Starting a Private Pediatric Practice

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Kim Hazelton in Lutz, Florida

65 months ago

There are quite a few resources out there available for those of us trying to work independently. I have used the ebook "The Independent Clinician's Guide to Private Patients" from The Independent Clinician at www.independentclinician.com, and the DVD course "Starting and Running a Pediatric Private Practice" from Therapy Seminars at www.therapyseminarsllc.com. The DVD course also provided me with 6 hours of continuing ed. While they both have a lot of helpful information, there were still areas that I felt were not covered by either resource and I've just had to take a giant leap of faith and do what I thought was the right next step.

Susan, I worked in the school systems in TN for over 9 years and got burnt out over the limitations to therapy in that setting, so I have not looked into contracting with the schools now that I've started my private practice. I did work for a private clinic that has a contract to work for the special needs charter schools (which fall under the public school umbrella) here in Hillsborough County Florida, so I would assume it's possible to contract with the school system here as a private practitioner. I don't believe the schools have a no-compete clause for anything.

I'm not sure how to answer your question regarding being a sole provider getting on insurance provider lists. I have recently finalized several contracts with insurance companies, but I incorporated my business. So that may be the difference (sole provider vs. small corporation). The problem I'm running into with the insurance companies is that they are refusing to pay for home visits for the children I see. They are willing to approve clinic visits, but I don't have a clinic (yet). So the majority of my patients are still private-pay. Needless to say, in this economy, it's more difficult to find parents wiling/able to pay for therapy out of their own pockets.

I hope I've been able to provide some helpful information!

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Fran OT in Colorado Springs, Colorado

65 months ago

Outpatient therapy can be provided in the home, a clinic, or the therapist's office. There is no difference in reimbursement from the insurance companies. I have found it is sometimes easier to get insurance contracts as a solo practitioner, but sometimes you don't even need a contract.
The book "The Small Patient Practice" was just published this year and addresses most of the things Pediatric Therapists face when dealing with insurance companies, including current trends.
Most school districts don't expect Medicaid to cover the full cost of services, they just look at it as supplemental income for services they are already required to provide.

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kimhazelton in Odessa, Florida

65 months ago

Fran, I agree with you in theory, but in practice I have not been able to get the insurance companies to agree to paying for treatment in the home. I met with the Tricare/Humana representative and was told in no uncertain terms that they WOULD NOT cover treatment provided in a patient's home. And I'm in discussions now with CIGNA because my contract states that therapy services provided in any location other than the one listed on the contract (which is my home address) are specifically excluded. I had one Medicaid pt a few years ago, and they DID pay for the home visits. Maybe I'm not working with the right insurance companies! lol If you have any hints or advice to get the reimbursements, I'd definitely appreciate them!

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Fran OT in Colorado Springs, Colorado

65 months ago

I am a Tricare provider and I see all of my patients on an outpatient basis in their homes. Every insurance company has a policy that both parties will comply with Medicare rules. You can cite
Medicare Benefit Policy manual, Pub 100-02, chapter 15, 230.4

as your authority to see outpatients in their homes. Even though you are seeing children, the rule still applies.
But most important, not all of the employees of every insurance company understand or need to know this rule. Most will think you want to provide home health care and that will not be authorized, because the patient would have to qualify for home healthcare services provided by a home healthcare agency. The people who need to know this rule (payment office) will know it.
So when you request an authorization for services, do not mention 'in the home', just say outpatient OT, then when you actually bill for the services and use outpatient OT codes with 'patient home-12' as location of service, you will be paid. Your office is still the office your have listed with the insurance company and that is still the office you work from, but the location of service is the home.
I have to admit when I first started doing this, I did have a stand-off with one of the TRIWEST case nurses, but I finally contacted a higher level administrative supervisor who was quite aware of the rule and I never had a problem again. It is best to avoid the angst of confrontation, you just need an outpatient authorization and it will be up to you to correctly bill for payment.

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kimhazelton in Odessa, Florida

65 months ago

Fran, Your response was incredibly helpful! Thank you so much for taking the time to provide such detailed information. I will definitely use this information in my current talks with CIGNA and Tricare/Humana, as well as with future insurance contracts.

