The Practice of Therapy

Gordon Brewer 0:00
This episode is brought to you by therapy notes, therapy notes calm. They are the leading Electronic Health Record system for private practices in the mental health field. They're who I use in my practice, so be sure and check them out therapy notes.com.

This is the practice of therapy podcast with Gordon Brewer, helping you to navigate your private practice journey.

This is session number 192 of the practice of therapy podcast. Hello, folks, I'm Gordon Brewer. glad you've joined me I hope you're having a good August as I'm putting this particular episode out. And, you know, it's hard to believe that fall is just around the corner I her heard advertise some pumpkin spice stuff. I'm not a big fan of pumpkin spice. But seems like that's more of a fall time thing. But I guess since kids are back in school people think that it's fall already. But it's not. It's still August. So anyway, I don't want to get too far off on a tangent here. But anyway, I'm glad you join me for this particular episode. And this is going to be a solo episode. And one of the questions that I get asked a lot is just around the structure, how to structure your practice. And so what I thought I would do in this particular episode is just walk through with you how I have my practice structured, not that it is the complete correct way to do things. But it makes sense for me. And I just want to walk you through that kind of how I've got things structured in my practice from the time we receive an intake from from a client until the time we discharge them just kind of all the little things that happen along the way, and particularly on the clinical side, but also the business side of things. So looking forward to you hearing for me just kind of walking you through all of that. But before we get to that, I'd like to let you know about a few things that are upcoming, some events that are coming up, and also just some new things that I've got coming out. So the first one is that if you listen to the last episode, Episode Number 191, you heard a talk with Whitney Whitney and James Owens about the enneagram. And they are putting together I've put together a full c course on using the enneagram in your practice, both on the clinical side of things, and also using it with your staff if you're a group practice. So it's really great stuff, I really got interested in the enneagram this past year, and just did a lot of deep diving into that of really how to use that particular instrument or that particular measure of personality. And what I like about the enneagram over, say the Myers Briggs, which is really kind of the gold standard for for personality assessment. I like the nine types of the enneagram. Just that it, I think it's more user friendly. And also, it goes in deeper into the motivation behind why we do what we do or why we see the world as we see it. So anyway, I'm looking forward to you finding out more about this. And if you go to practice of therapy.com enneagram course, that'll be a direct link that will get you to the signup page to enroll in that it's gonna be a live course, they are going to teach it live on through webinar ninja or something like that. They're going to teach the course. And then you'll have access to it afterwards, to continue to use it as a study thing and also get your CPUs and the dates for that are September 20 and 21st. It's going to be a two day kind of event online event. But I encourage you to check that out. Whitney is a good friend and James her husband is just a gem of a guy get to getting to know them better. And they're doing this in conjunction with our friend Dr. David Hall over at psych Maven. So anyway, be sure and check that out. The other thing I want to let you know about is killing a camp. It is coming up in October and it is an event that is put on by Joe Sanok and the folks over at practice of the practice. I'm going to be one of the speakers this year again. Last time we did it live was in 2019 But I can tell you, that was a it was one of the best events I've ever been to and you talk about a more, you couldn't ask for more beautiful location. It's in Estes Park, Colorado and which is right. The conference itself is being held at the YMCA of the Rockies. Denver Airport is easy to get out of. And the the wildlife there which YMCA of the Rockies is right on the border of Rocky Mountain National Park, I remember just the elk running just kind of kind of like her here in in East tennety. See, it would be squirrels. But in Estes Park,

