can get. And I'll just list three of them quickly. One is the ASHA Affinity member benefit, um, that you, you have to sign into the ASHA webpage to see it. One is called Mercer Consumer, which was formerly Marsh, and I think that's a really popular one.

Yeah. I personally use Healthcare Providers Services Organization, HPSO, for short. Um, and all three of those links are gonna be listed on the episode page. Um, the costs vary significantly in terms of which plan you choose, and like I said, the cheaper it, if you're just one person, it's like a hundred dollars a year.

But if you're an LLC or incorporated and considered a group, it can be upwards of $650 a year. Um, which is something again to consider for your budget. In terms of incorporation, now that we've sort of opened that can of worms, incorporating yourself as a business is the, [00:15:00] I'd say the. Highest level of protection you can get.

Oh, and I should have said shame on me for not saying this at the very beginning. Massive disclaimer. I am not an attorney. I am not an accountant, so I'm about to spew all of this like advice related to legal issues and accounting issues. But you listeners out there, you should find your local professionals.

You should find your local attorney or a friend you, you know, went knew in college, who's now an attorney, or use the resources around you to get actual legal and accounting advice. This is all, this is not that. This is my experience and what I have learned, and hopefully a handful of people out there find it helpful.

So shame on me. I should have said that at the, at the beginning. But moving on. So incorporating your business is the, is the one of the higher levels of, um, protection that you can get. And let's say for the sake [00:16:00] of example, that little Johnny puts a marble in his mouth and he swallows it and something terrible happens because he has followed this marble and he was playing with you when it happened, and the parents sue you as a clinician.

This is what an attorney is gonna say to you. They're gonna set you up for the worst case scenario. So what do you do? This is terrifying. It's terrifying. But this is why a lot of people don't go into private practice, I think. Yes. So in a court of my understanding, I am not an attorney disclaimer. My understanding is that in a court of law, you would need to prove that you and your business are separate entities.

And if it's just Amy and not Amy, incorporated. There is no difference between you and your company and that's called the, the court. The person suing you would be trying to prove that Amy, the person and Amy the incorporated business, are the exact same person. It's called piercing the corporate veil.

That sounds very [00:17:00] formal. Somebody can Google that. So they would be trying to pierce the corporate veil. So if, let's say that you were incorporated and you had an LLC and you got sued, that's your company getting sued, not Amy, the person getting sued. So in order to take your house or come after you for something, they would have to prove in court that there's no difference between you and a business.

So if you're not incorporated, you have none of that protection. In other words, incorporating your business separates you from your business. So somebody would have a very hard time, a much one additional layer of protection to prove that you and your business were the same thing. 

Amy Wonkka: So I know that you're not a lawyer, so you might not know the answer to this.

Did I say 

Kate Grandbois: that already? I am not a, I am not an attorney. You 

Amy Wonkka: mention that Kate not a lawyer. Amy. I'm not a lawyer. Amy. 

Kate Grandbois: Definitely 

Amy Wonkka: not a lawyer. Um, so what's the difference between, if you know it between an LLC, which is what you are, right? Is that I am an LLC? Yes. What about like A DBA? Because that's, so 

Kate Grandbois: yes, we will get to that.

So [00:18:00] DBA is actually not incorporated. DBA stands for doing business as, um, and I will skip ahead since you asked about that, but I gotta find my notes. So, A DBA in most, it varies by state and in most states it's just a certificate. So you register your business name. It's like in Massachusetts where we are, it's $65 for a filing fee.

You renew it every couple of years and it protects your name, but you don't get any additional legal protection. So if there's another Amy Wonka out there who wanting to do speech pathology and you're doing business as Amy Wonka, that person. I'm pretty sure that's how it works. Ask your attorney or Google it and send me the feedback if I've said this wrong.

Um, but, so A DBA doesn't give you any additional legal protection because it's not incorporated. It's not an incorporated entity. So the levels of incorporated entity are LLC. In some states it's PLLC, which stands for Professional Limited Liability Company, and that goes through the state professional licensure.

I [00:19:00] used to be A-P-L-L-C, now I'm an LLC. There's almost no legal difference between the two and the, there's no accounting difference between the two. So it's just what's, what government body is your, is your incorporation going through? And it's very, that varies completely by state. So some states have PLLC, some don't.

Um, there is S corp, there's C corp, there's incorporation, there's being incorporated. Each one of these, um, entities has different tax. Liability. So yes, she's raising her hand at me again. Sorry. Yes, Amy. What, what would you like to say? 

Amy Wonkka: I was wondering, you know, so if you are thinking about going into private practice and you're trying to figure out and, and you say, okay, like this is what I would do if I were to do it, I would say, oh, I'm a very risk averse person.

So I, I would like the idea of this incorporating thing That sounds good to me. Is that a question for your attorney? Is that a question you ask your accountant? Do you talk to both of them about it? Like how did you arrive at your [00:20:00] decision? 

Kate Grandbois: I would talk to both of them. So because they have different, um, because they have different tax implications.

The questions my accountant would ask me, she knows a tax bracket I'm in. Mm-hmm. She knows that I'm filing jointly with my husband. Yeah. It's passed through taxes. So there are, every, every person brings a different set of variables to the table in terms of their, their tax. Package. Um, so I would definitely talk to your accountant about it.

Um, but also I would talk to, I would talk to an attorney about it as well, because there are different equity components to it. So for example, there is a single me, single, single member, LLC, and then there's a multi-member, LLC, and a single member LLC, which is what I am, I'm a practice owner. Mm-hmm. I don't have any partners.

But if I incorporated as a multi-member, LLC, then I could take on a partnership, in [00:21:00] which case myself and another person jointly owned the business at different percentages and are jointly responsible for the business and have a joint investment in the business. And then. Get, you know, a, uh, we get, we can draw money outta the business based on our percentage of ownership.

And those are all legal issues based on, you know, if you have a partner that you wanna go into business with, a multi-member, S-L-L-L-L-C might make more or less sense than an S corp depending on the different variables. I don't know much about S Corp and C because I have never, I have been incorporated as A-P-L-L-C and LLC as an end in Inc in the various different businesses that I have owned and run over the years.

