2011
Starting a Professional
Private Practice
Written by Iris Kimberg,
MS PT OTR
[STARTING A
PROFESSIONAL PRIVATE
PRACTICE ]
This workbook is geared specifically for therapists in the beginning stages of starting a professional private practice. This
workbook is given out at the Starting a Professional Private Practice Seminar but is also a stand alone workbook that
therapists who cannot attend the workshop can follow. The workbook is updated twice yearly, and is available as a
downloadable PDF file ($95), a CD($100) or a hard copy($125). * Starting a private practice is a multi faceted process in
which the end product is an entity that matches both your business capabilities and your professional abilities. The purpose
of this workbook, which is geared toward PTs, OTs and STs to offer a concrete, step by step approach to discussing all
aspects of starting a practice. * Workbook includes reviewing the legal forms that the practice can take, minimum start-up
requirements and costs, identifying marketing strategies and contacts to build a referral base, beginning billing set-ups, and
ideas to sustain your practice once it is up and running. It is newly revised to include all HIPAA documentation. This 72 page
work book is a comprehensive in depth guide with sample forms, letter and extensive on and offline resources
INTRODUCTION
Many of the e-mails and telephone calls I receive begin with “ I have always wanted to…” or
“I dream of one day starting”… This is the best time to seek advice! You are motivated, no
mistakes have been made and you are probably gainfully employed! Not all therapists go into
private practice and not all therapists want to. Those who do seem to possess a need for
autonomy, a desire to be their own boss, and an entrepreneurial drive. Notwithstanding the
honorable intention that a therapist wants to provide a service to people with a disease or
injury, it is important to always remember that starting a professional practice is starting a
business.
Starting a private practice is a multi faceted process. The end product results in an entity that
matches both your business capabilities and your professional abilities. The purpose of this
workbook is to offer a concrete, step by step approach to discussing all aspects of starting a
practice for PTs, OTs and STs. This will include reviewing the legal structure that the practice
can take, minimum start-up requirements and costs, identifying marketing strategies and
contacts to build a referral base, beginning billing set-ups, and ideas to sustain your practice
once it is up and running. Be prepared to wear “many hats” at first because most likely you
will be responsible for doing all of the above! Remember too, that a successful practice
requires both patients and patience!!
No part of this workbook may be reproduced in any manner without the expressed written
consent of Iris Kimberg and NYTHERAPY GUIDE. Newly revised and updated 7.2011
© 2011 Iris Kimberg. All Rights Reserved.
Please note: I have worked with therapists all across the country. While there is some
information in this workbook that is specific to the state where I live (New York), it should still
be useful if you live elsewhere to guide you as to the proper questions to ask regarding certain
laws and compliance issues. The common challenges we face in building and maintaining a
practice far outweigh the differences in the individual states. In the back of the workbook is
an extensive list of both on and off line resources that have proven to be very helpful. They
are also included in the body of the workbook when applicable. Please note that website
addresses constantly change, and some of the addresses listed may no longer be valid.
DISCLAIMER: The information presented represents the view of the individual presenter and is
offered for educational purposes only. While intended to provide accurate information on the
subject matter listed, this is sold and /or given out at workshops with the understanding that
the presenter is not engaged in offering financial or legal advice, which can only be obtained
from professionals credentialed in these areas.
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Table of Contents
INTRODUCTION ...................................................................................................................................... 2
About the Author ...............................................................................................................................................6
STEP 1: IDENTIFY A NEED THAT YOUR PRACTICE CAN MEET ............................................... 7
Three Pieces of the Health Care Pie – Who is Eating the Biggest Piece? ............................. 8
STEP 2: WHO, WHAT AND WHERE ................................................................................................... 9
STEP 3: DETERMINING THE LEGAL STRUCTURE OF YOUR PRACTICE ............................. 10
UNINCORPORATED BUSINESS ENTITIES................................................................................................ 10
STEP 4: CHOOSING A NAME: When the “I” becomes “We” ..................................................... 14
STEP 5: MINIMUM START UP REQUIREMENTS ......................................................................... 16
A. THE BUSINESS PLAN – FORMAL OR INFORMAL .............................................................................. 16
B. INSURANCE (MALPRACTICE, GENERAL LIABILITY AND RISK MANAGEMENT FOR
RELATED SERVICES)...................................................................................................................................... 20
C. THE PLACE OF BUSINESS ......................................................................................................................... 21
D. CONTRACTING WITH INSURANCE CARRRIERS .............................................................................. 24
E. Financial Considerations ........................................................................................................................ 27
STEP 6: MARKETING .......................................................................................................................... 37
STEP 7: GROWING YOUR PRACTICE
Healthcare Reform and Private Practice………..........................................................41
RESOURCES /WEBSITES/SAMPLE FORMS .................................................................................. 66
Many thanks to Carrie Strauch OTR/L for her help in editing this manual.
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NOW ALSO AVAILABLE: FOLLOW-UP WORKBOOKS
PRACTICE ANALYSIS AND STRATEGIES FOR SUSTAINED GROWTH AND SUCCESS
This workbook is geared to those therapists already in practice who want specific strategies to bolster their long
term viability, growth and success to help reach the full potential of their therapy endeavor. The workbook
presents concrete ways to analyze a practice to determine strengths and weaknesses and then develop
strategies for continued growth and success. Ideas on how to adapt to the changing business conditions we face
are discussed. Plans for expansion, including considerations for opening a second location, starting a
staffing/contract agency, trends for the future, as well as the sale, acquisition, merger and valuation of a practice
are also covered.
This workbook is a comprehensive in depth guide with sample forms, letters and extensive on and off- line
resources. It is a logical follow-up to the first workbook “STARTING A PROFESSIONAL PRIVATE PRACTICE”. The
workbook can be purchased as a hard copy for $125 plus $4.50 S/H, PDF $95.
FOCUS ON PEDIATRICS: Addendum to Book 1
55 page supplement to Starting a Professional Practice focusing specifically on issues relevant to setting up a
Pediatric Practice ($75 hard copy, Plus $4.50 S/H $55 PDF)
NEW PERSPECTIVES ON MARKETING FOR THERAPY PRACTICES AND BUSINESSES
Therapists in private practice need to adjust their marketing campaigns because of the current economic climate,
increased competition for healthcare dollars, and our fundamental shift from a healthcare referral system to a
consumer choice system. This 37 page color workbook presents an overview of the dramatic changes in
healthcare marketing in the last decade, and explores what made significant 2009 marketing campaigns in
healthcare successful. It includes over 20 actual examples from the award winning marketing campaigns of the
Cleveland Clinic, Visiting Nurse Service of NY, and Mount Sinai Medical Center, and how these high price
successful marketing campaigns can be implemented by therapists in a low cost effective manner. ($85 color
hard copy, $75 download)
Taking Care of Business- 50 columns from the OT Advance
Written by Iris Kimberg, this is a bound edition of columns covering many aspects of private practice – all
columns from 2004-2010
$55, hard copy only plus $4.50 S/H
POLICY AND PROCEDURE MANUAL
All practices are unique and reflect the individuals that are their creators. Yet there are commonalities that must
be present in all practices by virtue of the fact that we are all compelled by similar professional practice acts,
work and professional ethics as well as state and federal regulations including OSHA and HIPPA. The onus is on
each private practitioner to establish and be able to demonstrate policies and procedures that adhere to national
standards and the continuance of improving business practices.
The purpose of this book is to offer generic guidelines, policies and forms from which a therapist can then
customize their own policies, procedures and forms to best meet their individual practices. Remember that
policy and procedure manuals should be reviewed yearly and updated as often as necessary to reflect current
standards of practice, new regulations and any changes in state and federal law. The following topics are
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covered in this workbook. It can be purchased as a hard copy for $195 plus $4.50 S/H, PDF $160 (Table of contents
on next page)
SECTION ONE: FORMS FOR DIRECT PATIENT CARE:
Introduction to a Policy and Procedure Manual
1. Initial Intake Form- One for General Adults and One for Pediatrics
2. Generic Evaluation Forms (Adult and Pediatric)
3. Generic Progress Re-evaluation Note
4. Generic Discharge Form
5. Assignment of Benefits Form
6. Patient Notification of Billing/Cancellation/Discontinuance of Services Procedures
Financial Policy Form
7. Medicare Beneficiary Form
8. Authorization for Release of Confidential Information (HIPAA)
9. Notice of Patient Privacy Practice/ Patient Information Consent Forms (HIPAA)
10. Patient Satisfaction Survey
11. Referral Source Satisfaction Survey
SECTION TWO: FORMS AND POLICY STATEMENTS FOR GENERAL OFFICE PROCEDURES
1. Incident Reporting and Form
2. Child Abuse
2. Confidentiality, Release and Handling of Information including HIV Information
3. Confidentiality for Emails/Faxes
4. Emergency Preparedness Plan
5. Health and Safety Issues Including Universal Precautions, Infection Control/ Handwashing Procedures
6. HIPAA Policy and Procedures
7. Rehabilitation Update/Documentation for Medicare Patients
8. Clinical Chart Review Form
9. Photo Release Form/Waiver Form for Onsite Classes/ Permission Slip for Caregivers
10. FERPA Compliance
11. Child Protective Services
12. Confidentiality Statement for Faxes and Emails
13. Off Line Authorization Form
SECTION THREE: FORMS FOR HIRING THERAPISTS
1. Orientation and Minimum Requirements of Therapists
2. Reference Forms
3. Clinical Competency Review Form
4. Employee Health Assessment
5. Hepatitis B Consent/Decline Form
6. Freedom from Impairment Form
7. On Site Clinical Competency Form
8. Sample Employee Handbook
9. Code of Ethics – PT OT ST
10. Employee Application including EOE regulations
CONTRACTS
1. Sample Temporary Personnel Services Agreement
2. Sample Home Care Personnel Services Agreement
3. Sample Contract for School District Service Provision
4. Sample Independent Contractor Agreement
5. Sample Employee Contract
6. Sample Buy Out Form
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About the Author
Iris Kimberg MS PT, OTR has worked in the non-clinical aspect of therapy for the past 27
years. She transformed a one person solo practice into a multimillion dollar rehabilitation
agency that she later sold to a public entity. After 9/11, Iris, a longtime downtown resident
formed a fund, The Downtown Therapists Assistance Project, to aid the fourteen physical
and occupational therapy practices located within the vicinity of the World Trade Center.
She raised over $35,000 for them, mostly donations from therapists across the country.
This past fall, she organized a drive in NYC on behalf of Operation Medical Library to help
replenish the medical libraries that have been destroyed in Afghanistan over the last 30
years.
Iris now enjoys sharing her expertise with others in the field through workshops, seminars
and private consultations. She is a Professor at Columbia University DPT program, teaching
a marketing and business entrepreneurship and has also guest lectured at both Touro
College and Long Island University. Since 2004, she has been Merion Publication’s (parent
company of Advance Magazine) business columnist, writing over 70 columns on business
practice and management. Iris regular participates as a speaker in both NYSOTA and NYPTA
conferences. She was a panelist at the March 6, 2005 symposium The Crisis in Reimbursement
held at the NYU Department of Occupational Therapy. More recently, Iris was a keynote
speaker at the Fall 2009 and 2010 NYSOTA Conference and at the Fall 2010 Private Practice
Section of the NYPTA Conference in Washington D.C. She has been asked to be a contributor
to the Fall 2011 Private Practice Sections, IMPACT MAGAZINE, and will be writing an article
about service management in therapy, entitled If Disney Ran Your Practice.
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STEP 1: IDENTIFY A NEED THAT YOUR PRACTICE CAN MEET
While it is important to have internal needs and dreams and desires that motivate us to create
and pursue opportunities for ourselves, it should be the needs of the patients and not the
needs of the therapists that form the core of your practice. You cannot easily create a need or
demand for your service; you want to be able to identify a need that already exists. Ideally
you want to be able to match your personal needs and your clinical skills with a need you have
identified in the community where you intend to practice. It takes more than an idea to get
started. Remember, ideas are like bellybuttons, everyone has one!
Sometimes this is easy. In my own case, thirty years ago, I worked at a world renowned in
patient rehabilitation center in New York City. When patients were discharged home, they
often asked their treating therapists to see them at home after discharge. A need was clearly
identified: follow-up care at home after a hospital stay. I spoke with the department head
twice telling her we needed to start a home care program. To make a long story short, they
did not start one, so I decided to do it on my own, and my practice was born. (Thirty years
later this facility still does not have a home care program).
Oftentimes, the need for a particular practice is obvious as was in my case. Other clear
examples are needs in underserved communities, or when specific doctors approach you
stating they need a place to send their patients for treatment. If you are not sure whether
there is a need for the type of service you want to provide, you might start by trying to find
out if there are waiting lists for patients to be seen in the outpatient department of your local
hospital. If your specialty is pediatrics, see whether there are school aged or pre- school
children not receiving their mandated therapy services at school. If the answers are yes you
can be sure that there is a need out there. If there is a shortage of pediatric therapists in your
area you can assume there will be a need for therapists to treat pediatric patients and thus a
market for your service. In general, if the supply of a particular kind of therapy practice is low,
the demand is generally high, and so is the need.
TRENDS TO KEEP IN MIND AS YOU THINK AND PLAN
 Consolidations in the healthcare industry now are occurring on two fronts: SERVICE
PROVISION AND NOW IN THE PAYOR SECTOR
 HOW TO MAINTAIN PROFITABILITY WHEN YOU HAVE NO CONTROL OF YOUR FEES SHOULD YOU BE LIKE THE FARMER WHO PLANTS MORE CORN WHEN PRICES FALL
TO MAKE UP FOR LOST INCOME?
 WHERE ARE WE AS A WHOLE IN THE HEALTH CARE CYCLE NOW? ADULTS VERSUS
PEDIATRICS/ SUPPLY of therapists versus DEMAND for services. HOW DOES THIS
IMPACT WHAT YOU ARE DOING TODAY AND WHAT YOU MIGHT WANT TO BE DOING
TOMORROW??????
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
CONSUMERS WILL CONTINUE TO TAKE ON MORE RESPONSIBILITY FOR THEIR
HEALTHCARE AS DEDUCTIBLES AND COPAYMENTS INCREASE AND HEALTH SAVINGS
ACCOUNTS AND MEDICAL SAVING PLANS GROW IN POPULARITY. THE DEEPER THE
CONSUMER DIGS INTO THEIR OWN POCKET, THE EXPECTATION OF WORTH AND
VALUE OF THEIR TREATMENT WILL INCREASE.
Three Pieces of the Health Care Pie – Who is Eating the Biggest Piece?
1 Piece- Consumer (Patient)
1 Piece – Service Provider
1 Piece Payor (Insuror)
Keep your eye on the pie, and keep alert to how health care reform (discussed later on) may
alter this.
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STEP 2: WHO, WHAT AND WHERE
Now that you have identified the need for your services, it is important to begin your market
research and answer the following:



