Starting my own private practice: How I began seeing client's on the side

Determine your business structure. Research different business structures and speak to an accountant in your area. Business  structures include a Sole Proprietorship, LLC, Corporation (C-Corp, S-Corp) and Partnerships.  It is important to also be aware of your state rules and see what will work for you.  For example a sole proprietorship costs less money, but comes at an expense of more liability.  Ultimately, I went with a Sole Proprietorship because in the state of California they do not allow a single member LLC.  If I could have, I would have went with an LLC since it is a flexible business structure and separates business and personal liabilities. 

Determine your private practice model.  Your choice for a business structure may also depend on your private practice model - are you only going to be seeing patients in their home? Are you going to open up a clinic and have an office-based practice? How big do you anticipate the clinic being? Is this going to be part or full time job? I chose to do in-home therapy since real estate is so expensive here in CA and I didn’t want to jump right into that. I initially wanted to see children in my own home, however after checking with local Zoning Laws, I found out my city doesn't allow that.  So check Zoning Laws as well!

Get Professional Liability Insurance if you don’t already have it.  Popular companies for SLPs to use are:
 https://www.hpso.com/ and  https://www.proliability.com/

​Insurance or Cash Only? I chose to be a private pay only practice.  Since this was a part-time job for me, I did not feel the need to contract with insurance companies (become an in-network provider) in order to obtain clients.  This decision will also depend on projected scope of business and what disorders you intend to treat, experience (are you an expert in a particular area that families will seek out?  Is your area of expertise typically reimbursed by health plans?), the affluence of your community, and the state of economy.  If you decide to go with a cash only practice, you can provide families with documentation of your services to submit to their insurance companies.  Make sure they sign a form indicating that they understand they are responsible for the payment even if they are not reimbursed by their health plan.  I always require payment on the day of service or I have client's pay in advance for the month.  Families can check with  their insurance companies before beginning therapy services to see if their insurance company will reimburse for out-of-network benefits.  If you choose to become an in-network provider with insurance companies, know that it takes a considerable length of time.  The process of applying can take months.  Submitting claims, determining eligibility, collecting co-payments and tracking payments also takes up a lot of time.  For reimbursement purposes, you need to get an NPI number (National Provider Number) and this will identify you as a provider on claims you submit to insurance.  For tax purposes, you may also need to obtain Tax ID number (EIN - Employer Identification Number) to receive payment from insurance companies to your business.  (Even though I do not contract with insurance companies, I got an EIN number and file my taxes under that instead of using my Social Security number).

Writing a Business Plan.  If you are seeking a bank loan to start up your business, you will need to write a business plan.  Consult with an attorney and accountant to set up your business and write your plan.  Helpful websites include: https://www.sba.gov/ and https://www.score.org/

Determine a name for your practice. You can just use your own name if you choose to be a sole proprietor or decide on a company name as well that is different.  I chose Gate to Communicate Speech Therapy as my business name and in order to do that I needed to get a business license with my city (~$130) and had to file a DBA (doing business as) with my county (~$35).  It's important to research whether the name is already being used by others.  If it is being used by others, you may have a difficult time getting the domain name that you want for your website and may confuse people.  Ideally, choose a name that is not in use.  You may also want to consult with an attorney to ensure whether your state has regulations regarding your name choice and if it needs to be approved.  You can also ask about trademarking your logo or name.  Remember your vision of your practice.  If you open your practice as "Jane Doe, Speech Therapy Services" and then in a few years when the business is growing, you want to add employees you may need/want to rename your business and that can be difficult.  You can check this website to see if a domain name is taken:
https://www.name.com/domain/search

Creating a website.  Your next step is to look into creating a website for your business.  In this day and age, most people find companies with a quick internet search, so a website is important.  You have options of using SquareSpace, Weebly, Wix, Wordpress,  GoDaddy etc. I chose Weebly and found it very easy, great customer service and price was good.  Also make sure you get on Google My Business, so you pop up when customers search your area for speech therapists.

Get a business email. You can get a HIPAA compliant email by signing a BAA through G Suite and this will give you a more professional looking email @yourdomainname such as [email protected].  I also have seen practices who use a typical email at gmail.com as well.  If you are not transmitting personal health information or client information, this may be okay.  You can also look into: Hushmail, and ProtonMail.