it's out there, just prolific and everywhere. But anyway, killing it camp is really becoming the premier private practice conference. And it is a great place to network, and learn from lots of experts in private practice and, and also just learn from others on how they're running their practices. And there are several different tracks you can take with this. But if you go to practice of therapy.com, slash killing it camp, and again, there'll be links in the show notes here. And I'll make sure we have those links up and available. That'll get you to the landing page to register for that. But you might want to hurry because it's going to fill up pretty fast and want you to grab your spot, we are taking COVID cautions I've been talking with Joe about that. We're asking everyone that comes to the conference to be fully vaccinated. And we're gonna Of course, where I'm asked and just follow all the CDC protocols for the conference. So anyway, check it out, it's coming up fast. Oh, I forgot to mention the dates. It's October 14 through 17th. So be sure and check that out. So it's going to be a great conference. And then finally, before we get to my two more things, before we get to my discussion about how to set up your practice or how to structure your practice, be sure to check out the new course that I've got. Coming out, I'm doing the pre launch right now. And it's using Google workspace as a practice platform. And I'm going to talk about a little bit more about that. That how I use it in my practice. But the pre launch of the course that goes into a lot of detail. And the nitty gritty is happening this month, during the month of October. And you can get a significant discount on that by doing the pre launch of that, and you'll get access lifetime access to the course, and also get things as they get loaded. So you can go ahead and get in on the on the front end of that practice of therapy.com slash g w s platform, that'll get you to the teachable page to enroll at the discounted price. So be sure and check that out. And then also, before we get to talking about how to structure your practice, be sure and check out therapy notes. And I'm going to talk a little bit more about that, again, in this episode here a little lighter. But therapy notes is a wonderful sponsor of this podcast. And you can check them out at practice of therapy.com slash therapy notes and be sure and use the coupon code or the promo code, just Gordon, g o r d o n and you can try them out for two months free. So that's all the announcements and the things I wanted to tell you about before I jump in here and talk about how to structure your practice.

You know, one of the things that I get a question, get a lot of questions about is just about how to structure things in your practice. And so what I mean by that is I get a lot of questions about how to set up systems and processes and the best way to do intakes the way the best ways to do documentation. Also, the best way to set up your pricing structure also questions about you know, how do you build clients? How do you file for insurance, all of those things that people ask about, and just thinking about running a practice. The other thing I get asked about or you know if you are a group practice, what's the best way to pay people and, and all of those kinds of things. So what I want to do is just kind of give you a walkthrough of how I've got things set up in my practice and my practice is Kingsport. counseling associates. And we're a small practice, located in East Tennessee, we're in the northeast corner of Tennessee. And I have currently I've got four other therapist one, including one and term that are working for me as employees of, of my practice. And so they are all licensed people or pre licensed people. And we do we mainly work with just a broad range of different issues, anywhere from just individual work around anxiety to doing marital work to doing I do a lot of work with men that are struggling with pornography and sex addictions also do a lot of work with couples around infidelity, that kind of thing. And then we have two of our therapists that work with children. I don't work with children. But that's a whole other story. But you know, it's a fairly, fairly general, you know, practice in that sense. But anyway, I'm going to walk you through just kind of how I've got things set up and maybe hopefully give you some things to think about. One thing I'll say, on the, on the front end of this, the way I have it set up is not necessarily the correct way, and I'm using air quotes here, the correct way to to set up your practice. But it's what works for me. And I think ultimately, that's what you have to figure out for yourself, is what is going to work for you What makes sense to you. And just thinking about your workflow, how your practice ties into your lifestyle, and all of that sort of thing. So anyway, let me walk you through just kind of how we think have things set up. You know, as I think about walking through this, maybe the logical place to start is just thinking about how we do our intakes. In my practice, we've in addition to the other clinicians that are working with me, we also have a part time intake coordinator Nikki. And the way we have it set up is that probably the vast majority of people that come to us usually is through our website, Kingsport counseling calm, they find our website, they've done a Google search, or they found us on Facebook or any number of places, the other place that our referrals tend to come from, we do get a fair amount of direct referrals from like doctors offices, that sort of thing, but also insurances. We are an insurance based practice, and we get a lot of referrals from people that find us in the insurance company directories. And so people will contact us and any any number of ways, but predominantly, they just give us a call our we have an 800 number and also a regular number. And all of our phone calls are handled through an application that we use called phone Comm. And I'm going to include links to all of these things in the show notes of the things that I mentioned here. But phone comm is a HIPAA secure VIP