So I know more about those, but I would definitely, to answer your question, accountants and attorneys, okay. Basically rule the world here and they both have different things to offer. Um, so the major advantage of incorporating your business is this additional level of protection. Um, it is the high, like basically the highest level of protection from a [00:22:00] lawsuit, but there are some disadvantages too, which sort of goes back to what your professional goals are.

If you wanna, you know, it's one thing to take one or two private clients versus wanting to open an entire clinic and have employees. Um, the disadvantages are that it's really expensive to set up, so if you do it properly, you, it costs about $3,000 to do it through an attorney. I know it's, it's not cheap, and so that might be worth the investment.

If you have these grand plans of having a brick and mortar and, you know, having a volume of, you know, 150 clients and a whole bunch of different employees, um, you can, so you have to pay the $3,000 to have the attorney dropped up the paperwork and then you also have to pay annual fees to the state. That also varies by state.

So this is an, an additional budgetary concern slash consideration. 

Amy Wonkka: Silly question. 

Kate Grandbois: Not a, there's no such thing as a silly question. This is very dry, but I get really into this, so I'm sorry. I [00:23:00] appreciate, I appreciate your questions. 

Amy Wonkka: Um, when you, so when you file an LLC paperwork, is that also with your state?

Kate Grandbois: Yes. 

Amy Wonkka: And as an SLP it's all 

Kate Grandbois: with your state. 

Amy Wonkka: So we are in the northeast and our states are geographically kind of tiny and close to one another. If you file in one state, are you, do you know, like, could you do business in a different state? 

Kate Grandbois: You, the only reason you couldn't do business in a different state is if you're not licensed.

Amy Wonkka: Okay. But if I, so 

Kate Grandbois: we're right next to me. We're right next to New Hampshire. 

Amy Wonkka: Mm-hmm. I 

Kate Grandbois: could practice in New Hampshire if I had a New Hampshire speech and language pathology license. Board of, 

Amy Wonkka: so you don't need your LLC to be set up also in New Hampshire. And 

Kate Grandbois: I don't, I don't know the answer to that question.

Right. I've never done business in a different state, so I don't, there are probably, I know that there are tax considerations for that. Um, you need to register your business in a, in the town where it, where it exists. Mm-hmm. So you [00:24:00] probably have to register with the state, but, and that's probably a small fee.

Like I know in the town where I am registering your business is like, it's like 30 or 50 bucks or something and it lasts a couple of years. So I think you have to register, but you don't have to reincorporate, you don't have to. I'm pretty sure you don't have to pay like the, you know, rate. But that could vary state by state too.

So I, I would definitely check with no matter where you are, no matter what state you're in, no matter where you plan to do business, I would always check with the Secretary of State's website or check with the state government to make sure that you're in compliance because every state does it differently.

Um, 

Amy Wonkka: and your attorney might have that information too, right? Right. If you want. Right, 

Kate Grandbois: right, right. But 

Amy Wonkka: as we, as we've mentioned, attorneys are, right, 

Kate Grandbois: so what an attorney does is they draft up articles of incorporation, which has all this legal jargon in it. Mm-hmm. Um, and we won't get too into that, but you could also do it through LegalZoom.

LegalZoom will, like, an attorney, will, what's legal legalzoom.com. I'm like, they're commercial. So when you go to an attorney, they will talk to you [00:25:00] about your business goals and they'll draft up these very complicated articles of incorporation that are specific to you and exactly what you're doing. When you go through LegalZoom, they'll ask you some like general questions, and they give you a boilerplate, um, articles of incorporation, and they do it for you.

It's like a third of the price. The last time I checked it was like a thousand dollars, so it's much, much cheaper. But if you were to get sued, it's not gonna stand up as well in a court of law. So like all this all roots back to what your goals are and what your level of comfort is. I mean, some people are like, well, I don't really care.

Nobody's gonna sue me. I'm doing X, Y, and Z with one person, DBA sounds great. I'm all. Versus somebody who is, you know, again, this brick and mortar mortar with a much larger, um, you know, set with, with a lot more volume. 

Amy Wonkka: Um, so if I, if I were thinking of this Uhhuh, just the way that my brain works, I would take a sheet of paper and make two boxes.

And for each of these areas that we're going through, I would kind of keep a running pros and cons list for myself to kind of [00:26:00] figure out where I would, where I would shake out in this. Yeah. Yeah. You talked about the pros of incorporation versus not, 

Kate Grandbois: so in short, incorporating is your maximum level of protection.

Um, it has a lot of disadvantages. It's expensive to set up, it's expensive to maintain 'cause you have to pay fees with the state to stay registered. Um, and when you incorporate, you become a group. Which means that your malpractice insurance is much more expensive. So I think the biggest disadvantage is that it's much more expensive and your personal situation, you may have been saving for this and you wanna invest all of this additional time, um, and money into, um, into setting something up.

Um, so at the bare minimum, let's say that you have one client and you don't wanna do any of this and you're just gonna register doing business as in order. If you were to get sued in a court of law, you would still need to [00:27:00] prove that you as a person are different than you as a business. And the biggest way to do that is to keep your money separate.

So if it feels like a segue 

Amy Wonkka: into accounting, it 

Kate Grandbois: does. You could smell it a million miles away. 

Amy Wonkka: I could. I'm not even near you. 

Kate Grandbois: Um, so at the very, very least, keep your money separate. So if you do a DBA, you go to the bank, you open a business checking account, and every single dollar that you get paid working as a speech pathologist gets deposited into that business checking account.

And then you pay yourself as a person out of that business checking account. So if you were to get into a court of law and they were to say there's no difference between Amy the person and Amy the business, you could say, oh yes, there is. I haven't used any of that money. All of my business money is separate.