WHO else is doing it
WHAT exactly are they doing,
WHERE are they located.

FOR WHO and WHERE: The Yellow Pages, internet and local newspapers are a good
source of initial information –look under speech, physical and occupational therapy
(regardless of which discipline you are), and record all the practices. Check the on line yellow
pages and internet search engines as well as the national and state associations who also
probably have a listing. Don’t forget to look under Physicians as well, since many hand
surgeons, orthopedists, physiatrists have their own in house therapists etc. In addition, find
out whether the hospitals in the area have out- patient PT, ST and OT departments. Make a full
listing of the location of each practice to determine areas of over saturation and/or under
representation.

FOR WHAT: (this will entail a telephone call) Find out WHAT the practices offer: this
includes not only the particular modalities, but areas of specialization, hours of operation ,
length of sessions, what insurance companies /plans they participate in, whether the office is
accessible, what languages are spoken, etc. Talking to colleagues can also be a good source of
information about what particular practices have to offer. This information will come in very
handy when you begin the marketing phase of your practice, as you may try to offer what
your competitors do not so that you can help differentiate yourself in the marketplace.
It is very important to do a thorough job during this part of your market research as you will
be coming back to the information you have gathered oftentimes during the planning stages
of your practice.
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STEP 3: DETERMINING THE LEGAL STRUCTURE OF YOUR PRACTICE
This section does not replace consultations with an account or a lawyer. It is included to
provide basic information so that you can become informed about options and then be an
active participant when consulting with professionals. There are many forms that a private
practice can take ranging from a solo practitioner to a corporate practice with shareholders.
The legal entity you choose will directly impact the tax structure and operating structure your
business will have to take. It is important to remember that you can start your business in one
format and later on transfer it into another format with little difficulty. When you consult with
a lawyer and/ or accountant make sure beforehand that they have the knowledge and
expertise to handle your specific needs. In my case, I decided to find out who the New York
State Physical Therapy Association used as an attorney and consulted with them on the
assumption (correct) that they knew the profession from a legal stand point.
This is also the section where I found myself saying, “ remember, it is always better to ask
permission than to beg forgiveness”. Find out the rules and regulations within your state and
make sure you follow them to the best of your ability. Remember too that there are rules,
exceptions to the rules, and rules that prove the exceptions.
Please note: This information pertains to practice in NY State but can serve as a guide to those of
you out of state as well. No matter what state you practice in, for starters, find out whether your
state has a Corporate Practice Act ( most states do) This helps to determine whether you have to
be a professional as opposed to a general business corporation.
The two broad categories that your business can fall under is either as a corporation or an
unincorporated business entity. A corporation is recognized as a separate legal entity.
UNINCORPORATED BUSINESS ENTITIES
*1. Sole Proprietorship - This is an unincorporated business entity. In New York City (any of
the five boroughs) you file a Certificate of Conducting Business Under an Assumed Name
(DBA – Blumberg Form x201), which you can do yourself at the local county clerk’s office.
(DBA stands for “doing business as”). Here are the basics of registering a DBA ( Doing
Business As) in NYC- You need to fill out a Blumberg X201 form, which you can find at a
commercial stationary store that sells legal forms or call Blumberg at (800) 221-2972 or visit
www.blumberg.com. In Manhattan, the form has to be filed at the:
County Clerk Office
60 Centre St Room 103B 212 374 8361
Locations of other county clerk offices can be found online.
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In accordance with New York State General Business Law (Section 130), the County Clerk
accepts and files certificates of persons conducting business under an assumed business
name. The General Business Law requires that individuals or partners conducting
commercial activity under a name that is not their real name must file DBA certificates with
the County Clerk. Filing a DBA protects the business name from use by others in the county
where it is filed. There are three basic DBA filings; an original, for amendments and for
discontinuances.
Original DBA
Prior to filing an original DBA, the filer reviews business names already assigned to ensure
that the desired name is available; a list or computer search is available for public viewing at
the information counter of any County Clerk’s Office.
Once the filer is sure the desired name is available he or she completes a DBA form. The
form is presented to a clerk for filing. The fee varies from county to county but does include
the filing, a copy for the filers records and a certified copy for proof of filing. A certified copy
is normally required by banks when opening a business checking account.
Amending or Discontinuing a DBA
A DBA can be amended by filing the appropriate amendment forms.
Amendments can only be filed to change the business address, the business name and to
add or remove (withdraw) partners. Amendments and withdrawals require a reference to
the original, or most recent filing.
When individuals or partners cease to conduct business, a DBA can be discontinued. A DBA
is discontinued by filing the appropriate forms at the Clerk’s Office.
Call or check online in advance to find out the fee, and the forms of payment accepted . For
DBA’s you can use your SS # - you do not need to get a tax( employer) ID number. Prior to
going, you should also check online at a domain name company (ie. GoDaddy.com) to make
sure you can also capture the name as a domain name for your website.
With a DBA, legally and financially, the therapist and the business are one in the same. Your
profit from the business is treated as your own income for tax purposes. You have full control,
and unlimited liability. You are personally liable for all the expense and debt of the business,
so theoretically your personal assets are at risk. You can get both malpractice and general
liability insurance as a sole proprietorship. This is how most private practices start out and
how most private practices end up. This can also be done without the assistance of a lawyer.
REMEMBER you can also start your practice as a sole proprietorship and transfer it over time
to another form of business entity.
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*2. Partnership – This is when two or more people come together to form a business entity. In
NY you can register a partnership as a DBA using the Blumberg form mentioned above. You
share control and profits but also have shared personal liable for all the business debt and
expenses. IN NEW YORK YOU MUST BE A MEMBER OF THE SAME PROFESSION to form a
partnership, and must follow NY Partnership Law. ( Consulting a lawyer on this is the prudent
thing to do).
INCORPORATED BUSINESS ENTITIES
1. Corporations – The legality of setting up your practice as a general business corporation
differs from state to state. Some states, including NY State have a Corporate Practice Act that
clearly states that general business corporations (inc.) are NOT authorized to practice physical
or occupational therapy services. For other states: CHECK WITH YOUR STATE EDUCATION
DEPARTMENT OR WHICHEVER STATE ENTITY THAT GRANTS YOUR STATE LICENSE OR
REGISTRATION to see if you have a version of a corporate practice act.
There are several allowable types of corporations in New York State:
a. Professional Corporation – P.C. – Professionals, in accordance with Article 15 of the
Business Corporation Law, form a professional practice by registering with the State
Education Department and the Department of State. All shareholders of the professional must
be licensees of one profession. The PC may only practice that profession. A PC is taxed as a
corporation, and any profit left in the company would be taxed at the corporate level. You
must take all the profits as salary in order to avoid taxation at the corporate level.
b. Professional Limited Liability Partnership – PLLP Professionals in accordance with Article
8B of the Partnership Law form a professional practice by registering with the State Education
Department and the Department of State. This may be formed by members of certain
different professions to offer multi-disciplinary services Profits can be treated as personal
income so you are only taxed once, not twice like at the corporate level.
c. Professional Limited Liability Company – PLLC - Professionals, in accordance with
provisions of the Professional Limited Liability Company Law form a professional practice by
registering with the State Education Department and the Department of State. This
organization may be formed by members of certain different professions to offer multidisciplinary services. (cannot include professionals licensed in Medicine and Dentistry).
Taxation is the same as a PLLP.
*A sole proprietor and or a partnership may have more difficulty securing a bank loan if that is
the route you are going to finance your practice.
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The issue of whether to select sub chapter S status for your corporation is beyond the scope
of this workbook, but is something you should definitely discuss with your accountant – it is
an election for tax purposes, not legal purposes.
Detailed guidelines on the specific requirements for each type of business entity can be found
at: http://www.op.nysed.gov/home.html
GETTING A TAX IDENTIFICATION NUMBER (EIN) – An Employer identification number, also
known as a Federal Tax Identification Number is a nine digit number that the IRS assigns to
business entities to report tax information. The IRS uses this number to identify taxpayers that
are required to file various business tax returns. If you decide to start out as a sole proprietor,
it is okay to use your social security number as your tax identification number. If you are
opting to organize as another type of business structure mentioned above, you need to apply
to the IRS for a tax identification number – this is an easy process and can be done online –
The form you are required to fill out and submit is FORM SS-4. You can go to www.
irs.gov/pub/irs_pdf/fss4.pdf for the form.
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STEP 4: CHOOSING A NAME: When the “I” becomes “We”
Therapists often wonder whether to begin their practice under their own names or to develop
a company name. When starting out as an occupational therapist, it didn’t take me long to
realize that I didn’t have to call myself an occupational therapist to be one. Holding yourself
out to the public under a business name is often easier, and more meaningful when you are
starting out. When I started out as Iris Kimberg, Occupational Therapist I was forever
explaining what it was I offered. When I came up with the business name of Home Therapists
Association, there was instant recognition of what it was I offered – home therapy!! Having a
name that describes the services you offer can go a long way especially in marketing. The
creation of your public image begins with your choice of a business name, and the moment
you name your business, you no longer are just a person who provides therapy, but a business
offering therapy. A great deal of the marketing you will do is to the general public and NOT to
the medical community so a descriptive yet professional name can be very helpful. You want
the name to reinforce the image you are trying to create. The Yellow Pages, both on and off
line again is a good source of information to get ideas about what others have named their
businesses. Keep your eye on future expansion from the start and try not to choose a name
that may be self-limiting in the future unless you are sure you want to stay within a narrow
target market.
Web Name Registration
Make sure the name you are thinking about is available to you as a domain name for a web
address/site as well. Sometimes your names may be available as a business entity, but may be
already taken as a domain name.
Even if you are not ready to set up a website immediately, it is always a good idea to secure
your web domain name (that matches your business name) as soon as possible because often
they are taken. It is very low cost and is renewable yearly. Here are 2 domain name registrars
that I recommend – www.networksolutions.com and www.godaddy.com. Remember that
you are just registering a domain name, not purchasing a hosting package. That you will do
when you actually want to have a live website.
Oftentimes when therapists choose to practice under their name, and later grow to hire
additional staff therapists, patients are reluctant to be treated by anyone other than the
owner of the company. For long term planning purposes, there will come a point when you
will be doing more administrative and less hands – on direct patient care. This will be much
easier to accomplish when patients are used to coming not to an individual, but to a facility
that offer therapy, by you as well as others. Operating under a business name early on helps
to create the atmosphere that you have a company with many key personnel – people begin