service for four phones, there are a lot of others out there. And I would say just research them to find out what's best. But when I stumbled on phone calm, I was using another service that wasn't HIPAA secure before this, and I thought they were but they weren't. And so we got to work through that. But phone comm has an app, an app associated with it so that our intake coordinator can just use the app on her phone at home to answer phone calls. And also it's got an automated voicemail system. So when people call in, they can leave us a message and then Nikki, our intake coordinator follows up with those. So one thing I'll say about that, is that when you're initially starting your practice, and one of the things that happens very quickly for people is when they start to fill up in their practices. Usually one of the first things they want to outsource is somebody to answer the phone. So I think it's good to have a system that's accessible from anywhere rather than just having maybe you can have like a dedicated cell phone number. But what I love about a vi o p system is you can access it anywhere but again, phone comm works for us and it allows us for people to leave messages. It also allows Niki to return phone calls from the app so that her our work number shows up on people's caller ID so that they're not, she's not giving out her actual cell number. So that's one one feature that I like about phone comm also, I can set up individual inboxes or voicemail boxes for all of our therapists. And so it's like, you know, it's essentially your virtual phone system that just works really well. There is some setup involved to it. But again, you can check out the links here in the show notes to phone comm or just simply go to phone comm to check it out. So anyway, that's kind of the starting place for people also, they will fill out some of the contact forms on our on our website. And those are routed to both me and to Nikki, we have an info at Kingsport counseling comm set up through Google workspace. And it's routed to both me and Nikki in our, our email. So she gets it first, the backup for that. And then if I'm out of town, I have somebody else back me up on that. So that way, any calls that come in, or any peep any people that ask about our services or want to make an appointment, he gets routed through Nicky, first our intake coordinator, and then I'm the backup and then other people backup at various times, depending on our situation. So the other thing, the other tool that we use when we as far as our structure goes is Google workspace. And as anybody that's been listening to me for a while know that I'm a huge fan of Google workspace, and Google workspace is what we use for email system within our practice is just through Gmail. And I've got, as I've mentioned, before, I got a whole course that I'm in the process of getting out there, it's in the pre launch on how to use Google workspace as a platform in your practice. And in particularly the business side of it. So things like communication with clients, things like letters, things like one of the other things, we use Google workspace for contact forms, intake forms, that kind of thing, are all done through Google workspace. Also just I use Google workspace for some of the metrics and some of my dashboards, of just being able to track things within our practice. So the number of number of referrals we've gotten the number of

people that convert, so to speak, are in other words, somebody that calls us, and then they set an appointment. All of those things I track on Google Sheets, or using Google Forms, those kinds of things. Also, there are a lot of other little perks to Google workspace, like Google Keep as a way for me to kind of track reference materials, that kind of thing. Again, a lot more to go into it than I then I can in this particular episode. But if you go to a practice of therapy.com, slash JW s course, which is the original Google workspace for therapists course, which goes over the basics of all the different tools of Google workspace, and some of the ways that you can use them in your practice, but also the new course, which is practice of therapy.com GWS platform, which tells you how to use those tools, and then set them up in a platform for your practice. So the other thing that I use Google workspace for is I've got a staff portal that I created using Google Sites. And it's, it's just an internal web page that we use, you can go there, and people can click on links to get to our therapy notes portal, also to our web page to our forms. What are the other things that we've got links to they're just, Oh, we've got a local directory that we that I've set up for the local therapists that we can refer out to and other resources that are there. So it's just a portal that I set up for our staff to use also our employee handbook, all of those kinds of things are all within that portal with quick links. So anyway, getting back on track, so getting back to the intake, so Nikki contacts the people or she talks to him directly, and she sets up our appointment. Now the appointments are all set up in therapy notes, and let me explain Why I'm using therapy notes, and Google workspace. The one thing about therapy notes that I absolutely love is that it's also linked to a clearing house. And with our practice, since we're insurance based, all of the insurance claims are filed through therapy notes, and that we set up the patient biographical information, we do our documentation, all of that sort of thing is handled through therapy notes. In other words, the whole clinical side of our practice, is managed through therapy notes. Now, there is a little bit of overlap with that, in that there are some forms that we have at Google workspace. But we, primarily, we use therapy notes. So if a new person comes to us, and we asked them to do the intake information, we send them to the therapy notes portal, we send them an email that from that gives them access to the therapy notes portal, they fill out all of their intake paperwork online through therapy notes. And then we do all of the individual patient billing through therapy notes. And so all of that clinical stuff, again, is handled through therapy notes, which our staff was at. I can also within therapy notes, run some various reports, looking at the number of sessions we've had, also look at, you know, our accounts receivable, in other words, what insurance companies owe us, all of those kinds of things. Now, as far as the filing of the individual insurance claims, I've got that outsourced as well, through practice solution. So