Amy Wonkka: And you could do that even if you aren't. Taking the step to do A DBA if you are just working, 

Kate Grandbois: yes, 

Amy Wonkka: as a full proprietor under, but I 

Kate Grandbois: don't think that you can open a business checking account without a DBA registered with the state. So when you go, I mean you [00:28:00] could open, I guess a separate joint checking account or a separate checking, personal checking account.

But if you were interested in getting the benefits that go along with a business checking account, which varies by bank, um, you would need, they'd need to look you up in the state database. 

Amy Wonkka: So I feel like you just made a great point for DBA, which previously I wouldn't have considered if I were gonna do this because I'm not worried about somebody copying my name.

But it's not just copying your name. It also, I know Amy Wonka is 

Kate Grandbois: a pretty sweet name also. 

Amy Wonkka: It's a pretty sweet name. It's a pretty sweet name. 

Kate Grandbois: Um, can I say Wonka Wonka Wonka Now Wonka Wonka. Are you gonna make me edit that out? 

Announcer: No. 

Amy Wonkka: So I feel like the, the piece that A DBA gives you is also the added layer of you are to some degree a business.

You're more of a business than you are if you don't have it. 

Kate Grandbois: Yes, it is. I mean, it, it gives you no legal protection, but it may at least be a, you could [00:29:00] say that it's documentation that you're separate from your business, but it doesn't. Well, it's 

Amy Wonkka: more than if you don't, more than if you don't have it. 

Kate Grandbois: I, this is a great question for an attorney.

My understanding is that it gives you no additional legal protection. That's the way it was explained to me. 

Amy Wonkka: Legal protection. But it does allow you to access things like a business checking account, potentially check with an attorney. Yes. We aren't 

Kate Grandbois: that potentially depending on the bank too, because every bank does this differently.

Amy Wonkka: All right, lots of variations. 

Kate Grandbois: So whether or not you incorporate also has implications for HIPAA regulations. So everybody knows what HIPAA is. If you don't know what HIPAA is, HIPAA is the Health Insurance Portability and Accountability Act. That was instated in 1996, and it regulates the transmission of, and I quote individually identifiable health information, including demographic data that relates to an individual's past, present, or future physical or mental health condition provision of healthcare to the individual in the past, present, or future, et cetera, et cetera.

You can find more about [00:30:00] this on, um, at www.hhs.gov. The link is on our website. You have to abide by HIPAA if you are considered a covered entity. So you are considered a covered entity entity if you bill electronically, if you use a clearing house for billing or if you accept insurance, you have a question.

What is it? 

Amy Wonkka: And I think that this is something that changed for speech language pathologists at some point in the not super distant past. So HIPAA was out in the nineties, but I feel like I remember, do you remember this? Maybe in like the mid two thousands there was a lot of information on the ASHA boards about there were somehow changing the way that it applied to speech pathologists and maybe it was.

The inclusion of us as covered entities. 

Kate Grandbois: Um, so I have a whole, I have a whole section here about ASHA and hipaa, and I don't remember the date that it changed, but I think it moved. But there 

Announcer: was a change, right? Well, 

Kate Grandbois: I think they, we, they [00:31:00] always had strong recommendations about us adhering to hipaa. Um, I think my understanding is that what changed is our code of ethics.

Amy Wonkka: Ah, okay. 

Kate Grandbois: So our code of ethics did, when did it change? It did change at some point in the last, I remember sometime in the last five years I looked at it and then I looked at it again. I was like, oh, this looks different. Um, but basically if you are incorporated, you are considered a group. I mean, I guess it doesn't really matter because as a speech pathologist, you should be adhering to HIPAA based on ashe's recommendations, code of ethics, right?

Yep. So even if you're not a cover on the, based on the law, so speech pathologist or no, you have to comply with hipaa. If you bill electronically, if you're user clearing house for billing or if you accept insurance, if you are not one in one of those buckets, ASH is still advises that you remain compliant with the law.

And we have links to this [00:32:00] directly, that we have a whole page, Ash has a whole page about it, and there's a link to it on our, on our website. Um. It's in our code of ethics. Principle one oh individuals shall protect the confidentiality and security of records of professional services, provided research and scholarly activities, activities conducted, et cetera, et cetera, et cetera.

So in our code of ethics it says, it says that you definitely need to adhere to, um. Protecting the health information of the people that you serve. Um, there are some suggestions out there in terms of how to do this when you're in private practice. So keeping all ident identifiable information private.

Um, back in the olden days, like Amy said, if you used pen and paper, you had to keep it behind at least one locked entry. Yeah. Um, but now with digital file storage, there's OneDrive for business, there's Dropbox for business, there is practice management software. Like Simple [00:33:00] Practice is a really popular one for speech pathologists.

There's web pt, which is for PTs, but I know a handful of speech pathologists that use it. These are all HIPAA compliant ways to store your notes, your billing files, all of those kinds of things. This is another time to consider cyber insurance, which is a thousand dollars a year. So it's not cheap, and that's a ballpark number, but.

You know, if you only have one client, it probably doesn't make any sense to purchase that additional layer of cyber insurance. Using a HIPAA compliant digital file storage system is probably fine. Um, if you use an old timey fax machine, which believe it or not, health insurance companies are still using, sometimes you should consider using an online one.

At the very least, you need to password protect your computer. Um, you should consider purchasing a domain name for your email use because Google and all these different free emails are not Google compliant. They have little software programs called Spiders that go through your emails and read your emails and [00:34:00] then have ads pop up on the side so your patient information is not protected in a regular Gmail account.

Google G Suite is HIPAA compliant and FERPA compliant. I believe. So that's another one now that I'm thinking of it. 

Amy Wonkka: But that's a thing you have to pay for. Yeah, you have to pay extra. 

Kate Grandbois: All of these things are additional, additional money. So before you go into purchasing these things, that's another question for how many, how many clients do you need to see to make all of these additional expenses worth it?

Amy Wonkka: So how do you keep track of all of these different moving parts, right? So there's all of these expenses, you hope that you make money, like when you're doing your planning. You mentioned a budget. What is that like? Oh, I use, does that a 

Kate Grandbois: budget 

Amy Wonkka: look like we 

Kate Grandbois: have a budget? So, so actually I was thinking about putting a budget up on our website for people to purchase for like the low, low price of a dollar 99 or something like that.