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JoanJOT in Portland, Oregon

63 months ago

I live in Portland Oregon and just started a LLC -I am attempting to see patients in their homes/schools/communities and am going through the insurance credentialing process. This conversation was very helpful for me. If anyone has other words of advice, I would greatly appreciate it. I am using my home address as the LLC and hopefully will be able to have an office space eventually. What do you all think are the best marketing strategies to use?

Thanks much

JoanJOT
Oregon

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JoanJOT in Portland, Oregon

63 months ago

I live in Portland Oregon and just started a LLC -I am attempting to see patients in their homes/schools/communities and am going through the insurance credentialing process. This conversation was very helpful for me. If anyone has other words of advice, I would greatly appreciate it. I am using my home address as the LLC and hopefully will be able to have an office space eventually. What do you all think are the best marketing strategies to use?

Thanks much

JoanJOT
Oregon

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kimhazelton in Odessa, Florida

63 months ago

JoanJOT,

Congratulations on starting your private practice! I started mine a little over a year ago and am still seeing pediatric patients in their homes and preschools at this time. I would love to be in an office, but I don't have a caseload large enough at this time to support it.

In addition to the advice offered in this thread, I would also recommend that you join LinkedIn if you haven't already. I have recently joined LinkedIn and have gained a good deal of information on there in the specialty groups.

Good luck to you in your new venture!

Kim

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OTR in Grovetown, Georgia

63 months ago

Is a physician's referral needed for private pay clients?

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OTR in Grovetown, Georgia

63 months ago

JoanJOT in Portland, Oregon said: I live in Portland Oregon and just started a LLC -I am attempting to see patients in their homes/schools/communities and am going through the insurance credentialing process. This conversation was very helpful for me. If anyone has other words of advice, I would greatly appreciate it. I am using my home address as the LLC and hopefully will be able to have an office space eventually. What do you all think are the best marketing strategies to use?

Thanks much

JoanJOT
Oregon

How did you start your LLC?

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OTR in Brandon, Florida

63 months ago

Kim Hazelton in Odessa, Florida said: JoanJOT,

Congratulations on starting your private practice! I started mine a little over a year ago and am still seeing pediatric patients in their homes and preschools at this time. I would love to be in an office, but I don't have a caseload large enough at this time to support it.

In addition to the advice offered in this thread, I would also recommend that you join LinkedIn if you haven't already. I have recently joined LinkedIn and have gained a good deal of information on there in the specialty groups.

Good luck to you in your new venture!

Kim

Kim,
I am a member of LinkedIn as well. What groups have you joined to assist you in researching?
I am a member of LinkedIn as well.

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kimhazelton in Odessa, Florida

63 months ago

"Pediatric and School Based Therapy Group" and the subgroup "Pediatric Therapy Clinic/Private Practice Owner/Manager Subgroup" have been the most helpful. I use the message boards to ask questions and get advice from other members.

I have also found another private practice OT in another state and we help each other out. We discuss insurance questions, continuing ed (actually met each other at one!), and other business issues. I have found this to be a very helpful relationship without having to worry about being in competition.

Are you a private practice OT? You're not too far from me. If you'd like to share tips and questions, feel free to message me.

Best of luck!

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natalie in Grovetown, Georgia

63 months ago

I am at the very early stages of developing a private OT practice...I am doing a lot of research (indep clinician and Iris Kimberg's site)...For those already in private practice, I have two questions...how did you choose your malpractice insurance? and how did you set-up your business website? Any info would be greatly appreciated...

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JoanJOT in Portland, Oregon

63 months ago

Thanks for all the advice! I just started my practice, got my state business license, and finally got my liability insurance. HPSO is fair to go through, although their rates were high for me since I will be providing therapy in the community. I am working on logo and website design, as well as insurance credentialing.

Does anyone use a company to help bill insurance? If so, is it worth it? What about documentation? Do you do this online for insurance billing or use a type of electronic online record for evals/notes?