to know your practice not just by your name but by the company name. It is important to
remember that if you do choose a business name, make sure it is listed on all your documents
including insurance policies to prevent any confusion.
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If you do decide to create a business name, as a DBA when you go to file the
Paperwork, you will have to do an on -site computer search (at the court house) to make sure
the name is not already taken. If filing as a corporate entity, that will be done as part of the
filing and your lawyer will be notified if the name you selected is available.
Once you have selected a name have a logo designed, which again reflects the image you
want to create. Your name and logo needs to be incorporated into all material that emanates
from your business – business cards, letterhead, mailing labels, fax sheets, business checks,
web sites, email addresses, and signage. Your name and design will establish a sense of
stability and consistency by its own ubiquity.
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STEP 5: MINIMUM START UP REQUIREMENTS
A. THE BUSINESS PLAN – FORMAL OR INFORMAL
A business plan can be a very complex or a simple document; I have seen some written on the
back of a napkin to serve as a self-guided path, and others as long as a 100 page document
used to solicit for investors. What is most important is to invest some time and effort on your
own to establish one.
A written business plan can be a helpful tool to provide a detailed specific description of your
practice as well as a place to format the future planning of your practice. For therapists who
are looking for outside funding for your practice (be it a bank loan, line of credit or if you are
looking for partners to go into practice with you), the business plan is essential, and a formal
one should be created. It is a formatted explanation of the steps that need to taken to meet
the objectives of starting and running your business.
Even if you plan to fund the business yourself, having some sort of written plan or blueprint
for yourself still helps to clarify things, and encourages you to remain focused. It can also be a
tool to review and measure your progress over time, keep you on track and make sure that
you have covered every point. It is a tool you can use to try to pinpoint the reasons for success
or causes of any failures. I did not write my first business plan until ten years after I started my
practice, and did so only when I was contemplating getting investors. The nice thing about
writing a plan for yourself is that you can do it in pencil; that is, you can be flexible and adapt it
as your practice evolves.
Regardless of whether you do a formal business plan for a potential lending source or an
informal one to serve as a self-guide, the following topics should be included in one. Much of
the information to be covered in the rest of the workbook is based on the contents of a
business plan. For those who require a formal plan, online resources for help are listed below.
Business Plan info: http://www.sba.gov/category/navigation-structure/starting-managingbusiness/starting-business/writing-business-plan
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CONTENTS OF A BUSINESS PLAN or “Is failing to plan planning to fail”
1. Cover Page – Company name, address, telephone number, principal owner(s)
2. Executive Summary – Summary describing the business (including legal status), location(s),
mission statement, services to be offered, current stage of development, marketing strategy
including target market, competitors, management and organizational plan, and long term
goals. The summary can generally be one or two paragraphs. If you are looking for funding it is
the place to initially tell investors or the bank what the funds will be used for, or how potential
investors will be rewarded.
3. Business Description –
A. Describe the business (mission statement, your goals, any relevant history about yourself,
and how you got to the place where you are, as well as your plans for the future and how you
will get there)
B. Industry analysis (can include description of the industry, current trends and opportunities,
economic cycles, supply and demand data)
C. Target Market/ Competitors – (can include description of customers and client
demographics, who and where competitors are, and what their position is in the marketplace.
You may want to list the strengths and weaknesses of each competitor, and how you will
carve out a place, and capture some of the market for yourself)
D. Market Plan/Strategy - (can include what makes this business/practice unique, how will
business be promoted – include the various types of marketing vehicles and methods you plan
on using such as press releases, advertising, internet, participation in community events, trade
shows, participation in professional organizations)
E. Synopsis of Operation - (can include how the business will be run and organized, methods
of quality control, initial capacities, whether you will have a Board of Directors, mechanism by
which key decisions will be made)
F. Structure of Internal Organization -(can include principles and other key employees,
advisors, consultants, management style, organizational chart)
G. Long Term Plan - Where do you see the business going in the next five years? Here is where
you can show potential for secondary/complementary markets, and potential for multiple
locations, satellite clinics, etc. Despite the fact that therapists are so capable of making short
and long term goals for their patients, this is often the most neglected aspect of planning that
therapists do for themselves. Early on, it is important to build in ways your practice can
function without you doing all the hands on treatment.
4. Financial Information - If you are creating the plan because you need funding, here is
where you need to show how much capital you require to get started, and how much money
you can expect to make from your company. This section traditionally includes personal
capital being used, amount of capital needed in total for project, equipment list with
breakdown of cost and vendors, analysis of break-even point, projected profit and loss for
first twelve months of operation.
5. Supporting Information -This can be done as an Appendix and can include resumes, letters
of recommendations, job descriptions, contracts you plan on bidding on or applying for)
17
THE SUNFLOWER MODEL – adapted from SMARTUPS Lessons from Rob Ryan’s
Entrepreneur America Boot Camp for Start-Ups
Sunflower Center – Analyze Core Competencies
_____________________________________________________________________________
___________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Sunflower Petals – Products, Services and Markets, Ways to Leverage Core Competencies
_____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________
________________________________________________________________________
Sunflower Stem – Underlying Assumptions
_____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________
________________________________________________________________________
Planting and Making Your Sunflower Grow
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________________________________________
18
____________________________________________________________
Example – Iris Kimberg/NYTHERAPYGUIDE
Sunflower Center (Core competencies): I am adept at offering business advice to healthcare
professionals
Stem (assumptions): (1) There will always be new therapists coming into the marketplace
who want to start private practices and do not have the necessary skills. (2) There will
always be therapists already in practice who need guidance in how to best position or grow
their practices for the future. (3) There are not that many consultants who offer what I do.
Petals (services/products to best leverage my core competencies: (1) Consult to therapists
beginning practices, (2) Consult to therapists looking to expand or sell their practices (3)
establish academic programs in accredited schools to teach my core competencies (4) offer
workshops on my core competencies (5) offer products, material related to my core
competencies
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B. INSURANCE (MALPRACTICE, GENERAL LIABILITY AND RISK MANAGEMENT FOR
RELATED SERVICES)
Regardless of what legal form your business takes, it is absolutely essential that you take out
both malpractice and general liability insurance. Common insurance carriers for therapy
practices are listed on the Resource Page in the back of this book.
Keep your insurance paid, and current in terms of information. If you have limited hours in the
beginning, inform your broker and the cost of the premium will be adjusted. As you add hours,
the onus is on you to inform the broker so your policy and premium can be accurate.
In addition make sure you inform your broker if you add on a location, provide services at
another location or hire any employees or independent contractors.
For everyone’s protection you may want to have them listed as an “additional insured”.
Once you have insurance, do not hesitate to ask your carrier for advice should a question
come up. All insurance carriers have lawyers on staff who work for them, (and thus, you) and
are there to answer questions regarding how best to protect yourself.
In private practice today, it is not uncommon for therapists to offer services that extend
beyond the traditional realm of therapy, including but not limited to the provision of fitness or
wellness related services, consulting, offering seminars etc. One consideration that is
sometimes overlooked is the risk exposure when beginning such programs. It is important to
realize that not all of the risk exposure involved in the provision of a therapy-related service
may be covered by your professional liability(malpractice) insurance. The majority of
professional liability policies are designed only to cover therapists for medical incidents that
occur while performing a professional service. For insurance purposes medical incidents are
considered any act, error or omission in your providing or failure to provide professional
services, including your responsibility for anyone acting under your direction or control.
For starter it is important to determine whether your services fall within the scope of the
practice act in your state. It is necessary to understand what you can and cannot do before
you enter a new area of practice, and distinguish between the provision of a professional
service versus one that is more general such as a wellness or fitness related service. This is not
to discourage you from providing the complementary service, but rather to help you be
prepared and knowledgeable in regard to your level of exposure and risk in providing the
service. You also need to consider whether your scope of personal competence is compatible
with the type of service you wish to provide.
Under most policies that are issued to therapists, in order for an incident that results in harm
to be covered by malpractice, there would have to be a direct relationship with the client or
patient that is performed and documented. The interpretation that a interaction occurred
during a direct therapist/ patient relationship requires that there be a level of what is
considered the six elements of patient/client management. The elements are examination,
20
evaluation, diagnosis, prognosis and intervention and a medical referral. For many therapists
today running wellness programs, yoga classes, play therapy etc. it is conceivable that the
way therapists have structured these complementary services makes them fall outside the
realm of their malpractice coverage. The prudent thing to do is first determine whether your
existing malpractice insurance policy is sufficient as is, or whether other coverage may be
needed. This can only be done by speaking directly with your carrier to make sure that all of
your practice-related risks are adequately covered. Be prepared to give details about the
services you offer including the types of classes, who runs them, if medical clearance is
required for participants, whether you have waiver forms etc.
Should you find that what you are offering in your practice falls outside the realm of coverage
under your policy, you might consider changing the format or style of the class or program so
that it becomes a covered part of your practice. Some insurance carriers offer supplemental
policies to add to your original coverage in order to provide protection for services that you
provide in a non-medical capacity. This type of endorsement is for therapists who use their
knowledge as a licensed professional to provide non-medical services such as teaching, acting
as an expert witness, speaking at seminars, and consulting. Otherwise, it may be wise to
purchase an additional policy. There is a growing segment within the insurance industry that
now offers what is considered a “wellness” professional liability policy. In some cases it might
be necessary to join a sponsoring group on order to be able to purchase the insurance. For
additional information, you can visit
www.fitnessandwellness.com , www.fitnesspak.com, www.cmmeiers.com
C. THE PLACE OF BUSINESS
There are many factors to take into consideration when deciding where to set up your
practice. The location of your practice is particularly important and requires doing the proper
research and asking the right questions. This is usually the first real investment you make in
your practice. In addition, your location is the first impression clients will have of your practice,
oftentimes even before they have met you. There has to be a degree of compatibility with
your business location and the image you are trying to project. For some, initially, the most
cost effective place to run your practice is out of your home, or by subletting a space.