Because it's really hard. It's really hard to plan all of these things out. Um, and I have a budget, I'll make it [00:35:00] available. It's basically a plug and go system where you plug in the number of clients, you see how much you charge, how much you're gonna pay yourself, what your expenses out are, and it spits out a monthly net value of how much you make per month, how much you can pay yourself at the end of the year, um, and all of that kind of stuff.

But using Excel and planning some of these things out is really. I think a cornerstone of good decision making when you're running a business and considering to go into private practice. I think it's over the years, I've talked to a lot of speech pathologists. I, I totally get it. We get really carried away with like, I'm gonna make business cards and I'm gonna make a website, and I'm gonna go on Instagram and hashtag hashtag because this is gonna be so great.

I'm like, I get it. That's all wonderful, but you can only purchase the business cards if you have, are you laughing at me because I don't know how to use Instagram? 

Amy Wonkka: I thought it was funny. Hashtag hashtag

Kate Grandbois: I'm such a dinosaur. A [00:36:00] medium old. Just medium. God dammit. Oops. Curse words. Sorry. My bad. Um, so if you, what was I even saying? Oh, you get us so excited about starting your business and investing in all of this stuff, but if you don't have income, you'd only have, you only have a business if you have a customer.

You only have a business if you have a client. So it's great to like, pay for ads on the Instagram hashtag Instagram or it's great, you know, it's great to like spend a lot of money on business cards and it's great to like, you know, spend a lot of money on a website, but if you don't have any clients, then you really need to be very careful about how you're investing in your startup costs and all those kinds of things.

Amy Wonkka: Um, I would think too, it helps you to know how many clients you need to have. Yeah. Yeah. How many. How many clients do I need? We'll, we'll get 

Kate Grandbois: there. We'll get there. 'cause believe it or not, I'm not done talking about HIPAA because this system, HIPAA is so, so boring and dry. But I'll go through it quickly.

So, so consider a domain name, use a private email. Um, [00:37:00] purchase HIPAA compliant. Emailing and archiving. Consider encryption capabilities when you're cons, when you're sending an email. Consider locking and password protecting your documents. You have to provide your clients with a HIPAA privacy practice notice and then have them sign it.

And, um, you have to have a consent to release form. So if any of this feels really overwhelming to people who are listening, don't be overwhelmed. There is a handout where all of this is listed. It's basically a to-do list of things that you need to do to open a private practice. You can also email me.

Like I said, I love to nerd out on this kind of thing. This is like my favorite area of mentorship, um, because I just, I just find it interesting. Um, so there's also a chunk of documentation that you have to provide clients when you first bring them on to maintain HIPAA compliance. And I have a list of that on the handout as well.

Um, just looking at the time, we have so many more fun, nerdy things to go over and I wanna get to them. Um, contracts and service agreements that have things like [00:38:00] how, explain how your services are provided and the pricing. You have to explain your billing process. You have to explain how they're gonna be billed, and you gotta protect yourself.

You have to tell them when you expect them to pay you. You have to tell them what's gonna happen. If they give you a bad check, you have to tell them how you're gonna handle it when there's a nonpayment on, on their account. So, you know, we're all do-gooders. I think that's how we get into this field. And when you are treating someone who's fallen on hard times, what are your policies around what you expect in terms of payment or if you are accepting insurance and they haven't met their deductible?

You know, you have to have a lot of these things in writing. Um, I have a lot of templates also that I would be happy to share. Um, so please feel free to email me. Um, there's a lot related to our ethical code in terms of consent to release that is really important to consider. Um, permission to video and [00:39:00] photography.

Photographs, hashtag Instagram. Um, client is client history. I hate Instagram so much. Um, clinical documentation. Um, there's a lot in our code of ethics about clinical documentation and how we keep our records. So that's, um, principle IQ or principle one, not I, principle one. Item Q. There's a whole bit about that.

Um, you have to consider what your documentation is used for, where it's gonna go if you're sending it to parents and clients, uh, parents or teachers, insurance companies. And there's actually a really great Alito article about documentation standards by Becky Sutherland Cornett. I don't think I said her name wrong.

Um, but the reference is, um, on our website, on the episode page. It's a slightly outdated article because the medical industry has changed so much in the last 15 years, but it still hits all the high notes. So it gives a nice outline of what they, what the documentation standards are. Okay. I feel like I raced through that onto budgeting.

Budgeting [00:40:00] back to budget. So coming back to Amy's question, I do have budgets that I would be happy to share. I will find a way to put them up on the website. Um, we've already talked about some of this. You do not have a business unless you have customers. And it is really so hard, so easy to get carried away with, like looking at rental space and daydreaming about, I don't know why I keep coming back to business cards.

I was really excited to buy a business card for myself when I started this process. Um, and you have to balance your expenses with your income. You have to make sure that you're making more than your spending because that is like basic practice budget. Budget 

Amy Wonkka: 1 0 1, 

Kate Grandbois: budget 1 0 1. You have to know, you have to do the math.

If I'm charging X number of dollars and I have room in my schedule to see. 10 clients, how much money is that per year? How much do I need to make as a person to cover my rent and all of my ex my personal expenses based on those two numbers, how much can I actually afford to spend on my business? Mm-hmm.

Um, I [00:41:00] think there is a, people get a little excited about like, I'm gonna use a home office and buy my, use my business money to buy a toilet paper, toilet paper's. Such a hot topic right now. 

Amy Wonkka: So I think that's, think that's why I thought of that. You can't even use your business to buy toilet paper. Right.

Exactly. But, 

Kate Grandbois: you know, people, we get really excited about these things, but it's really, it's really important to balance your income, um, with your expenses. Um, and um, so I will make that budget available. And I think all of this goes into taxes. So this is the big, horrible, horrible situation of taxes that death and taxes.

Everybody has to pay 'em. 