JoanJOT

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kimhazelton in Odessa, Florida

63 months ago

Since my practice is still relatively small, I only have 2 insurance clients at this time. I have found OfficeAlly (www.officeally.com) to be a good way to bill insurance companies. They're FREE to use, and after you sign up, they will give you a free tutorial over the phone. Once you do one or two claims, it's relatively easy.

They also have other products to help you keep track of scheduling, do billing, documentation, etc. I am able to keep track of all of this on my own at this time, but will definitely consider using them for these services in the future when the time comes.

Hope this has been helpful!

Kim

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OTR in Brandon, Florida

63 months ago

How did you market yourself besides using a website? I'm looking for ways to generate traffic to a website. I believe if people see a respectable looking website, they would be willing to try you out.

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kimhazelton in Odessa, Florida

63 months ago

Therabill,

Can you tell me where to find the reviews you are referring to? As I said in my last post, OfficeAlly is meeting my needs right now. But as my practice grows and I have a need of additional services, I'd like to be able to look at reviews before committing to a company or program.

Thank you.

OTR in Brandon,
I have gotten the majority of my clients from word of mouth. I started with one patient, and his mother told a friend about me, and so on. I have also talked to Moms' Groups and done free screenings at some local daycares. To be honest, the daycare screenings were very time consuming and didn't yield the clients I had hoped. I have gotten a few clients from the Moms' Groups and they have referred me to their friends as well. The website seems to be most helpful AFTER a parent has either met me or heard of me from a friend. It's just a way for them to gather more information about me before they contact me. I believe it helps to have a picture of yourself on the website too. Several parents have mentioned that they liked seeing what I looked like before they called me or had me come to their house.

I hope this has helped.

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Therabill in Grayslake, Illinois

63 months ago

In addition. Please see the member reviews of Therabill at therabill.healthcarebillingreview.com/

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Therabill in Grayslake, Illinois

63 months ago

Ok. Sorry it took so long to get back to you. Me and my wife had a baby on Sunday night (we weren't expecting him to arrive until October 7th).

Here is a link to the KLAS performance ratings of Office Ally as a clearinghouse. www.klasresearch.com/Research/Segments/?ID=132
They used to have one check in the confidence rating... but they have lost that one checkmark and now have zero confidence ratings.

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JoanJOT in Tolleson, Arizona

63 months ago

Has anyone had success in providing parents with a reciept/bill and having them submit themselves for out of network reimbursement? Im considering taking private pay clients only to start (which will significantly decrease the patients I can see) until I get certified through all the insurance companies.

Also, has anyone used an online documentation system? I will probably use office ally for billing, but what about a EMR for daily documentation or evaluations?

Thanks much for your suggestions

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Therabill in Grayslake, Illinois

63 months ago

Hi Joan,

Billing the parents and having them submit the claim to insurance is very common. Most insurance companies will allow you to submit claims them even if you are out of network, however, a lot of them will require that you share your NPI with them before you can submit electronically and a lot of them will send the check to the parent if you are not in-network.

Many Therabill members will give the parent a bill (using the client statements available in Therabill). At the same time, they will create a pre-filled CMS-1500 claim form (which you can do in Therabill, but I don't think you can do it Office Ally). The parent will pay them and then they hand the parent the CMS-1500 which the parent can then send in to insurance (some members will even submit the initial insurance submission for the client). It really is a nice touch. If you do it this way, it will be an easy transition when you begin billing the insurance yourself.

As for documentation. Therabill does have the ability to enter therapy notes. Check out www.youtube.com/watch?v=Pc3-v4akBqw for a video on taking notes in Therabill. You can view other instructional videos at www.therabill.com/videos/how_to.php. I believe you can add on EMR into Office Ally, but then you would be basically paying the same as a normal Therabill account which includes, billing, scheduling and notes.

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JoanJOT in Pasadena, California

63 months ago

Thanks so much for the great advice! I really appreciate all the input and resources everyone has shared with me.