one of the things you run into with with insurance companies and taking insurance is that it's as much as I'd like for it to be seamless, which for the most part, I would say 80 to 90% of the time, it is pretty seamless, we enter the information in therapy notes, we fill out our our progress notes, or session notes, and do all of those things. And once we've saved those things, it syncs therapy notes has built into that, to set up the claim to be set. So what practice solutions does is they go in, and they look at all of that information to make sure that the claims are ready to be sent in. But also on the back end. They're the ones that do the follow up if there's a problem with the claim, or the insurance company is rejects the claim for any reason, all of those things are very time consuming. And so I've got that outsourced. Now, that doesn't mean if you know if you're a solo practice, and you have the time to do those things, you can do all of that in conjunction with therapy notes, but for our size, practice is much more cost efficient for us to outsource that. So anyway, we do we do a session now. We enter that and we save the note the note is locked and therapy notes. And then every week's their practice solution goes in. And they scrub the play. Actually, the the software scrubs the play of the claim. But they they follow through on all of that on the back end with the billing of insurance. Also what they do, which is another thing that you run into with insurance practices is a lot of times we might not know what the copay is for clients, they send out statements to clients that still owe us money. So also the way we've got things structured is that each individual therapist within our practice sets their own schedule. And they also are made aware of when clients I was money or we need to collect a copay. So they're notified about that and they a follow up that we follow up individually with each client about what they owe us if they owe a copay or not. So again, on the collection side of thing which really overlaps into the into the business side of things. It's therapy notes as a wonderful platform for handling all of that. The other thing that's nice is within therapy notes as it's got a telehealth portal that can be used to do sessions with people back during COVID we were using several different ones because, you know, internet connections can can vary from one place to another. And some of us working at home, some of us in the office, that kind of thing, we were using a combination of doxy made doxy. Again, it's just do x y.me. And would they had a free a free version that she could do telehealth with, again, all of these, all of these platforms are HIPAA secure. The downside of the free version of doxy.me is that you could only do, you could only see one client at a time. So if you had a couple, they couldn't log in from separate locations that have to be in the same room together. The other one we used as Google meet, again, part of the Google workspace platform. And then we were starting to use the telehealth portal within therapy notes. But it was we had our system down around communicating with clients about telehealth sessions. And also I had created just a template within Gmail so that when it was time for their session, we'd send them a premade email that had all the links in it and that sort of thing. So okay, so how they schedule a session, we have the session, we do our documentation in therapy notes, we collect from them and enter that information in therapy notes.

