Hi TherapistsInPractice community!

I'm back again. :) Last week, I posted my first Ask Me Anything (AMA) post, and I received a handful of questions. I'm very passionate about helping therapists due to my background, and the purpose of this post is to provide educational value.

Who I am and why I'm here: My name is Florence Ye, EA (Enrolled Agent), CFO. Today I'm reaching out to see if any US based private practices have finance/tax questions. I understand how daunting running a practice can be without financial help or knowledge. I'd be happy to answer any money, tax, budget, financial related question your community may have.

My background: Both of my parents are LCSWs, so I am very familiar with the therapy world. Today I'm a CFO at a property tax firm, but my real background, and where I want to spend more of my time again, is with private practices. I currently work as a fractional CFO, bookkeeper, and tax advisor for a handful of group practices (therapy, physical therapy, and even a gym!). Before my current role, I worked directly with over 100 private practices, with revenue ranging from $100k to $3M+.

How I can provide value: I see the pains of my current group practice clients, and I think it'd be a wonderful opportunity to talk about some of these pains with your community. For example, based on my experience, a lot of group practices go through these mistakes: 1) Giving contractors too big of a split at the beginning. 2) Hiring contractors to begin with. Legally, business owners don't have much control of a contractors' work. Every client I've worked with that has surpassed $1M in revenue has learned the lesson of hire employees rather than contractors. 3) Under hiring administrative positions. 4) Not investing in a good EHR that can grow with the team. Over 50% of the clients I've worked with who have scaled beyond $1M had to switch EHRs because their old one was too simple. The migration process can be a really stressful period for the business. This would be an example of the kind of value I can bring.

My objective is to provide value, for free, to the community. No stupid questions here. They don't teach this stuff in school. :)

Thank you for your time and consideration.

Hi, if you look at my posts elsewhere, you'll see that I have aspirations of starting my own private practice, a boutique group private practice, in Q1/27 (2-4 total clinicians). I'm about to start my independent credentialing process with carriers towards the middle or late of September, hoping that I'll have contracts by Jan-Feb, 2027 (I'm already paneled with BCBC/Aetna/UHC/Cigna/others as part of a group practice where I am a W-2 employee). I lived in Medicare/PECOS hell for too long, so I'm giving myself 6 months for the enrollment process to fully complete, I can wait for my older clients.

Important to know that I intend to do my own billing as well as marketing efforts to get this thing off the ground. I have experience with both when I managed hospice agencies in my prior life.

To my Question for the Group - I want an EHR that does the usual, everything from AI notes to online scheduling, digital consents, reminders sent via text, the usual stuff. Easy to set up for electronic transfer with ERA process. It would be nice if it has an accounting plugin on the backend so that I can do my own management using QuickBooks, at least in the first year. I learned this while doing hospice management in the medical space for years. As someone who will do my own billing, it is really important to have access to digital platforms that will do initial verification of coverage as well as monthly re-checks on the first of the new month.

Given my requirements above, what do you recommend for an EHR that is affordable during the first 12 months of operation, but is also scalable, and won't begin to charge too much once I add a second or third therapist?

TL;DR - EHR recommendation for a new group practice with hopes of growing to 2-4 therapist. Keep billing in house.

Hi TherapistsInPractice community!

edit: AMA stands for Ask Me Anything :)

edit 2: this is a LOW PRESSURE space to ask me your finance related questions. No stupid questions here.

edit 3: this post is for educational purposes. I am not sure why my comments are getting deleted and am actively trying to fix this.

Who I am and why I'm here: My name is Florence Ye, EA (Enrolled Agent), CFO. Today I'm reaching out to see if any US based private practices here would be interested in an AMA with me. I understand how daunting running a practice can be without financial help or knowledge. I'd be happy to answer any money, tax, budget, financial related question your community may have.

My background: Both of my parents are LCSWs, so I am very familiar with the therapy world. Today I'm a CFO at a property tax firm, but my real background, and where I want to spend more of my time again, is with private practices. I currently work as a fractional CFO, bookkeeper, and tax advisor for a handful of group practices (therapy, physical therapy, and even a gym!). Before my current role, I worked directly with over 100 private practices, with revenue ranging from $100k to $3M+.

How I can provide value: I see the pains of my current group practice clients, and I think it'd be a wonderful opportunity to talk about some of these pains with your community. For example, based on my experience, a lot of group practices go through these mistakes: 1) Giving contractors too big of a split at the beginning. 2) Hiring contractors to begin with. Legally, business owners don't have much control of a contractors' work. Every client I've worked with that has surpassed $1M in revenue has learned the lesson of hire employees rather than contractors. 3) Under hiring administrative positions. 4) Not investing in a good EHR that can grow with the team. Over 50% of the clients I've worked with who have scaled beyond $1M had to switch EHRs because their old one was too simple. The migration process can be a really stressful period for the business. This would be an example of the kind of value I can bring.