Amy Wonkka: This is the second most scary thing. I feel like this is a big, you know, 

Kate Grandbois: it is. How do you, and I think as long as you know, you have to pay them. You're gonna be okay. I think people get into trouble when they don't have their business money separate. They have, let's say they made a hundred dollars a week for a whole year and they just like cash the a hundred dollars and they tell themselves, nah, I'm [00:42:00] not really gonna spend it all.

And then they get this massive tax bill and they're like, WDF, where did this come from? Like, I knew I had to pay taxes, but I didn't know how much. 

Amy Wonkka: Well, because the taxes are different. Right? So your tax, your tax, you have an 

Kate Grandbois: additional self-employment tax. Yes. 

Amy Wonkka: Right? 

Kate Grandbois: Yes. So, which is different. So when you pay taxes, you pay your tax bracket.

Plus 15% self-employment tax. That's a federal law. You can learn more about it on our website. On our website, there's a link to the irs.gov page that explains all of this. Um, what I recommend generally that people do is because you have to, you should be keeping your business funds separate anyway.

Mm-hmm. You have your separate business checking account. You do your math, you talk to your accountant that says, okay, based on my tax bracket, for every a hundred dollars I make, I can pay myself X amount. I have to set aside [00:43:00] 60%, 50%, 70%, 40%, whatever the percentage is for your tax bracket, plus this 15% self-employment tax.

You set that aside and you let it sit in your business checking account, and you draw off of your business checking account and you pay yourself out of that account. You keep all that money separate. You can use that, those separate funds for business expenses. But when the tax, when the tax man comes in April, or maybe you've chosen to pay quarterly, which is definitely something to talk to your accountant about.

So you don't get like a big scary bill. You have the money set aside and you have a good understanding of exactly how much you're gonna, oh, I think if you go into it with that education and just those basic fundamentals, it's really not that bad because you're prepared for it. 

Amy Wonkka: Um, you make it sound not as scary, Kate.

It's not, it's not 

Kate Grandbois: that scary. I do it every year. So if you're keeping your business funds separate. One other thing that you need to think about for a business checking account is that you need a tax id, or it's also [00:44:00] called an EIN, which stands for employee Identification number. You can apply for one of those easily.

The web, the link is again on our website. Um, it is free. I'm pretty sure it's a.gov website, but I don't have it in front of me. And that way you can use your EIN or your Tax ID number instead of your social security number, which is an additional separation between you as a human and your business. Um, you pay yourself, your, your allotted amount, and you can take, every time you invest in your business with your business funds out of your business checking account, you take them as a tax deduction.

So this is where the tax deductions come in. And I know this also gets really confusing. Mm-hmm. You pay tax, and this is again. All information related to all of this information changes based on the corporate structure that you have. So if you were an LLC or an S Corp, or a C corp, all of this information is different.

I know personally from my experience being an LLC, it's passed [00:45:00] through taxes, which means I pay taxes as a person. I, my, I the, I'm not gonna explain this properly, but it's called pass through taxes. Somebody could, somebody could Google it, but you can take tax deductions. All of the expenses that you use for your business are tax deductible.

So you get taxed differently based on what kind of incorporation you have, based on what kind of do you have. So you file one 

Amy Wonkka: set of taxes, you don't file a set of taxes Yes. As case and then a set of taxes as see, you know, so much. I'm learning, I'm learning. 

Kate Grandbois: You're No, exactly. Um, in terms of, and so this is where I think, and I, I'm not sure if I said this earlier, but I would highly recommend even if you're just a DBA.

It is worth paying an accountant for one hour of their time, go find an accountant. Say you would like a consultation, pay them for one hour and learn everything you need to learn. And then you never have, if you don't wanna hire them to do your books, you don't wanna hire them to do your taxes, that's fine.

I think it is worth the [00:46:00] investment for one hour quick education that would for, and, and an attorney too. If you can find an attorney that will give you, um, a consultation, I think it's definitely worth the time and money. 

Amy Wonkka: And do you think that's the type of situation where you can just go in with a list of questions on a piece of paper and say, these are all the things that I need to learn about.

Help me. 

Kate Grandbois: I think so. Yeah, I think depending, if you go in with a super long list, they might charge you extra to sit in their office. Um, but I think even based, even a little bit of time with an accountant or an attorney is gonna be really helpful. Um, so moving on to other components of accounting that I think people don't really think about are administrative tasks.

So, and this is again, dependent on your volume. If you have one client or 10 clients, do you wanna do your own books and do you wanna do your own billing? So if you are billing for 10 people, that's a whole lot of time to make sure that all those bills go out at the end of every week or at the end of every month.

[00:47:00] And it's a lot of time. There are billing services out there that usually will take a small percentage of your income. And if you're seeing 20 clients, that might be worth it, depending. And again, this is the income and expense balance that you have to do. 

Amy Wonkka: Well, and having worked outpatient, do those billing services, do you know if they, they do the fund follow up over and over and over again with the insurance companies?

That is sometimes required in order to get, sometimes, 

Kate Grandbois: sometimes. So a billing service will do private pay. An accountant will do private pay billing too. You just like have them batch out your bills at the end of the month. Mm-hmm. Um, but a billing service I do, I do think really comes in handy when you start accepting insurance.

If you start accepting insurance. Um, this is, so once upon a time I had 15 clients. They were all on health insurance. I was by myself. I was a single practitioner. Each one of those clients had a different copay. Some of them had co-insurance. They each had a different [00:48:00] deductible and I had to submit a claim for every single visit and every claim was a different amount.

And I had to follow and track each individual patient client account and how much they owed me, how much they owed their insurance company, which ones I was sending a copayment bill to which ones I was sending like a full amount bill to because they hadn't paid their deductible. It is a massive, massive undertaking.

I did it myself because I didn't want to bet to pay for a billing service at the time, and I will never do that again. If I ever do a large volume of insurance, clinician insurance clients, I would definitely hire a billing service, but it might not make sense to you if you don't wanna pay for it or if you only have a smaller number of things.