USING YOUR HOME AS AN OFFICE: Some therapists do offer in office treatment in a
section of their homes – If you want to consider this as an option, city dwellers need to
get approval from their landlords, co-op or condominium boards and home owners
need to find out whether there are any local town ordinances or laws that prohibit
certain commercial or service entities from being in a residential community.
21
SUBLETTING: One option to explore is subletting space either from another therapist, a
physician or somewhere in the community like in a gym, or health club. A targeted mailing
to health providers in the area where you would like to set up asking if they have any or
know of professional office space to sublet can usually do the trick. Make sure that an
attorney reviews any lease or sublet agreement and that the parameters of the agreement
are clearly spelled out. In addition, if you are subletting from a medical provider, Medicare
has established guidelines to follow to formalize the nature of the relationship between the
“sublettee” (you) and “sublettor; This was done specifically to avoid confusion as to the
nature of the relationship and to avoid any appearance of impropriety regarding fee
splitting, reduced rent for referrals etc. Language to include in any sublet arrangement
between you and a medical provider is:
“The rental amount is at fair market value, has been fixed in advance and does not take into
account either directly or indirectly any volume or value of referrals or other business that could
potentially be generated between the parties. The rental amount calculation is based solely on
the amount of space and duration of time that the premises will be used by you".
Also discuss with your attorney whether you might be better off with a “Space Use and
License Agreement” instead of a formal sublet agreement which can make you responsible
for all the terms of the lease.
RENTING SPACE:
If you have decided that you want to rent space on your own, it is first important to know the
types of space is available; professional, commercial and retail. The type of practice that you
are setting up with help to point you in the right direction as to what type of space would
most suit you.
 Professional office space is also usually the most economical and is space located in a
building with other health care providers such as dentists and physicians. This is ideal for
therapists with a focused or niche market (i.e. such as hands) since most of the patients
will come through referrals.
 Commercial office space – This is general commercial space; for an urban setting, this can
be in an office or mixed used (residential and commercial) building and in the suburbs
can be in a strip or mini mail. For practices that will focus more on the general
population, such as in wellness or sports performance, this is ideal.
 Retail office space, almost always the most expensive is storefront space in a mall or
street. Although this gives you the most visibility, there may not be enough justification
for this unless you are in a direct access state where you do not need a physician referral
prior to starting and can accept more or less “walk-in traffic”. Do not pay for ground
floor space if, due to patient privacy concerns, you have to frost or cover the windows.
Once you narrow down the type of space you are look for, there are several factors to take
into consideration to determine where to look for the space. Go back to the WHO WHAT and
22
WHERE section and review the area demographics. While you do not want to open in an
area that is saturated with practices, if there are specialty practices that could be
complementary to your practice, it might be good to open near them.