Going back to the intake, we use phone comm as our phone service that is HIPAA secure. See, I'm trying to think of all the different tools that we use. The other other tool that we use for faxes is a service called s fax. Again, it's a HIPAA secure, online Fax Service that we use. There are several others out there. I liked s fax, it was one of the first ones I discovered. And it's just we've gotten used to using it. So if we need to, like fax providers or fax things to people, that's what we use is s fax for that. So our intake quarter gets everybody set up gets the initial information, gets the clients to sign the forms online, through therapy notes, then they pay us and the individual client payment records are all handled through therapy notes. But on the business side of things I need to handle, be able to track the business side of things. So I do that in common. A combination of using Google, Google Sheets, I see it have different ways to track what we bring in through Google Sheets. But also, I use QuickBooks as my main accounting software. So one of the things about using QuickBooks though, is you have to be careful about not using client names. So in QuickBooks, if we receive a payment from a client, I've just got it labeled as a client payment, or if it's a payment from insurance companies, and I've got the individual insurance companies listed in there as customers, and a lot of information, I got too much information to go into around QuickBooks. But again, just thinking about the money side of things I do, again, have a course out there called money matters in private practice. And it goes into the whole accounting side and financial side of running a private practice. And you can get to that I go into practice of therapy.com slash money matters. But anyway, what I was gonna say is we collect from the patient, we are the client, and we enter that in therapy notes. And then we have a it also therapy notes has a way to to stop a built in credit card management system in there as well through card merchant, I think it is. But all of that when somebody swipes a card and we collect from a patient, it just goes directly into the bank. And so again, it's very hands free. And so with QuickBooks, I'm then able to go in and download from the bank the payments we received. And the one thing about QuickBooks is that it recognizes who the payment is from and it automatically puts it into the right account within QuickBooks, and that's one of the benefits of using a dedicated accounting software like QuickBooks. You could also use set up some Google Sheets, but one of the things is, is once you start growing, you really want to use something like QuickBooks or freshbooks. Again, use what your accountant might recommend for you to use. QuickBooks has kind of the gold standard about that with with those kinds of things. But anyway, we collect the payments from the clients. During throughout that once a week, I go into QuickBooks download from the bank, the payments that we've received, either from credit cards or insurance companies. Again, one of the things about structure, the more you can have things set up on direct deposit, the less you have to handle it, we still have a few insurance companies and vendors that send us checks directly. So I'll go through, and we have clients that write checks. So about once a week or every other week, I'll, I'll go in and get those checks and make a deposit and take it to the bank. But again, all of that entered into QuickBooks. And let's see what else so with discharge from clients, again, all of that is a clinical kind of thing. And we handle that through therapy notes do the discharge plans. Also, I didn't mention treatment plans are done in therapy notes. And so.

So that's basically the structure we did from intake to discharge. We handle our intakes and do the intake paperwork through therapy notes. Sometimes we have people that aren't as computer savvy, and we do have forms that we can send to them, you know, paper forms. And we can mail those to folks. Once we do the intake with them in the office or online, we start entering our clinical notes and clinical documentation into therapy notes. Communication is handled through either Google, Google Gmail or through s fax if we need to communicate with referral sources, that kind of thing, or send any documents out. See, am I missing anything? Practice solutions, does the follow up on our insurance claims. But all of the incharge claims are generated automatically in therapy notes. For if we're filing insurance. Oh, the other thing that I get questions about are just about payment and your pricing structure. Let me tell you a little bit about that. Before we kind of wrap things up here. One of the things that we of course being insurance based, is that what we get paid is based on our individual, individual contracts with each insurance company. And so it varies to some degree, depending on our provider contract with those insurance companies. And right now we just got a handful that were credentialed with Blue Cross Blue Shield Cigna at Humana try care amerigroup levy somebody united healthcare, behavioral or optim. Those are some of the some of the different insurance companies that were credential through either individually the individual providers or or as a group. But what do we do one of the things that we do we offer to people, if they don't want to use their insurance, or they don't have insurance, we have a sliding scale. And it's just a three tier sliding scale. Our full price is at the top tier of that full price for our practice. Then there's a middle thing there and then a lower one, the here, here's the hot tip on this, our lowest, our lowest tier on that sliding scale is the average of our insurance, our insurance reimbursement rate. So think about that you can create a sliding scale. And so what that helps me with is when I run my numbers or whatever, I have an average reimbursement rate that I know that I'm going to get from insurance companies. And so the lowest tier on our sliding scale is equal to that amount. So that's one reason why it's important to know your numbers is to figure those things out. And what we do is that there's no we have to accept people's insurance. If we are credentialed with that insurance company, that's part of our contract. But if we are not credentialed with that insurance company, we don't necessarily have to take that. So that's why we offer that sliding scale. The other thing too, is that there are people out there that don't want to use their insurance to pay for services, particularly when they know that we have to give them a diagnosis, if we file insurance, and they might not want that. So we offer them the sliding scale. So the other the other quick tip on insurance or buying insurance, is when you file an insurance claim, always put your full price on that insurance claim, not the contracted rate, because the insurance company's gonna pay you what they're going to pay you based on your contract rate, but always submit the full amount. And that's kind of a standard practice across the board and filing insurance claims. So you know, doctors offices do the same thing. So the services that I use for my practice, are, again, found calm for my phone service, use Google workspace for email, and documentation, not clinical documentation, but like writing letters, all of those kinds of things. Also use Google Drive for some