But there my point being, there are billing services out there. That can be helpful. There's also bookkeeping services that can be really helpful if you, you know, you have to balance your checkbook every month. Make sure that all the checks you wrote to Boardmaker or the state, make sure that they came [00:49:00] out.

Make sure that all of the people that you charged make sure all that money came in. Um, most accountants offer a, a bookkeeping service that can be a monthly charge as low as $50 a month depending on who you use. I'm sure it can be a lot higher than that too, depending on who you use. Um, you can also teach yourself how to use QuickBooks.

I will admit that, uh, the first. I don't know, month. I used QuickBooks. I cried a lot. It's not a very user friendly software. Um, and it, I I, I can remember a specific memory of like being on the phone with a customer service agent and being like, I just need to know how to build that. And he was like, well, our goal is not for our customers to cry, so maybe I can help you.

So it can be intimidating. Um, there are a lot of tutorials online, so you can teach yourself how to use QuickBooks. I have done it. You can also pay an accountant to sit there and do it with you. You can pay an accountant to do it for you. Uh, there's a lot of different ways, but I would [00:50:00] definitely recommend being serious about keeping your books 'cause it's gonna be incredibly helpful at tax time when you have an account, a record of all of your expenses, all of your tax deductions.

Um, you have to save your receipts, all of your home office expenses, all of those kinds of things. And that is accounting in a nutshell. Um, I did wanna talk a little bit about income because that's the reason why everybody goes into private practice. Now that we've covered all the scary things about legal issues and accounting issues.

Um, income is super important. You have basically three major options when it comes to generating income. You can go the private pay route, you can go private pay with insurance reimbursement, or a super Asha calls them super bills and you can go through insurance. Private pay is pretty straightforward.

Um, I, I think one of the biggest questions that people ask me is, well, how much should I charge? And I think that is a [00:51:00] very, that varies by, so it's so many different variables, so, 

Amy Wonkka: well, 

Kate Grandbois: and there 

Amy Wonkka: are funny rules around like, rate setting. Like you can't, it's one of those things where like you can't really talk to people about it.

It's a funny, so I have 

Kate Grandbois: mixed feelings about this because I think most people, most other industries who are selling products, they know what other companies are selling their products for because they just look them up online. There are more ethical restrictions and guidelines in terms of medical practice.

I think most people know the range based on their geographical area. So geo geography has, is a huge component. So different areas of the world, um, will charge in varying amounts. If you are a super experienced clinician with a specialty, you might be more comfortable charging at the top of that range versus a brand new clinician.

Maybe you're only, you know, you, maybe you're comfortable charging at the bottom of that range. I will say one piece of advice I will say is make sure [00:52:00] you're charging what you're worth. I think that a lot of people in our indu, in our field, this is gonna sound sort of, I don't know how to put this delicately, but we are doing it a lot of times out of.

The joy of being clinicians. We enjoy being clinicians. We enjoy what we do, and I think it's really hard to say, well, I, I'm just gonna, it's really easy to say, I'm just gonna charge you this like, low amount because I really like your family and I really like this. I really like working with this student or client, and this is my, this is my passion.

And I think that that's wonderful. But at the end of the day, you also have to run a business and you also have to charge, um, what you're worth and make sure that you're protecting your interests. Don't gouge anybody. Don't be a jerk about it. You know, consider all of these factors objectively in terms of how many years of experience you have, what kinds of experiences you have, if you have a specialty, and what your [00:53:00] geographic norms are.

Amy Wonkka: And I think that's probably another place where the budget can really be helpful as well. Mm-hmm. Because you're able to plug in, you know, a couple of different, especially if you're running in Excel or Sheets or something like that, which is an active, an active spreadsheet. Right, right. You can, you can play around a little bit with the different places in the range and think about what that means for your business.

Kate Grandbois: Yep, totally. Um, you know, I think it's great to say, you know, I think I am, I'm, I think we undervalue ourselves is maybe what I'm getting at. Um, yeah. And I definitely recommend that people try and be as objective about it as possible and a budget can definitely help with that. You know, maybe it feels good to you to charge on the lower end, but once you run the math with the things that you absolutely have to have, you have to buy tickets.

Uh, testing kits you have to buy materials, you have to buy, you know, a subscription to boardmaker. All of that adds up. You might not be able to stay in business if you're charging on the lower end, right? Or what you think is the lower end, but it's actually [00:54:00] below the lower end. Um, I think educating yourself that all that math is really important when you're trying to decide how much to charge.

There's no, there's, I get that. Ask that all the time. There's no answer, there's no straightforward answer. Um, but in terms of private pay, it's pretty straightforward. Private pay with insurance, rebo reimbursement is slightly more complicated, but not really. Um, what this basically is, is you say to a client, I don't, I am not contracted with insurance.

But if you have a PPO or you have an insurance plan that allows you to see an out-of-network provider, I can provide you with a bill that has a specific amount of information on it, you can take that bill and submit it to your insurance company and get reimbursed for my services. So that way the. The services are reimbursed, but you are not the one that's directly interacting with the insurance company.

Asha calls this a super bill. There is a link on our site that describes exactly what a super bill is there. Asha has [00:55:00] free samples of super bills. Um, you can make it look however you want. If you have a logo, you can put your logo on there. It's, it's just your bill, but it has certain information that needs to be on there for insurance, which is sort of a nice segue into talking about 

Amy Wonkka: insurance.

Quick question about the super Bill. If you are providing that to your clients, and I don't know if it's something that you've ever done, but if you're providing that to your clients and then they have trouble, how much support do you provide in that process? Or is that something you figure out and define in your contract, like you were saying earlier?

I would, that's a 

Kate Grandbois: really good question. I would say that's something that you have to define in your contract. 

Amy Wonkka: Yeah. Okay. Um, 

Kate Grandbois: I would be very, very wary of handholding, um, because frankly, it's a time suck and I think that we, as clinicians, we wanna do as much as we can for our clients, but. Going into an insurance hole is like a black hole.

