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Twelve Tips for a Financially Healthy Practice

Author: Sherry Zitter, LICSW

FOCUS Newsletter - February 2000

1. Expect clients to pay up front, even if they have insurance (i.e., only wait for your money if insurance requires it, such as Blue Cross and some HMOs; or if a client absolutely can’t afford to front the money until reimbursed).

2. Expect clients to pay at every session (unless they are paid every two weeks, or make some special arrangement with you). This helps make the connection between paying for therapy and receiving it.

3. Consider doing your therapeutic "business" (payment and date of next appointment) at the beginning of the session, not the end. This allows spaciousness to discuss clinical issues related to these topics.

4. Plan fee reductions to meet YOUR needs first; then see how much you can afford to flex for clients.

5. If a client cannot afford your lowest available fee at this time, consider letting her or him run a balance and pay it off later. My experience has been that as long as a client pays more than 50% of the fee and pays regularly the first 4 sessions, he or she will usually be dependable at paying off any balance when sessions become less frequent or after termination.

6. When making any changes that will impact your income, such as leaving an agency, cutting down to part-time in a salaried job, or leaving managed care panels, don’t try to do it overnight. With collegial consultation, develop a gradual plan over some months that addresses your need for change without leaving you financially stranded.

7. Become comfortable with discussing fees with clients, including saying "no" if someone needs a fee you can’t afford to give her or him. Practice with a friend, partner or colleague until you can talk about the tough subject of money without feeling guilty or apologetic. (Some of our clients - and ourselves - find money more difficult to discuss than sex or death.)

8. Learn to ride the inevitable ups and downs of private practice income. Find a rhythm that works for you. Some people work more hours than they’d like in the busy times and take more vacations during the leaner times. Others (like myself) tend to hold the line at the number of weekly client hours that feel like a sane maximum, and during less busy times, grab the opportunity to do more networking.

9. Let clients know during the first appointment, verbally and in writing, what your cancellation policy is. You can always be more lenient than a stated policy if circumstances warrant it.

10. Have a clear and easy record-keeping system, even for self-pay clients. Keep it updated at least monthly.

11. Bill clients monthly who have a balance with you. Whether they are still seeing you or not, this habit will emphasize their commitment to pay you, and will tend to increase collections.

12. Especially for clients who have terminated and are paying off a bill, consider putting directly on your billing statement:
a. this particular client’s payment plan agreement with you;
b. a policy of a $5 charge any month you don’t receive a payment;
c. a policy of a discount of some sort for paying extra any month.

Sherry Zitter is a licensed independent clinical social worker with a private psychotherapy practice in Westboro, MA.

Copyright Sherry Zitter 1998


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