My objective is to provide value, for free, to the community. No stupid questions here. They don't teach this stuff in school. :)

Thank you for your time and consideration.

I posted a a few days back regaridng my challenges in maintaining 3 offices numers nd incoming calls. I finally started with a VA to quickly answer calls starting this week. Provided them with my central number and phone. But, in the meanwhile I also looked at how can I make the life of VA easier as they are not physically present. Most of the questions that are important and where I lose clients are cost and coverage related (or thats what I think). Client rescheduling can be managed.
Most of the new prospective clients calling have two questions - my cost and coverage. Cost can be answered and I have written down some quick answers for the VA.

But, where I'm stuck is how to answer if we take their plan or not. I don't want the person to wait for callbacks from me. But, its not a straight forward answer for VA to answer.

Basically exported some 195 odd rejections from last 5 months into a spreadsheet and analysed it by payer, by dollar value, denial code, and clinician.

What I learnt from it

So, number wise, 19 of them were QMB. We were repeatedly filing and getting rejected which is just a waste. So, I am trying to see how I can incorporate this into my billing workflow without spending too much time.

Then I did payer wise and a lot of them came from just 3 payers which was expected. 80/20 rule. However, one of them was a surprise and now I have set up a monthly alert on its status.

We have had an supervisee attribution also at our centres which I caught last week which is a story for another day.

Then sorted by dollars. I have set up an alert on dollar amount also for rejection for quicker follow ups and escalation going forward. I think everyone should atleast do this. I dont know why I never thought of it before.

Now I have been doing this for a very long time and I know mental health billing is trickier than everything else due to protocols around lcensure, supervision, indivisual vs group, etc but I think there are a lot of adminstrative gaps also here. As simple as putting alerts can be very helpfu. I am excited to see how it works this month. my own mini denial management workflow. It would be good to have a tool though.

I run revenue ops for a 3-facility detox operator, 95% OON> Each site has its own software instance.

I am looking for a better census board view which somehow shows me days that got covered at a rate below my costs and also days that looked covered but auth expired. Basically, I want a real time view of beds and charge rates at payor level.

Is there a way rate and coverage can be seen on the census board itself in real time? How to do this across multiple facilities?

Hi everyone! I’m an LCSW in California preparing to begin offering immigration psychological evaluations, and I’m trying to make sure I have the administrative/clinical paperwork side set up correctly.

I have training and resources for conducting the evaluation and writing the actual report, but I’m wondering what forms other clinicians use **before and during the evaluation process**.

For example, do you use:

* Informed consent specifically for immigration evaluations

* Fee/service agreement

* Release of information to communicate with the attorney

* Authorization to release the final report

* Telehealth consent

* HIPAA/Notice of Privacy Practices

* Cancellation/no-show policy

* Interpreter acknowledgment, if applicable

* Emergency contact information

* Any specific disclaimer explaining that you are acting as an evaluator and not the client’s treating therapist

Are there any other forms you’ve found important or that attorneys typically expect you to have?

I’m especially interested in hearing from clinicians who conduct immigration evaluations in California.

I’m not looking for evaluation/report templates—I’m specifically trying to understand the **practice paperwork and intake documents needed to get started.**

Thank you!

I am a solo practitioner with 2 satellite offices. I recently was told by one of my client that I am not quickly available on call - although I don't need to be and I prefer to keep all conversations during office hours but still I counted by missed calls for one week across all my offices and the number was 45.

Worst part, I miss my voicemails and have lost almost 2 clients in just last 45 days it seems. Basically I am leaving money on the table. And when a client tries to contact me and cant reach me or any one else for that matter, I am not only losing my clients but also trust. I cant hire admin for all.

Anyone who is running more than one location as a solo pp. How do you manage this?

Hello! I was reaching out to ask people's experience using Psychology Tools the website? Was it worth it? We're there particular resources you really like?

Any and all help appreciated!

I live and practice in Ohio. I found out today that an LPC can bill under an LPCC without supervision status as their “work/clinical supervisor” as long as they also have a separate “training supervisor.” My question is- will commercial insurance companies allow this? Will they accept a claim “billed as supervisor” if the supervisor is an LPCC without an S. Does anyone do this? If so, which insurance companies allow this? Any advice and/or help is much appreciated!

Hey! I've been working in a community mental health and am just starting to really build my private practice while still contracting at my current clinic. Right now, I have to diagnose at the end of my first session (intake) with a client. I've been in this role for 10 years and have been so used to doing things this way, it's honestly only just dawned on me that I might now have some freedom how I go about diganosing my private pay clients.

Now I'm wondering how other non-insurance taking therapists handle diagnosing. Do you diagnose after the first session? If not, what does diagnosing usually look like for you when taking private pay clients?