It is ideal if your practice is in the same vicinity where you live. Not only will be more
convenient for you, but from a public relations point of view, consumers will appreciate the
fact that you are a member of their community

It is important that you choose a location that matches the need you have identified. If
you know a community is underserved, make sure you are in a central location of the
underserved community.

If you are starting a practice because a physician needs a place to send patients, it
stands to reason you should be located near that physician.

It is always good to be in close proximity to a hospital or medical center or in a
medical/professional arts building. Make sure you are in a central location close to mass transit
if you are in an urban setting and close to highways etc if you are in a suburban area.

It is almost essential that the space you decide on is wheelchair/stroller accessible( even
if you think your clientele will be 100% ambulatory). Certain state and federal contracts that
you may want to pursue in the future require that the principle place of business be
wheelchair accessible. Also when you are factoring in the size of space, remember that there
will be a time requirement (state by state) for how long you need to keep a copy of the chart;
in NY for adult care it is 7 years, pediatrics until the child turns 21! This can add up to a great
deal of space over time that must be in a HIPAA compliant area. Also note that some contracts
may not allow you to store charts off premises without prior written permission.

TERMS OF THE LEASE: An “ideal” location can quickly turn into your worst nightmare if
you do not cover basic points when negotiating a lease:

Find out the lease of the lease and whether you can have an option to renew. Does the
lease offer any options to exit before the expiration date? Are there provisions to allow you to
sublet?

Make sure there are no restrictions on the hours you can have access to your space
(including weekends) – especially in the beginning, you want to have the option of early
morning, evening and even weekend hours. Some buildings turn off elevators and heat during
the weekend – it is important to find this out before you make a commitment.

Are the utilities your responsibility or the landlord’s? What are the average monthly
costs?

Are there any known difficulties getting phone lines, electrical lines into the space?
Is there a superintendent/building manager/landlord on premises or nearby?

Is there any known upcoming construction or new building that may be slotted for the
area that could impact your location and patient foot traffic?

Does the space have individual temperature control?

Does the building have a secured entrance? Explore the usual activity in the area both
during the day and at night.
23

First time business owners sometimes have difficulty proving financial stability to
landlords. Show potential landlords potential contracts you have with insurance companies,
Medicare etc. to prove you have financial viability.

The decision of leasing or buying a space always boils down to one thing – finances. It is
almost always better to start out by leasing; usually a 3-5 year lease with an option to renew is
good. If you can negotiate the renewal terms at the onset, that is advantageous.
D. CONTRACTING WITH INSURANCE COMPANIES
Managed care is everywhere and marketing to the insurance industry has become a necessity
for almost all practices.
While you are still in the planning stages and long before you open your doors, apply to become
a provider with key insurance carriers, HMOs etc.
Regardless of whether you intend to treat Medicare patients are not, it is almost always
helpful to become a Medicare provider. At this point all other insurance carriers, HMOs, plans
etc. look to Medicare and follow their lead for provider approval, all coding, billing, fee
schedules etc. Some networks will automatically include you as a provider if you have met the
proper credentialing for Medicare. Approval as a Medicare provider can take from 6-8 weeks
so apply early. Being an approved Medicare provider can help you establish instant credibility
with other carriers, is a plus when you start marketing, and may even help if you are planning
to secure bank financing.
Whicj HMOs, PPOs should you try to become affiliated with?
Becoming a provider in at least one plan can only help you in the beginning. It is a
relatively easy way to get your name out and have patients coming in to jumpstart
your practice, regardless of whether the fee you are receiving is the one you are entitled to.
To decide which ones to apply to:

Go back to your Who What and Where Info from Step Two. See what plans other
therapists in your vicinity participate in, and let that be your guide. If there are plans that you
see they DO NOT participate in try to get approved by them as well – this may end up being a
key marketing point for you in the beginning.

If there are particular physicians that you know will be referring patients to you, you
want to make sure you participate in the same networks as they do.