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Therabill in Grayslake, Illinois

63 months ago

Please keep Therabill in mind for the future. After you have used Office Ally for a few months, you might want to come and try Therabill for the 30 day free trial. Therabill likes it when therapists try other software first, those therapists tend to appreciate Therabill more when they use it :) You can't believe the number of times I hear the phrase.. "I wish I would of found Therabill a long time ago".

You can try Therabill for 30 days with no restrictions and not credit card needed up front. Try it with one or two patients... then if you find it doesn't meet your needs, you can just walk away and you wouldn't have invested too much time in it.

Good luck with your new practice and I hope to see you in the near future.

Joe Dundas

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Marielly Mitchell in Los Angeles, California

61 months ago

Marie in Westminster, Maryland said: I'm thinking about starting a private pediatric practice and would appreciate any suggestions on where to get info. about starting one up. I especially need to learn about how to bill insurance companies.

Hello everyone!! My name is Marielly Mitchell and I am an OTD student at the University of Southern California. My capstone project is dedicated to developing a program for pediatric OT entrepreneurs who want to start their own practice. This program would connect OT entrepreneurs with mentors who would help them with the establishment and development of their practice, while also helping with incorporating concepts of Occupational Science into practice. I was wondering if you think this program may be of benefit to any of you and if you were interested in pariticpating? It's still in the begininng stages but Australia has a mentorship program that is working and the OTs there love it. Any feedback about what you would like to see in the program or any suggestions would be greatly appreciated. I plan on recruiting mentors from USC and posting advertisements and OTAC and AOTA conferences and in the back of OT Practice. Any suggestions are greatly appreciated and I wish you success on your future endeavors!

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Marielly Mitchell in Los Angeles, California

61 months ago

Marie in Westminster, Maryland said: I'm thinking about starting a private pediatric practice and would appreciate any suggestions on where to get info. about starting one up. I especially need to learn about how to bill insurance companies.

Hello everyone!! My name is Marielly Mitchell and I am an OTD student at the University of Southern California. My capstone project is dedicated to developing a program for pediatric OT entrepreneurs who want to start their own practice. This program would connect OT entrepreneurs with mentors who would help them with the establishment and development of their practice, while also helping with incorporating concepts of Occupational Science into practice. I was wondering if you think this program may be of benefit to any of you and if you were interested in pariticpating? It's still in the begininng stages but Australia has a mentorship program that is working and the OTs there love it. Any feedback about what you would like to see in the program or any suggestions would be greatly appreciated. I plan on recruiting mentors from USC and posting advertisements and OTAC and AOTA conferences and in the back of OT Practice. Any suggestions are greatly appreciated and I wish you success on your future endeavors!

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Therabill in Grayslake, Illinois

61 months ago

Marielly Mitchell in Los Angeles, California said: Hello everyone!! My name is Marielly Mitchell and I am an OTD student at the University of Southern California. My capstone project is dedicated to developing a program for pediatric OT entrepreneurs who want to start their own practice. This program would connect OT entrepreneurs with mentors who would help them with the establishment and development of their practice, while also helping with incorporating concepts of Occupational Science into practice. I was wondering if you think this program may be of benefit to any of you and if you were interested in pariticpating? It's still in the begininng stages but Australia has a mentorship program that is working and the OTs there love it. Any feedback about what you would like to see in the program or any suggestions would be greatly appreciated. I plan on recruiting mentors from USC and posting advertisements and OTAC and AOTA conferences and in the back of OT Practice. Any suggestions are greatly appreciated and I wish you success on your future endeavors!

Hi Marielly,
I have people contacting me all of the time at Therabill who are just starting new businesses and have many questions. I think having resource like you mention would be valuable. It would be a great place for me to point people to.

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redds822 in Virginia Beach, Virginia

57 months ago

I am in the beginning stages of trying to start and OT practice as well. I could really use some advice. I am getting stonewalled trying to get contracts with the cities to provide early intervention services and on becoming an approved provider for insurance.

does anyone know, if you decided to do a "group" for a group of moms and thier kids would you need a physicans prescription?

thanks!