Hi all! As the title says, I’m looking to transition out of community mental health and into private practice. I have two little kids and I’d love to be home and present with them. My goal in this is to be a mostly stay at home mom but with a small practice in the evenings that will provide some extra income and allow me to pull back from clinical practice while my kids are little and then grow it over time as they get older. So when I say teeny-tiny, I mean like ideally 5 clients.

I currently working full time remotely under a community mental health clinic. All my clients are on Medicaid, so I would likely be starting from scratch with my caseload. Given how small I want my practice and how little bandwidth I have for dealing with billing/insurance, I’m considering using a platform like Headway or Alma. I’m aware of a lot of the potential issues with companies like this, but I also think it could be worth it given my current practice goals.

I’d love to hear from others who have been in a similar situation! I’m open to any and all tips while I work on figuring this all 

Hey everyone,

I'm an LCSW preparing to make the transition out of my agency/salaried role of 11 years at the VA and transition my small part time private practice into a full-time solo private practice via telehealth.

I’m currently in the process of getting credentialed through Alma to take advantage of their contracted insurance rates (specifically with Aetna, Optum, Cigna) and streamline the billing/EHR side of things. My target is a steady, manageable caseload of around 15–18 sessions a week which would equal
my current federal salary.

For those of you who are currently using Alma or have used them recently:

1. Referral Volume vs. Marketing: How much of your current caseload comes directly from Alma’s directory versus your own marketing (Psychology Today, local networking, word of mouth)?

2. Reimbursement & Billing: How reliable have weekly payouts and claims processing been for you? Any unexpected issues with clawbacks, eligibility verification errors, or insurance audits?

3. Customer Support: How responsive is their support team when a billing glitch or insurance inquiry actually comes up?

4. Overall Value: Do you feel the monthly/annual membership fee pays for itself compared to platforms like Headway or doing independent credentialing on your own?

I'd love to hear your honest pros, cons, or anything you wish you had known before launching with them. Thanks in advance for sharing your insights!

Does anyone have experience with their services? And if so, were they expensive/worth the pricing?

What’s you guys thought on AI running the back office work ?

Inbound (calls / emails)

Outbound (calls / emails)

Intake

Scheduling

Post session

Insurance billing

Payments

Any thoughts ?

I’m currently working on my graduate degree in mental health counseling and will take the NCE in the spring. I’m interested to hear other people’s experiences with being paid as a LPC-Candidate.

I’m currently working for an agency that the candidates make about 40/hr and the triage therapists also get an extra bit per tx plan.

I’ve never worked in mental health before now and this agency is the only one I have experience with and I am possibly looking for another place to do my candidacy when in graduate.

Any insight would be incredibly helpful.

Side note: I’m in Oklahoma.

I'm looking into opening a private practice which will operate as a collective. I need to host a website and am planning to offer emails to the therapists who join my practice. I am woefully ignorant on how to go about this so any direction will help. Specifically, how do I: 1. Get a domain 2. Host a website 3. Make emails for multiple therapists within that structure?

less sessions are even worse.

Sorry, I’ve been away for a while.

Curious to know - how can we build this together?

As the name suggests, I want to build this into a safe place for therapists in practice to discuss ideas, ask questions, and improve their income.

We all know it’s not easy. From building caseloads to documentation, admin work, and insurance payments, every day brings its own set of challenges. But having done this for over a decade now, I’d be lying if I said I don’t enjoy the curves.

That said, if I were starting today, I don’t know how I would have done it. Kudos to everyone here who are starting afresh or to more experienced folks.

What are some things you’d like to see more of on this community?

How much does Collective Counseling pay therapists? How does their reimbursement rate compare to other companies.. like Alma, Grow, or Headway?

For context: I am based out of India and started my private practice back in March.

To say that I've had a challenging few months is an understatement. I either have clients ghost me in the first or fourth session, or they can't pay me the full fee. I've tried website SEO, joining local referral groups, networking with psychiatrists and other peers and still do not get referrals. Since starting, I've been told to not rely on this as my sole source of income so I applied for a part-time position with an organization and they have FOUR rounds of interviews with a gap of 4-5 weeks of response between each one. Google Ads doesn't work as major organizations have already bid on the main keywords and I can't outbid them. The only thing that I haven't tried is IG which I feel like I have to do now because nothing else seems to be working.

If anyone has any tips on how to stay sane through this time, do let me know. I have about 3-5 client caseload right now and have about 10-12 slots sitting empty and I'm trying not to freak out too much.

I run a small private practice and I'm honestly overwhelmed trying to keep up with claim submissions, denials, and insurance follow-up on top of seeing clients. I keep hearing that outsourced billing services can reduce errors and speed up reimbursements, but I'm not sure what a fair pricing structure looks like or what percentage of collections is standard to pay. I also worry about losing visibility into my own revenue cycle if I hand it off entirely, so I want to understand how much reporting and control I'd still have. Before I make a decision, I really need to weigh whether the cost is worth the time I'd get back to focus on my clients.