Find out what plans the major employers in your vicinity offer their employees as
plans. These will constitute the patient pool you will be treating; for example, in the NYC area I
would contact the Human Resource Division of places like the NYC Department of Education,
Verizon, Con Edison to see what plans they offer their employees.
24
When you are discussing fees with any plans, most times they are pre-determined. However,
should you have special certification (i.e. Certified Hand Therapist, SI, or NDT Certification,
present yourself as a “specialist” and not a “ generalist” and see if you can “carve out” a
special fee for your service.
What to do if you are “locked” out of a plan?
Unfortunately, oftentimes HMOs and PPOs periodically stop accepting new therapists as
participating providers, stating that they are saturated with practices in that particular
geographic area. For starters, make sure their information is current. Oftentimes, therapists
drop out of plans, but their names stay in the database. Make sure that the practices in the
area are still active participants. Letter of support for your enrollment from physicians stating
why your participation in the plan is needed also can be helpful. Finally, try to zero in on
something that your practice will offer that the others don’t. For example, if you are the only
therapist certified in lymphodema on the Upper West Side, you should be included as a
participant regardless of how many other practitioners are members of that network. . DO
YOUR OWN RESEARCH – FIND OUT WHAT IS LACKING, MISSING IN THOSE PRACTICES, AND
OFFER IT. Give the plan a specific reason (be it a modality, a treatment, a program that you
offer that no one else does) as to why your participation in their plan is crucial for them (not
you). If all else fails, ask to be put on a waiting list and periodically check in with the carrier.
Enrolling in Medicare
A therapist opening a practice must enroll themselves, their business and any therapists they
employ. A separate enrollment form is required for the business and each therapist must
enroll and receive a UPIN (unique provider identification number). Medicare process a claim
for the services provided by an individual PT under the PT’s UPIN. Should a therapist want
payment to go to the business name, another form (CMS FORM 855R) must be submitted to
the Medicare carrier or fiscal intermediary. This essentially reassigns the monetary benefits to
the business. Make sure you have your NPI number before attempting to enroll in Medicare.
Oftentimes there is confusion regarding enrolling and participating in Medicare. Treating
Medicare patients does not necessarily mean you are participating.
Participating Provider – This means that you will always accept assignment on any claim
submitted for services rendered to a Medicare patient (beneficiary); that is, you agree to
accept Medicare’s payment as payment in full and are not allowed to collect any monies
beyond the deductible and co-payments. Medicare will reduce its payment by 5% and then pay
80% of that amount to you. One advantage of being a participating provider is that Medicare
will often process the beneficiary’s secondary insurance automatically for you (as long as the
beneficiary has assigned payments). This eliminates a billing step for you.
Non-Participating Provider – This means that you have the option of accepting or not
accepting assignment on a claim-by-claim basis. As a non participating provider although
Medicare will again reduce payment by 5% and then pay 80%, you can bill the beneficiary
25
(patient) for the remainder of the full amount due (as long as the full amount does not exceed
Medicare’s charge limit). To find out whether you must file Medicare claims electronically or
whether you fall into the “exceptions” category, check out:
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%2011%2
0Part%20B~Browse%20by%20Topic~New%20to%20Medicare~8EELTA8837?open&navmenu=Bro
wse^by^Topic||||
OTHER INITIAL INSURANCE CONTACTS

WORKER’S COMPENSATION– Although worker’s compensation insurance differs from
state to state, when an employee becomes sick as a result of the employment environment
(considered a non-traumatic injury or occupational illness) or is accidentally injured
(considered a traumatic injury) in the course of performing their job, medical care costs
(including therapy) is covered either under a federal or a state plan. On the Federal level,
employees of Federal agencies (civilians) are covered under the Federal Employee’s
Compensation Act (FECA). For most practices, it is a good idea to become a provider for
Worker’s Compensation. Go to the Worker’s Compensation Board in your State and find out
the procedures to become an approved provider. At that time you will also need to get the
Fee Schedule for your state or region within your state and find out the documentation and
authorization requirements for treating patients covered by WC.

NO FAULT INSURANCE for MOTOR VEHICLE ACCIDENT LIABILITY
When a person is injured in an automobile accident, there can be coverage from a number of
sources depending on the state where you are: there is Med Pal (the medical coverage on a
motor vehicle policy), the private health insurance that the person may have, no- fault
insurance, enacted by law in many states (including New York) under which compensation is
made regardless of who is at fault, and finally coverage by the state where there is an
uninsured motorist at the wheel. The amount of coverage varies from state to state – for
example in NY, No Fault will pay up to $50,000 in medical bills, including the cost of
occupational, speech and physical therapy. One way to potentially get referrals on No-fault
patients is to contact attorneys who specialize in automobile accidents.
****Please note that in NYS (for WC and NF) it is okay to add a 50% surcharge to the fee for
every treatment session that you provide at home (as opposed to in-office). This applies to
those therapists who will be starting a practice that provides therapy in the patient’s home.
For therapists in other states, inquire as to whether there is a similar standard surcharge for
home visits.

PRIVATE INSURANCE CARRIERS
Most large private insurance carriers now have managed care divisions for people who have
had catastrophic injuries. It can be very helpful to market directly to the case managers of
26
these units; they are responsible for referring patients for care as well as authorizing the
payment of the bills. There is nothing better than getting a referral from the source that will
also be paying your bill. It can be very helpful to send out a letter of introduction to some
private insurance carriers to find out whether they have managed care departments so that
you can market your practice directly to them.
For a full listing of insurance companies throughout the country:
American Association of Health Plans www.aahp.org
ESTABLISHING A CASH BASE TO YOUR PRACTICE
Even if you do not think that you will initially have a cash based practice, it is important to set
the stage from the onset to build one in to your practice. You can do this by establishing your
own fee schedule for initial evaluations, ongoing treatment, consultation time, etc. Even if you
work as a participating provider with particular patients, depending on the terms of your
insurance contract, your patients may be able to become cash paying patients if they still
require services beyond what the carrier is paying for.
To make it easier for patients you might want to consider accepting credit cards as a form of
payment in addition to checks and cash. Credit card payment can be arranged through an
outside group such as Paypal or through the bank where you have established your business
account.
E. Financial Considerations
BUDGETING
The financial unknown and the risk associated with borrowing and spending money for a
practice can be overwhelming and in some cases paralyzing. For many determining your
financial needs (how much money you need to start and to stay afloat for the first six
months) is done while you are working on your business plan, with the goal being to
make financial projections about your expenses and needed income. This will then let
you see whether you have enough money to do this on your own or if you will need to
borrow money. A budget is traditionally viewed as a financial statement of the
expenditures (expenses) over a specified future period of time in relation to the income
being generated (revenue). Creating a budget can be easier to do if you:
List your anticipated expenses and then determine your needed income.
Almost all practices have similar expenses that must be funded such as furnishing,
supplies, equipment, utilities, insurance costs, space and personnel. These are often
referred to as overhead. Remember that in the beginning you will probably have some
additional one time expenses that will not normally be in your monthly budget such as a
27
security deposit, not only on the leased space but possibly on certain utilities and pieces
of equipment. There will be two broad categories of costs that you need to take into
consideration: fixed and variable. A fixed cost, such as rent, utilities, and insurance will
remain constant despite any changes you have in the number of patients. The variable
costs you incur will change in relation to how busy your practice gets, and include most
consumable items such as office and medical supplies, marketing material, and salaries.
EQUIPMENT NEEDS: The specific therapy equipment needs that you have will be
determined by the type of practice that you have. If you know your practice has specific
necessary equipment needs that require certain weight or construction specifications
(i.e. – SI hanging equipment, large whirlpools, make sure you have cleared this with your
landlord before you invest in them.) No matter what type of therapist you are or what
type of practice you have your first piece of equipment should always be a locked,
fireproof filing cabinet. In order to be HIPAA compliant and to enter in almost any
insurance contract, you will need this.) Most therapists buy the basic treatment tables
etc. and lease many of the equipment modalities. If you war considering making an initial
investment in capital equipment (more expensive items with a long life span that can be
depreciated over time), make sure you discuss this with your accountant. For your own
information and planning, an easy way to figure out depreciation is to divide the cost you
pay for something by its estimated “useful” life. Example: a treatment table costs you
$500 and you assume you will need to replace it in 5 years. The annual depreciation rate
would be $100. Equipment vendors are usually very amenable to leasing equipment, or
leasing with an option to buy etc. How you acquire equipment can have a major impact
on your cash flow situation. A lease will give you a fixed-term obligation to pay on a
monthly basis for the use of equipment. Contracts can last from one to five years, often
with an option to purchase the equipment at the end of the lease term. Especially in the
beginning, leasing is an attractive option for many because:



It keeps your up front costs down
You may be able to negotiate flexible payment terms that work best for you:
(1) Straight fixed payments: good for practices that have a set amount to
spend each month, (2) deferred payments: can give you up to 90 days to
begin payments which can help to build your cash reserves, (3) balloon
payments: often based on a low rate and shifting most of the cost to the end
of the term, which can free up cash for other uses during the term of the
lease, (4) graduated payments: uses a schedule that allows a practice to pay
smaller installments at the beginning of the lease period.
Oftentimes, shipping costs, training and installations are included in the lease
price.
Establish what your potential break-even point is – roughly speaking, how many patient
treatments you have to provide to cover your monthly costs.
28
For example, if your monthly expenditures are going to be in the range of $3000 per month, in
order to meet this, assume you will have to provide approximately 47 treatment sessions per
month (average fee- $65 per session), or roughly 12 sessions per week.
ASSESSING THE NEED for SECURING A LOAN
This is a very individual decision that depends on many factors. Most practices can be opened
with some combination of personal resources such as savings, existing personal credit and
loans from close family members and friends. For some practices it actually becomes easier to
get a loan, not at the onset, but a year or so down the road when you are more established
and can show concrete evidence of the potential of your business.
If you do decide to get a loan for your practice, you will need to devote quite a bit of time to
investigate sources of financing and potential lenders. Initially find out if you qualify for any
loans for minorities, women owned business and military personnel. Start with the bank
where you do your own personal banking, where you have a mortgage etc., but do check out
other lenders as well. You will probably have to present a business plan, as well as personal
and financial documents including prior tax returns (usually 2-3 years prior), and a C.V. Bear in
mind that most lenders also expect that you contribute a percentage (up to 20%) of your own
capital to your business. Debt financing (when you borrow a specific amount of money for an
agreed upon term and rate of interest) is good for making major purchases, renovations of an
office etc. If your primary financial concerns are cash flow, applying for a revolving line of
credit might be your best option.
BOOK KEEPING/INITIAL FINANCIAL RECORD KEEPING
There are many software packages available to you tailored for bookkeeping purposes. In the
beginning it is almost better to create your own books so that you can see exactly what is
going on financially for your practice. Later on you can better determine what type of package
will work for you. There are basically two systems of bookkeeping you can utilize: cash vs.
accrual

CASH METHOD: REVENUE IS RECORDED WHEN PAYMENT FOR SERVICES IS RECEIVED
(not billed), AND EXPENSES ARE RECORDED WHEN THE BILLS ARE PAID. Using this method,
you cannot match your revenues and expenses and it is much harder to get a picture of how
your practice is actually doing on a month-to-month basis. (While the cash method is an easier
method for tax purposes, the accrual method is helpful to really determine the cost of your
services and how profitable your practice actually is.)

ACCRUAL METHOD: REVENUES IS RECORDED WHEN THE SERVICES ARE PROVIDED AND
EXPENSES ARE RECORDED WHEN THE EXPENSE ACTUALLY OCCURS. Using this method, at
the end of each month, you add up the number of sessions provided to get your revenue
number, and the expenses you had for the month. This provides you with more of an actual
snapshot of your practice on a month-to-month basis.
29
Even if you use the cash method of accounting, which most private practices and partnerships
do, it is very helpful to keep track of statistics using the accrual method so you can actually see
how well your practice is doing.
BILLING 101 - BILLING FOR SERVICES RENDERED
When starting out, billing for your services is just about the most important thing you can do
outside of treating the patients. As your practice grows and changes so will the method of
how you bill, who does your billing etc. In the beginning, DO IT YOURSELF and DO IT OFTEN.
Most practices have three types of patients:
- private pay (patients who pay by cash, check or credit card)
- patients with private insurance – here you can agree to accept assignment of benefits and
bill the insurance carrier directly or have the patient pay you directly and help them fill out
the forms for reimbursement as a courtesy to them
-patients who are members of HMOs, PPOs etc. whereby the HMO pays you directly.
VITAL INFORMATION TO INCLUDE IN INTAKE
It is important to have a financial intake form where you record all of the insurance
information on the patient. Taking down the financial information on the patient is as
important as taking down the medical information. Ideally, you want to record information
and verify it prior to beginning treatment. In order to verify a person’s insurance information,
you may need to send the insurance carrier a signed release form from the policy holder
allowing information to be released to you. Here is a checklist of what to include in your intake
form:

Name of insured if different from patient, relationship to insured, SS# of patient and
insured, policy number, Name of employer, Name of insurance company, and telephone
number. When you ask about the specific coverage a person has, make sure you find out
about the person’s deductible and whether it has been met for the calendar year, and any copayment/ co – insurance that the person is responsible for. When you call and verify coverage
make sure you record the name of the person on the telephone. You can also ask whether
they require a completed insurance form and assignment of benefit form each time you
submit a bill, and whether they accept universal billing forms. If your patient has an insurance
card, try to make a copy of it when they come in for their first appointment.

On the bottom of your intake form, you should include a statement that the patient or
someone acting on the patient’s behalf should sign: “NOTE: Your health information will be
kept confidential. Any information that we collect about you on this form will be kept
confidential in our office. Please note if a claim is submitted to an insurance company on your
behalf, the health information on this form will be shared with your carrier.”
30

The onus is on you to bill and bill correctly. Even if you ultimately hire an outside billing
service or an in-office medical biller, the only way you can make sure that the bills are correct
is if you yourself know the correct procedures. In addition, you are ultimately responsible for
any billing errors made on your behalf, regardless of who actually does the billing.

No matter what, you need to establish your policy and procedures for billing. To
determine what your fees are for private patients, go back to Section Two WHO WHAT
WHERE. See what the general going rate is in your vicinity, or what the insurance industry calls
“reasonable and customary”. Bear in mind that in NYS determining your fee based solely on
what other clinicians in your area charge is considered “fee setting” and is illegal.
For many patients you see, the fees are already established by a Fee Schedule, which is
based on the ICD-9 (diagnosis codes) and the CPT (current procedural terminology or
treatment) codes. The codes were developed by the Health Care Financing Administration
(HCFA) to assist in the assignment of reimbursement amounts to providers, originally for
Medicare. At this point most managed care and private insurance companies base their
reimbursements on the values established by the HCFA. A list of state-by-state Medicare
offices available to answer specific coding questions is included in the resource directory.
For billing Medicare there are some great websites that offer a free “Medicare” calculator,
which is an online tool for calculating the allowed amounts for each CPT code in each state
under the Medicare fee schedule. For PTs who are members of the APTA, you will have
access to the online Medicare calculator. Others (including OTs and STs can go to
http://www.cms.gov/PhysicianFeeSched/
Many therapists feel that they must go to a coding class to get a handle on how to bill using
HCPCS. The specifics of billing are beyond the scope of this book but there are certain
fundamental concepts that are important to grasp. The language of billing, regardless of
your discipline, state where you practice, what you are billing for and whom you are billing is
essentially universal, and is known as HCPCS.
ICD and CPT codes are considered HCPCS. This is an acronym that means:
H health care
C common
P procedural
C coding
S system

The ICD codes are listed in the book, the International Classification of Diseases, Ninth
Revision This is a book put out by the World Health Organization, and lists codes for most
diseases and diagnosis.

DIAGNOSIS CODING PROVIDES THE REASON AND THE MEDICAL NECESSITY FOR THE
SERVICES THAT YOUR PATIENT IS GETTING.