Get a business phone number. You can use your personal phone number or get a different business phone number.  I set up a free google voice number with an area code of where my business is.  I did this because my regular phone number is where is grew up in NY and wanted the area code to be in the area I am currently servicing.  You can also look into: Spruce Health, Grasshopper, Sideline and Line2.

Get a business bank account.  Make sure your business income is separate from any other income or money in your bank.  I did not specifically set up a "business bank account", I just changed my second savings account that I already had open to be named "business" and this is where I transfer all business income.

Paper documentation or EMR Software? What are you going to do about documentation?  If you decide on paper reports, SOAP notes, invoices, etc then get a locking file cabinet and place it in a locking room in your household for HIPAA compliance.  If you are looking into EMR softwares for paperwork, scheduling, billing, etc. Look into different choices: Simple Practice, WebPT, Office Ally, TreatWrite, Fusion Web Clinic, TheraNest, ClinicSource, Raintree, Practice Fusion, My Client Plus, Practice Perfect.  I do not have an specific recommendations as I do not use an EMR system.

Create your forms: Client intake forms, case history/developmental history, informed consent/authorization to treat, email/text agreement, payment policy, cancellation policy, video release, release of information, How did you hear about us, HIPAA forms, SOAP note document, Superbill etc.  Attached is ASHA's example of a Superbill for SLPs:
https://www.asha.org/Practice/reimbursement/coding/Superbill-Templates-for-Audiologists-and-Speech-Language-Pathologists/

Set your hourly rate: For your payment policy, you will need to list your hourly rate.  You can look to see what other therapists in your area charge and see what the typical price range is.  Just avoid discussing rates with other providers as it can be construed as price fixing.  This will also vary based on expertise and experience.

Decide on payment method: Will you accept cash and check only or do you want to accept credit cards? For the first two years, I only accepted cash and check.  I now use IvyPay for credit cards since parents definitely prefer to have their card charged then to have cash on hand or writing a check each session.  You can also look into Square, PayPal Business, Zelle, Wave App, Quickbooks, Authorize.net, Freshbooks, Go Card Connect are a few others that I have heard of, but do not use.

Determine your niche.   I believe it's best to focus on a specific area in our field or population and market yourself that way.  Ages, population, disorders, etc. (e.g. children,  preschool age, fluency disorders).  Have a goal of becoming the go-to person in your area for that disorder.

Creating business cards/logo.  I had cards made on Vistaprint and had my friend create my logo.  For business cards check out: Vistaprint, Moo, Zazzle, Staples, Canva or Makr and for Logos check out: Fiverr, Instalogo, Canva, Vistaprint, Etsy, 99 designs.

Buy assessments.  After you determine your population, age range and disorders that you will be working with invest a few assessments.  Look into Q global for online assessments.  Also be sure to look into free assessments such as the Communication Matrix.

Fax options: If you are in need of a way to fax items check out: sFax, Filesanywhere, Faxage, Ring Central Fax, Nextiva Fax, eFax, SRFax, Genius Fax and Smart Fax

Side note: If you are a sole proprietor, you may want to get a P.O Box with a real address for your business so on your paperwork you can put that address instead of your home address.  With getting an NPI, EIN number, and listing on all different websites your address begins to be plastered all over the internet and it's difficult to get rid of.

Marketing:

• Add yourself to the professional directory on ASHA ProFind
• Instagram, Facebook, Yelp, Google Ads, FB Ads, Craigslist, Twitter, Nextdoor, Speechtherapyconnect.com, Care.com, Mom's FB groups, Pinterest Business, Linked In,  Speechbuddys.com, SEO on your website (Search engine optimization- look into Brighter Vision) 
• Make brochures, flyers, ads, pamphlets
• Do free screenings are local day cares/preschools
• Speak with referral coordinators at pediatrician's offices.  Have a five minute meeting with doctors.  Give free books to doctor's offices with a sticker containing your business name and phone number on the back.  Pass out "when to refer" cards and have doctors leave them in their waiting rooms, bring in a bucket of Styrofoam stuffed with lollipops, pens, etc and have the name of your business on the bucket.
• Contact dentists, physical therapists, occupational therapists, psychologists, other SLPs, regional centers (or your states early intervention programs to vendor with them).
• Drop business cards off at local libraries, restaurants.
• Join Rotary Clubs, Kiwanis, Chamber of Commerce
• Look into resource centers in your area and contact them to get listed on their website
• Look into community events and health fairs to rent a booth
• Contact private or charter schools
• Give presentations in your community
• Word of mouth is huge!

Hope that was helpful to get you started!