non clinical file storage, storage, all of that kind of thing is used in there. Again, you can check out the courses that I've created, talking about how to use those different things. And then therapy notes we use for the clinical side of things, in terms of patient documentation, clip, clinical notes. Also, having a place to store intake forms, all of those kinds of things is all done within therapy notes. We use s fax, for Fax Service, we use card merchant through therapy notes, it's built into therapy notes for swiping credit cards, I use QuickBooks for my accounting software, as far as entering what are our general income and expenses and all of that sort of thing, or going through that. And, yeah, so there's so much more I could cover here, and just not enough time. One other one, or the thing I use, that I'll mention here that's more related to the business side is gusto. And gusto is the payroll service I use. And that is where I'd enter our payroll twice a month to pay my clinicians, and also through gussto, we are able to get our health insurance for those that need health insurance, all through gusto. And you can go to practice of therapy.com slash gusto. And you can find out more about that full disclosure, that's an affiliate link. So if you sign up for gussto, through that link, I do get a commission at no extra cost to you. So that's another quick tool there. So, boy, that was enough. That was a lot for this episode. I'd love to get your feedback on this episode and questions that you have. And you can email me at Gordon at practice of therapy.com. I love getting feedback from people. And also be sure to follow us wherever you're listening to the podcast. So anyway, thanks for joining this particular episode.

Well, folks, thanks for joining me for this episode, as I hopefully gave you an explanation of just kind of my structure and how to one particular way to structure your practice. There are a lot of moving pieces, obviously, in a practice. And as you move into group practice, they're even more moving pieces. But one of the things I'll say just in closing is, is spend some time on creating some systems and processes that make sense to you. And which ever platforms or software's you choose to use. Just make sure they make sense to use course a big fan of therapy notes, but they they're not the only ones out there. But I would do, I would say compare but I can. I can honestly say that therapy notes is not what I'm going to switch from anytime soon. And there are also a sponsor for this particular podcast, which I'm very grateful for and you can check them out by going to practice of therapy.com slash therapy notes and also use the promo code Gordon Glr do and and you can get too much of their services for free. So you can try them out for two months. And again, all the other resources I mentioned are in the show notes here for this particular episode. Also be sure and check out the Google workspace resources that I've got out there, I've got the Google workspace for therapists course, again, practice of therapy.com, slash GW s course. And then also practice of therapy.com slash GW s platform, which is the course that's in the pre launch that you can get a discount on. As I'm recording this was just goes into more detail than the original course on creating platforms. So Boy, that was a lot and be sure and check out the enneagram. That's coming enneagram course that's coming up. And then you can find links in the show notes here for that. So that's a lot, folks. And thanks again for joining me for this particular episode of the practice of therapy. And be sure and take time to follow us wherever you might be listening to the pod cast, whether it's on Apple podcasts, or on Spotify or Stitcher or amazon music, or even audible now, there are a ton of ways to listen to podcasts anymore, but take time to follow us. And also, leave us a review. I love getting honest feedback about the podcast and give us a rating and that just helps other people find us. So hopefully this has been a helpful episode to you folks, and take care. And we'll be talking to you next week. We've got some exciting guests lined up. So I'm looking forward to hearing from Take care.

You have been listening to the practice of therapy podcast with Gordon Brewer. Please visit us at practice of therapy.com for more information, resources, and tools to help you in starting building and growing your private practice. And if you haven't done so already, please sign up to receive the free private practice startup guide and practice of therapy.com. The information in this podcast is intended to be accurate and authoritative concerning the subject matter covered. It is given with the understanding that neither the host guests or producers are rendering legal accounting or clinical advice. If you need a professional, you should find the right person for them.