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Hannah Kupchik in West Hempstead, New York

57 months ago

Do you want a partner

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Hannah Kupchik in West Hempstead, New York

57 months ago

Do you want a partner

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Kids_ot@*****.***

57 months ago

Hi Marielly,

It has been a few months since your post on the project you are doing. It sounds great and we would love to participate if you are able to still get people together. Good luck!

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redds822 in Virginia Beach, Virginia

57 months ago

Hannah Kupchik in West Hempstead, New York said: Do you want a partner

i am not sure who you were talking to....me or someone else...
i am in virginia beach.....not sure how that would work with you in new york? i was trying to get someone to go in with me, but that didnt seen to be working out....

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kgibson in Apopka, Florida

56 months ago

I am in the beginning stages of opening a pediatric therapy clinic in the Apopka, Fl area. Looking for part time OT, and ST.
email for more information.....

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Lindaot in East Elmhurst, New York

56 months ago

OT08 in Orlando, Florida said: I am in florida as well but in the Orlando area. Also in the process of starting a practice. Since just one person has replied with some suggestions...how about we try to share ideas...? I am two weeks away. I am in the process of obtaining medicaid number and advertising. There is also another program for 1-3 yrs old (at least in Florida) it is called early steps. You may also have it in Maryland. The website is www.cms-kids.com/default.htm .

Let me know how it goes.I have a friend with a private practice in Kissimmee.I know a few things about billing medicaid in Florida and am medicaid certified there.Right now I'm doing IC work up in NY but might be going back down in June.my mail s lindaotservs@aol.com. Fell free to write.

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kelly in Los Angeles, California

56 months ago

Hi everyone-
I recently started working as a school-based therapist but some of my previous clients from a clinic have asked if I would treat their children privately. I have malpractice insurance but just wondering if anyone knows what else I need to do. Do i need to obtain a business license as well? I would only be for 2 clients for now.
Thx

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ot08 in Orlando, Florida

56 months ago

Hi all! I have a small private practice just like many of you. I have a question for all of you working with learning disabilities, visual motor, visual perceptions, fine motor, sensory integration...(school age children). After working with children with the above mentioned deficits, have you had any luck at all with getting reimbursement back? Thanks to all for sharing your experiences.

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ot08 in Orlando, Florida

56 months ago

Lindaot in East Elmhurst, New York said: Let me know how it goes.I have a friend with a private practice in Kissimmee.I know a few things about billing medicaid in Florida and am medicaid certified there.Right now I'm doing IC work up in NY but might be going back down in June.my mail s lindaotservs@aol.com. Fell free to write.

Thanks so much. I will email.

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ot08 in Orlando, Florida

56 months ago

redds822 in Virginia Beach, Virginia said: I am in the beginning stages of trying to start and OT practice as well. I could really use some advice. I am getting stonewalled trying to get contracts with the cities to provide early intervention services and on becoming an approved provider for insurance .

does anyone know, if you decided to do a "group" for a group of moms and thier kids would you need a physicans prescription?

thanks!

This is just a guess but pretty sure that this is a no because you would not be treating their children. Most likely you would be offering useful information to the parents.

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kimhazelton in Odessa, Florida

55 months ago

Hi everyone-
I recently started working as a school-based therapist but some of my previous clients from a clinic have asked if I would treat their children privately. I have malpractice insurance but just wondering if anyone knows what else I need to do. Do i need to obtain a business license as well? I would only be for 2 clients for now.

I'm not sure about what you would need to do in CA, but in FL we do need to have a business license. It's relatively inexpensive here ($30). A good accountant or your local SCORE/SBA should be able to provide more relevant input. Best of luck to you!

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kimhazelton in Odessa, Florida

55 months ago

OT08 in Orlando, Florida said: Hi all! I have a small private practice just like many of you. I have a question for all of you working with learning disabilities, visual motor, visual perceptions, fine motor, sensory integration...(school age children ). After working with children with the above mentioned deficits, have you had any luck at all with getting reimbursement back? Thanks to all for sharing your experiences.

