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The Mentor's Corner |
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Students/Early Career Professionals |
Miguel E. Gallardo, Psy.D. & Michael Murphy, Ph.D. |
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Tara Singer asks: I am somewhat new to this list. I am about to start a part-time private practice and am getting different advice about setting things up. Can anyone make recommendations about sole proprietorship vs. an S-Corp vs. a Limited Liability Corp.? Magalie Piou-Brewer responds: It would probably be best if you consulted with your accountant about this one . He/she could talk to you about the differences between each as they relate to your short and long-term goals. In terms of my own experience, I was advised by my accountant to operate as an S-Corp. - based on my needs and projected goals. Each person is different. Mike Monroe replies: Yes, I would definitely second Magalie’s suggestions both to find a GOOD accountant (ideally one who has worked with private practices) and then to have that accountant tell you that an S corporation is the way to go. Having done considerable research at the beginning of opening my practice, I found that an S corporation allows for tax breaks that other corps do not (it’s more work--but it definitely pays off--and do yourself a favor and have your accountant do the work--at least at the initial setup). Again, though, you would want to have an accountant review your particular situation to see what is best. Francine Silver added: I was in your same position just a few months ago- researching all the benefits of incorporating for a new private practice. After all the research, I concur with what others have just posted- that there are more tax benefits with an S-Corp. Apparently, a lot of practitioners are using an LLC- but I was told that the main advantage is simplicity- not the tax benefits. Jacques Richard asks: I was wondering how list members deal with patients who cancel at the last minute (i.e., phone call 5 minutes before therapy is scheduled, and want to reschedule for a later date). Do you allow that? How many times? Do you charge anyway? If you do charge, do you write on the receipt that the patient did not receive treatment? Frank Cushing comments: On the Procedures and Policies handout that all the patients receive (as a part of the HIPAA stuff) when they come to their first appointment, we clearly indicate “You are required to give 24-hour advance notice if you cannot keep your scheduled appointment. Failure to provide 24-hour notice may result in a cancellation charge up to the amount of your therapist’s normal charge. Glenwood Center has a live answering service after hours for your convenience.” Each therapist decides each time whether or not to charge the patient and how much to charge. I typically do not charge if it is the first NO SHOW but will discuss it in our next session and indicate that is the last “free pass”. If someone has what seems a legitimate excuse (to me), I will not charge even if they have missed before. I do it on a case by case basis--if someone is abusing it, I will charge my full fee and not allow him or her to reschedule until the NO SHOW fee is paid as insurance companies will not (and should not) pay for this. Our billing slip has a space to indicate a charge for “Cancel w/o 24 hr notice”. We make it abundantly clear that NO service was rendered—to bill an insurance company and mislead them into thinking services were provided would be fraud--not to mention unethical. It would also defeat one of the major purposes: the patient must pay so the patient is the one who pays the consequences. I also explain to patients that if they don’t show up, I cannot see one of my other patients who would like to be seen in that time slot and I LOSE money.....as I get paid ZERO for that time they took but did not use. Christine Szostak adds: You know, thinking of this makes me think, that it is pretty understandable to expect this type of policy. I mean medical doctors, psychiatrists,dentists, and even others such as hairdressers expect this type of policy, so I think we should do the same. I know that at the site I am currently doing a practicum at we write on our progress notes whether it was a therapy (individual or group) session, intake, phone contact or cancelled or no show. Thus, if it is a no show I am pretty certain they are charged. Ithink they have the same 24-hour policy. Anne Israeli contributes: We have started to charge people for missed sessions if less than 24 hours notice, and if people cancel (even in 24 hours) more than 2 sessions we discuss this. We have a contract indicating all policies that clients sign before commencing assessment and therapy. Kristy Wynns asks: I just read the thread about missed sessions and have struggled with how to handle that issue. I also wonder exactly how to respond when it’s time for clients to pay, and they say, “Oh I forgot my checkbook” or if it’s a teen - “my mom forgot to give me money.” A part of me thinks that they would never forget