It, it's, oh yeah. I mean, I would not go in there unless you are really, I don't know. You got time to [00:56:00] burn if you're sitting at home and you have nothing to do right now because of COVID-19 and you wanna go into insurance hole. I support that choice, but it is a deep, deep, dark place. So I would definitely outline some of those parameters in your contract for sure.

But in terms of what you have to put on a super bill, this is where we sort of get into some of the insurance lingo. There are some acronyms that you need to know. Don't get overwhelmed by the acronyms. All of it is in our handout. Um, but each claim, or each super bill, so when you submit a claim directly to insurance company or you put things on a super bill, it's the same information.

You need an NPI, which stands for a National Provider Identifier. The, uh, the National Provider Identifier, um, is given to you through the health insurance portability and accountability. It's, no, no, no. The NPI is, and this is a quote, um. A unique identification number for covered healthcare providers.

There is a link [00:57:00] to the Centers for Medicare and Medicaid on our website that explains exactly what this is. You get one through the national Plan and provider enumerator system website, N-P-P-E-S. Again, don't be overwhelmed by the acronyms, but you go to their website, it's free. It's just like the tax ID you go, you get the number.

You forget about it forever. Most people who are working in an insurance provider setting already have one of these, so you may already have one. I would recommend you go to their website and look that up to see if you have one. If you are a single provider, you get a Type one NPI. If you are a group or an LLC, you get a type two NPI.

So that's another consideration when you're deciding whether or not to incorporate. If you are incorporating, you need to get a type two NPI number. Um, CPT codes are another thing that you need to put on your super bill. CPT can't stands for current procedural terminology. It's basically a string of numbers that says what treatment you did.

So if you did speech and language therapy versus feeding therapy versus a a [00:58:00] c therapy versus an evaluation versus an A a C evaluation. Each one of these procedures, clinical procedures, has a different string of numbers attached to it called a CPT code. ASHA has some great resources on CPT codes, um, and they have some great resources on the superbills and there are CPT code templates up on the ASHA website.

Um, once you get a handle on the CPT codes and you know which ones go on your super bill, you also need to give each client something called an ICD 10 International Classification of Disease. Again, don't let your eyes glass over the, all of these acronyms are on the handout and on our website, but the ICD 10 is basically a string of numbers that goes along with the diagnosis.

So you're doing 9 2 5 0 7 for somebody who has F 43, which basically means, I'm not even sure what F 43 is, but that basically means. That you're doing speech and language treatment with someone who has autism insurance doesn't make it easy. They're not gonna use [00:59:00] regular English with you. They need to do everything through like strings of numerical code.

Um, sounds horrible. It's horrible. It's, it's horrible. One client can have a lot of different ICD 10 codes, and Asha has a whole page dedicated to explaining this also. So definitely go on our website. There's links to all of this stuff up there. 

Amy Wonkka: This stuff changes too, right? So it's something you have to keep on top of.

It's not like, because the last time I billed was when we worked outpatient and it was i CD nine. Yes. They just 

Kate Grandbois: changed it. They just did a whole revamping. Um, you learn it and 

Amy Wonkka: then it changes. 

Kate Grandbois: Yeah. So I mean, I think the biggest question, another big question that I get is whether or not I should contract with insurance.

There are some pros. One, you feel a lot more accessible to families? Um, I think a lot of us in the field have a hard time taking people's money. It's an awkward exchange. Um, you know, we have this, you know, great time spending, you know, this great amount of therapy or this great [01:00:00] time, you know, with the student or the client providing the therapy.

And then we come out of our session, we're like, that will be X number of dollars, please. It just has this very awkward transactional component to it. So a lot of people feel more comfortable accepting insurance. Um, I feel like that is often I hear one of the pros, well, I don't wanna take people people's money.

Right. I feel like they should be able to access their insurance. Right, 

Announcer: right. 

Kate Grandbois: Another really good thing is if you want volume, this is where you're gonna get it. It is a lot easier to find people and clients for your business who want to take their insurance. It's a lot harder to find people. All my doctors take 

Announcer: my insurance.

Yes. 

Kate Grandbois: It's a lot harder for people. It's a lot harder to find clients who are willing to private pay. So if you are wanting volume, you want this to be your full-time gig, you wanna hire people to do this with you or for you than insurance is where it's at. Um, the, I get a lot of questions about reimbursement rates.

Um, the reimbursement rates change and range per insurance provider. So if you're in network with Blue Cross, blue [01:01:00] Cross is gonna pay you a contracted rate. You could save, Hey, blue Cross, I charge $3,000 for one therapy visit. Blue Cross is gonna be like. That's great for you. Here's the money that we said we would pay.

You go about your ways. And Harvard Pilgrim reimburses a different rate than Blue Cross. So you have different amounts of reimbursement across different insurance companies and across different regions in the country. Blue Cross Blue Shield of Massachusetts probably has a different payout structure than Blue Cross Blue Shield of California.

I have no idea. So, um, it's definitely something that also changes State by state. 

Amy Wonkka: Can you do just some insurance? Do you, do you have to do all the insurance? How does that work? Right. Can you say, oh, I wanna do this one insurance because they're a better reimbursement rate? Or, I, I already know people who have that insurance, so I'm motivated to get that insurance.

So I'm able to see these clients who I have a relationship with. 

Kate Grandbois: That is something I feel like I. I don't, I, I know a lot about [01:02:00] that in Massachusetts, but I think that that changes in different parts of the country. 

Announcer: Okay. So, okay. I think like 

Kate Grandbois: around here, blue Cross and Blue Shield is very widely used.

They're mm-hmm. They're well known for being one of the easier insurance carriers to contract with. I don't know that that's true in other places. Um, I do know that, you know, tracking all of those different reimbursements rates can be really, really tricky. Which is sort of a nice segue into the cons of accepting insurance.

Did you have a question? 

Amy Wonkka: I was 

Kate Grandbois: just gonna say, I can you hear the elephants jumping around upstairs in my house. Hey, can, I can hear your upstairs? It's so apologies everyone. It's, that's my, that's my son stuck inside. COVID hashtag COVID-19. 