I have found that to be reimbursed, you need to make sure you have a billable diagnosis (code) from an MD, and then need to make sure you follow the guidelines of the contract you have with the insurance company. If you do not have a contract with that particular company and are providing services out-of-network, I would suggest calling the insurance company and finding out exactly what they will reimburse for. This can take several phone calls and lots of time, but is probably the best way to "guarantee" reimbursement. Best of luck to you!

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Sta in West Palm Beach, Florida

55 months ago

Do you have to be a licensed therapist in order to start a pediatric therapy center or can you have a business owner and then therapists who treat? I live in Florida. Thanks.

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kimhazelton in Odessa, Florida

55 months ago

Sta in West Palm Beach, Florida said: Do you have to be a licensed therapist in order to start a pediatric therapy center or can you have a business owner and then therapists who treat? I live in Florida. Thanks.

I really don't know the answer to your question since I am a therapist AND business owner. Anyone else?

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Kristina Sealey in Cape Coral, Florida

55 months ago

Hi, I am an occupational therapist and have recently opened a pediatric outpatient clinic. I only provide services for private pay. I always have a referral from a physician and document sessions, but are there any specific requirements since no insurance companies are involved? Just want to make sure everything is covered. Thanks, Kristina

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kimhazelton in Odessa, Florida

55 months ago

Kristina Sealey in Cape Coral, Florida said: Hi, I am an occupational therapist and have recently opened a pediatric outpatient clinic. I only provide services for private pay. I always have a referral from a physician and document sessions, but are there any specific requirements since no insurance companies are involved? Just want to make sure everything is covered. Thanks, Kristina

Hi Kristina,

As far as I know, you don't have any further responsibilities. But check with our state practice act and/or www.flota.org to be sure.

I'm curious about the success of your practice while accepting only private pay. I've considered doing that, but worry I wouldn't get enough income to cover expenses. I'd love to talk to you in more detail if you're willing. My email is klhazelton@gmail.com.

Best of luck to you!

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Jane in Miami, Florida

54 months ago

I would like to know how the private pay is going as well as I would like to do that too.
thanks

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Jane in Miami, Florida

54 months ago

Lindaot in East Elmhurst, New York said: Let me know how it goes.I have a friend with a private practice in Kissimmee.I know a few things about billing medicaid in Florida and am medicaid certified there.Right now I'm doing IC work up in NY but might be going back down in June.my mail s lindaotservs@aol.com. Fell free to write.

I would like more information on billing medicaid. I have a number already but work for another company and I would like to bill myself.

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Fran in Fpo

54 months ago

kelly in Los Angeles, California said: Hi everyone-
I recently started working as a school-based therapist but some of my previous clients from a clinic have asked if I would treat their children privately. I have malpractice insurance but just wondering if anyone knows what else I need to do. Do i need to obtain a business license as well? I would only be for 2 clients for now.
Thx

There is a nice book "The Small Patient Practice" available on Amazon. It tells you everything you need to do to see private patients and even bill insurance. Each state has different rules about business licenses. You can probably find that online.

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Martha in Miami, Florida

51 months ago

Jane in Miami, Florida said: I would like more information on billing medicaid. I have a number already but work for another company and I would like to bill myself.

Medicaid have billing courses FREE every month,
I'm working in a therapy center OT PT and I learned billing with this courses,
if you are in Florida I can help you.
Martha

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Mhornmandiola in Miami, Florida

51 months ago

Hi Martha. Can you e-mail me? I would like information. I am new in Miami.

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Jordana in Miami, Florida

50 months ago

Jordana in Miami, Florida said: I am trying to do the same thing as well, but it looks as though no one has replied to your message. I am currently doing research and as soon as I find out any information I will let you know ! :)

Hi Jordana.
I wonder if you were able to initiate a pricate practice in Miami.
I live in Miami and I will like to know information.
My e-mail, mhornmandiola@gmail.com
Thanks

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Melissa in Pasco, Washington

47 months ago

Are you still working on the student project for private practice. I was in private practice many years ago in a different state and would like to return to private practice again. However, I live in a different state with very little network and not a well known reputation. I am starting over again. Can you assist me in any way. Thanks for your time.

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