money to go to their M.D. (or mechanic or lawyer, etc) and part of me wonders if my age is a factor. I’m 29 (and clients assume I’m even younger b/c of how I look) with my Ph.D. and in private practice for the first time, and I wonder if it’s a respect issue. How do others handle this situation? Alta Paneras replies: This some times happens to me too. The first time I will accept it and agree they pay for both sessions next time. I think maybe this could happen to me as well and I would be very embarrassed by it and not do it again. If there is a second incident I might start by discussing if this is something that happens to them in other settings as well. It might be a time management issue, or they might need help with their organization skills. Also, it might be an indication of increased anxiety, dementia etc so maybe I would explore these if they seem warranted. Only after excluding the above I would proceed to discuss the meaning this might have regarding our relationship or their attempt to manipulate me. Similarly, sometimes especially after a very intense session people start to walk out without paying. I remind them to do so but most often see it as an indication of being lost in the here and now or being deep in their thoughts. Usually this is very embarrassing for them and does not happen again. Steve Walfish comments: I let it go one session. Most people are honorable and pay their bills and bring a check the next time. Occasionally I get burned if they don’t come back. I figure it is part of the cost of doing business. I would rather lose something occasionally than be stern about every dime. I think more comes to me in the long run because of this laid-back attitude. Frank Cushing adds: The way our office has handled it for 30+ years is to tell them, on the phone, when they make the appointment, what they will be expected to pay at the time of service. Then, upon the conclusion of their session, they are instructed to take the billing slip to our appointment desk where they set up their next appointment and are told: “your balance (left over from previous sessions or insurance underpayment) is $____, today’s charge is $____, HOW MUCH ARE YOU GOING TO PAY TODAY”. If they “forget” their checkbook, they are told, “That’s ok, we accept MasterCard, Visa, Discover and American Express” If they decline those options they are handed a self addressed envelope and told “Here is a convenient envelope to mail your payment back in--please write the check and send it out when you get home”. Sure, some people will figure a way around any systems, but ours has consistently produced a collection rate that exceeds 90%. It has become much more complicated with mangled care because of the varying amounts of co-pays--and our patients are told “Please check with your insurance company to find out what your co-pay will be--if you don’t know the exact dollar amount at the time of service you will be expected to pay 50% of the charge at the time of service—if your copay is less, the difference will be applied to future sessions or rebated back to you once the insurance company begins to pay” One doctors’ office in our area had a sign up indicating that there would be a $20 charge added to each patient’s account every time they did NOT pay their co-pay at the time of service. I am not sure that is even allowed within the contracts of managed care contracts but it is an interesting approach. I do not think that your age is the issue--it is just the nature of some people to avoid or even not pay their bills. The physicians treat the same people and, I know, have the same problems. The mechanics are different, if they don’t get paid, they do not release the car. The closest I come to that is that I will NOT dictate written reports in many (especially forensic) reports until and unless there is a zero balance. Obviously, the issue of “emergency” is considered, but, in most cases, many people who are simply transferring care--or trying to get the benefit of the services without paying for them, are not in an emergency situation. The reason I do not DICTATE the report is that a court cannot subpoena or others cannot demand a report that is not written--I also have not scored, analyzed, interpreted or even prepared a rough draft of such data and therefore, could not formulate an opinion at all so I can’t be called to testify about an opinion that has not yet been formed. Beverly Celotta concludes: I always ask clients to pay when they first come. This is written in my practice information sheet. If they forget, I give them a stamped self-addressed envelope and explain, jokingly, that the stamp is to make them feel guilty. I then remind them that I need to receive payment before their next scheduled session. This has worked with almost all. In fact, since I have been MC and insurance free, I rarely have more than $100 in collectables at any one time. Since I am not psychodynamic, I do not go into the motivations or dynamics. I just would like to be paid and so engineer it so that I am. |
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