Amy Wonkka: Yeah, dump it around. Dump it around. Don't jump around. Um, so, so I also feel like this might be a place where I'm, I'm not a user of this listserv, but I am on a number of the ASHA Listservs, um, for, for areas where I [01:03:00] practice and I wonder, I know they have a private practice listserv, so that might be something to check out too.

If you have questions for your geographic, like if you, you know, if you live in Minnesota and you wanna put a, put a question out to the group, the Asha private practice listserv, all the SIGs would be helpful. There is a private practice sig, I 

Kate Grandbois: think. Yeah. I'm 

Amy Wonkka: not a member of, no, that's very, 

Kate Grandbois: very helpful.

Um, I think it's sort of, there's a lot of things to think about when taking insurance. My, I think one of the biggest cons to insurance is that, is the. Royal pain in the butt, you enter into a massive amount of paperwork, contractual obligations, ethical obligations, um, that compared to private pay. There is no question that private pay is significantly more straightforward.

Um, it's just a lot easier to deal with. Um, it is so much paperwork, it is so much keeping track of visits, keeping track of all of these additional things. [01:04:00] Generally speaking, depending on what code you use, reimbursement rates are lower than private pay, but they're competitive in most geographical areas.

And again, that's something that probably changes state to state. Um. You have to keep, keep track of so much. We covered this a little bit already, but who owes you a copay? Who owes you the co-insurance? Are they even eligible for your services? You have to call the insurance company beforehand and make sure that they have speech therapy coverage depending on the insurance.

Do they only cover disorders that are acquired versus developmental? A lot of insurance companies will say, oh, well you can't see Johnny for a lisp because that's not a medical necessity. 

Amy Wonkka: Well, and a lot of insurance, I remember just from being outpatient, a lot of people have a limited number of visits for a year.

You have to keep track of that, right? Like have they gone, oh my god, they have like 14 

Kate Grandbois: visits a year and as soon as you're over 14 visits. Exactly. Um, you have to. I mean, even contracting with them is difficult. So in order to contract with an insurance company, you generally fill out their application.

You [01:05:00] have to get letters of reference, and then you usually have to go through a third party credentialing service, uh, company called CQH, so which is the Council for Affordability, quality Health. Um, and I pretty sure that link is gonna be up on our website. Also, they are a third party, not even related to the health insurance company that vets you.

So they say, okay, Kate, I need to see your malpractice insurance. I need to see your licensure. I need to see your letters of reference. And CAQH. The third party says, all right, Kate is an actual speech pathologist who is a real person who is covered and meets the standards for Blue Cross. So now we're gonna say Blue Cross.

Now you can contract with them and you have to update your information with CAQH four or five times a year, every 12 weeks or something like that. So there is all of this additional administrative burden that comes with contracting with insurance. Um, it takes about three months to get a contract contract up and going, and then you have to learn how to submit a claim.

So you see little [01:06:00] Johnny, and it's not just as easy as calling up Blue Cross and like, oh, hey, my friend Joe, my friend Joey at Blue Cross, I saw Johnny today, please send me money. Thank you. That's not how it goes. You have to submit a, an electronic claim form with all of these different codes. And this is why people, I think so often use billing services, um, because it's.

So, so difficult. Um, and I think, you know, just looking at the time and trying to wrap this up, at the end of the day, no matter how you get paid, if it's private pay insurance or a super bill, you have to get clients. So my like closing statement, and this is my, my favorite little tagline is that you, you have to be your own pimp.

You have to, you have to pimp yourself out. You and I, one of the biggest questions I get is, how do I do that? You can make a website, you can pay for business cards if you want to. Um, I would consider registering with Google Maps. Something that you can do nearly for free, and you get a little pin drop.

Somebody says speech therapy, and they say, oh, there's a speech pathologist in my [01:07:00] area. Um, if you contract with insurance, insurance companies are gonna be your biggest referral source because patients go to the insurance page and they search for a speech pathologist. Um, you could also consider meeting with pediatricians in the area if you're working or other, or hospitals if you're in, if you're working with acquired disorders or adults.

Um, go meet with the facilities, get on their referral list. So when someone comes in for an evaluation or the pediatrician has flagged you for having a language delay, they send, they hand you a res a reference list, a resource list to the family and you're on it. Um, so definitely making those calls, making those connections, networking in your community, telling people that you're seeing private practice, if that you're seeing clients in a hospital.

Um, those can all be really important. Um, really important things. And I think that pretty much wraps it up. 

Amy Wonkka: I feel like this was super helpful. I think that there are a lot of considerations around legal and how you incorporate and formalize your business. The accounting piece and the budgeting and how much [01:08:00] that comes into play in this whole process.

And then thinking about the choices you're making about your revenue streams that are coming in is just really makes it, I mean, I'm, I'm still, I'm still, no, you're still like, no, thank 

Kate Grandbois: you. 

Amy Wonkka: I feel like after this I have a much better, um, idea about kind of the big three, three buckets I guess. I like, I like to think of buckets, but you know, those are really the big three big pieces that you would need to think about.

And there are different questions, uh, that fall into each of those categories. And I also feel like knowing how to access professional resources and that they are important. I mean, I feel like, obviously, final disclaimer, neither of us are lawyers nor account. Neither of us. 

Kate Grandbois: Neither of us. But I'm happy to answer questions.

I mean, if somebody, you know, has questions and they, they wanna get some advice about any of these things, please email me. Um, yeah, I am, I, uh, I really do enjoy talking about all of these kinds of things. Um. I think that sort of wraps us up. Please don't forget to go to our website if you're interested in [01:09:00] getting Asha Professional Development.

Uh, this is one CMH one certification maintenance hour. Um, shameless plug for our next topics. Feeding and swallowing in the schools is coming up soon. Stress reduction is coming up soon. What else do we have there? Stress reduction partner training for alternative communication. We got some good stuff on, so stay tuned.

Um, and thanks for listening. We'll talk to you soon.