CPT Codes, or Common Procedure Codes are codes that describe medical or psychiatric
procedures performed by physicians and other healthcare providers. Every year a new CPT
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book comes out because new codes for new procedures come out. For example, this year
laser treatments are coded because Medicare will now pay for them. There are red bullets put
next to each new code.
ALL THERAPY AND REHABILITATION IS BILLED USING HCPCS.
IT IS VERY IMPORTANT THAT THE ICD9 CODES SUPPORT THE CPT CODES THAT YOU USE.
THERE ARE SOME CPT THERAPY CODES THAT ARE TIME –BASED, AND OTHERS ARE
MODALITY BASED and NOT TIME DEPENDENT. FOR ANY TIME BASED TREATMENT, YOU
MUST DO A MINIMUM OF 8 MINUTES TO BE ABLE TO BILL FOR THE SERVICE AS PER THE
APTA. The most common CPT codes for PT ST and OT are included in
the Appendix.
I recommend getting the HCPCS LEVEL One Book, the ICD 9 book and the Coding and
Payment Guide for Physical Therapists (all listed in the Resource section in the back).
In addition go to the following website: www.lmrp.net. This is the local medical review site
and there is one for every state. It is an educational tool designed specifically to help
providers submit correct claims for payment. It offers a very comprehensive list of diagnosis
codes AND the treatment codes that they support. It is the fundamental tool used in
processing Medicare claims, and is followed by other carriers. The bottom line in billing is that
the treatment codes that you want to bill for must be linked on the list to the ICD-9 code of
your patient in order for your claim to be processed and paid. In addition there is now a
Correct Coding Initiative (CCI) Manual, which is designed to help identify and eliminate coding
and payment problems. A Current copy can be ordered by calling the National Technical
Information Services (703-605-6000) and requesting Chapter 11- Medicine, Evaluation and
Management Services.
Don’t forget the ICD-10s are coming: read all about it: http://occupationaltherapy.advanceweb.com/Columns/Taking-Care-of-Business/What-the-New-ICD-10-Means-forYou.aspx
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Things to Remember in Billing:
1. You are not only entitled to bill for and collect any deductible, co-payment, co-insurance; law
requires you to. It is considered illegal not to bill and collect this unless your patient proves
that he or she is “medically indigent”. COLLECT ALL MONIES OWED YOU. (PAY SPECIAL
ATTENTION AT THE BEGINNING OF THE YEAR, when deductibles have not been met.)
2. If you have agreed to accept payment directly from the insurance company, makes sure the
patient signs the “assignment of benefits” section on the insurance form. Keep a copy of the
signed assignment of benefits form in the file. A sample Assignment of Benefits form is in the
Appendix.
3. If your patient has agreed to pay you privately or by credit card, have your patient sign a
form that states the cost of each session, how many sessions they will be receiving and the
terms of payment (due at the end of each session, weekly or monthly). If you want to make it
a policy to bill for a session not cancelled within 24 hours, put that in the statement as well.
4. If you are treating a Medicare patient and you are not sure whether Medicare will pay for
services rendered, have the patient sign an ABN or Advance Beneficiary Notice (see sample in
the Appendix)
5. In many states you are entitled to charge interest on all bills submitted but not paid by
insurance companies within 30 - 45 days. This must be clearly stated on each bill and you must
request the interest payment.
6. If you have billed incorrectly or incompletely and your bill is pended, do not give up. Figure
out the error and then resubmit your bill.
7. Should you feel that your bill has been improperly denied in its entirety, you can write to The
State Insurance Commission of the state you are in. This is the regulatory body that oversees
the insurance industry and is obligated to follow up and investigate every claim it receives.
HIPAA COMPLIANCE FOR BEGINNING PRACTICES
The Health Insurance Portability and Accountability Act (HIPAA) went into effect on April 14,
2003. The primary objective is to establish national standards for electronic health care
transactions and code sets. To improve the efficiency and effectiveness of the health care
system, the Federal Government enacted an Administrative Simplification provision of a 1996
law that required Health and Hospital Services to adopt national standards for electronic
health care transactions. At the same time, Congress recognized that the growth of the
electronic technology sector could potentially seriously invade the privacy of health
information. As a result, for the first time, the government established Federal protections for
33
individual health information, which became effective April 14, 2003. This rule does not replace
Federal, State or other laws that provide for even stricter privacy protection in some
instances.
The part of the law that most concerns us is the Privacy Rule. Because information is so readily
available by e-mail, fax, Internet, electronic records it can easily be obtained by people that do
not need to know information and could potentially misuse the information. When you are
starting out in private practice, even if you do not plan on doing electronic billing initially, if
you will be faxing, copying or emailing any patient information, you are required to be HIPAA
compliant.
HIPAA’s privacy rule addresses the following:
1. Greater restrictions for the use and disclosure of personnel health information.
2. Patients having more access to, control and protection of their health information.
3. Establishment of appropriate safeguards that healthcare providers must achieve to protect
the privacy of health information
4. Holding violators accountable with criminal and civil penalties that can be imposed if they
violate patient’s privacy rights.
As of April 14, 2003, therapists in private practices have to incorporate the federal privacy
standards to protect patient’s medical records and other health information provided to
health plans, doctors, hospitals and other health care providers. Even if
you are just starting out, it is important that:

All practices appoint a person to act as the HIPAA Compliance/Privacy Officer to be
responsible for seeing that the privacy procedures are adopted and followed. The privacy
officer can be someone (like you or your office manager) who has other non-privacy related
duties as well.

Your practice must develop a NOTICE OF PATIENT PRIVACY PRACTICES. This can be a
one-page document, which must be given to each patient, as well as be posted in the waiting
room. This NOTICE should describe to your patients how medical information about them
might be used in your practice. For example, personal health information may be used for
treatment, obtaining payment, during an audit, in emergencies, or when required by law.
Other points to include in your NOTICE is that patients will be asked for written authorization
to use their personal medical information for any other reason than those listed above. In the
NOTICE make mention of the fact that the patient has the right to review their personal health
information at any time, to request that inaccurate information be corrected, to request a list
of instances when the information has been disclosed for reasons other than treatment,
payment or other administrative purpose. You must include that the patient has the right to
restrict how the information is used and disclosed for treatment, payment and administrative
34
operations, and that the requests for restrictions will be considered on a case by case basis.
The NOTICE must also list who the Compliance Officer of your practice is, where and how they
can be contacted, and the fact that a patient also has the right to address concerns and
complaints about a potential violation of their health privacy to the US DEPARTMENT OF
HEALTH AND HUMAN SERVICES. A sample notice is included in the Appendix.
Your practice must have a PATIENT PRIVACY CONSENT FORM (A sample is included in the
Appendix) for all patients to read and sign once they have read your NOTICE OF PATIENT
PRIVACY PRACTICES. In this consent form you have to again spell out all the circumstances
that your practice may use or disclose the patient’s personal health information. In this
consent form, it is necessary to spell out that it is your office policy to send a copy of the
initial evaluation, progress notes, discharge notes etc. to the referring physician, and to the
insurance company if requested to do so. Spell out that the patient is granting you
permission to use and disclose their personal health information as described in the NOTICE
OF PATIENT PRIVACY PRACTICES, and that they are releasing you and your practice from any
and all legal liability that may arise from the release of such information. This consent form
should also spell out the patient’s right to revoke this consent by notifying you in writing at
any time except for that action which has already taken place.
Once you grow your practice beyond yourself, it will become necessary to provide
“training”(a policy manual) to any staff members/independent contractors that you might
hire or enter into an agreement with. Essentially you will have to develop a policy manual that
spells out who in your office will have access to confidential information, and how your
practice will maintain the confidentiality of all the information it receives. The bottom line is
that you have to spell out how you are going to “safeguard” patient information from being
seen or used by unauthorized people, enforce use of computer system passwords, be able to
“lock up” patient information, and keep others out of your administrative areas. You then
have to have each employee, independent contractor or “business associate” sign a
Confidentiality Agreement and Training Attestation. Included in that should be language
showing that such training has occurred and that the person hereby agrees to maintain the
confidentiality of all the information obtained in the course of their affiliation or employment
with you including but not limited to financial, technical, or proprietary information about your
practice as well as personal and sensitive information regarding patients, employees and
vendors. Included in this statement must also be the understanding that inappropriate
disclosure or release of patient information is grounds for termination.
PLEASE NOTE: Although there is not a “HIPAA” police force out in arms, HIPAA cannot be
ignored, and is enforced by the DHHS Office of Civil Rights. Failure to comply can result in a
fine up to $100 per violation! Wrongful disclosure can result in punishments from $50,000 and
up to one year in prison and upwards.
Additional resources for info on HIPAA:
http://www.hhs.gov/ocr/privacy/hipaa/administrative/
35
Make sure you have a confidentiality statement included on all emails and faxes.
PEDIATRIC THERAPISTS SHOULD BE FAMILIAR with FERPA compliance as well
See appendix for examples and info on both
36
STEP 6: MARKETING
Of all the hats therapists wear when starting out, the one most dreaded always seems to be
the “marketing hat”. The problem is that most therapists see marketing as “selling
themselves”, whereas in the service sector, marketing is really about building relationships
and educating the community about the value of your service. Marketing in the service
industry is more like an ongoing public relations effort; the more you interface with the public,
the better. For starters, make sure that everyone you meet knows what you do; the services
we provide are usually inherently interesting to many people! Initially, the most typical
obstacle in marketing is that you have limited financial resources to put toward a marketing
campaign so one of the first challenges and strategies to employ is to find inexpensive ways to
promote your practice.
Since you have already identified what need your practice will be meeting, it will be easier to
identify where to target your marketing efforts. Traditionally therapists think in terms of
marketing physicians since you need their prescription for treatment, unless you are in a state
with direct access. However, within the last ten years a revolution in marketing in the
healthcare industry has occurred in large part due to the pharmaceutical companies. In years
past, drug companies used to market physicians because they were the ones who prescribed
the drugs. However a shift took place and drug companies decided to market directly to the
consumer using and paying for the product. The results for the drug companies have been
incredible in terms of product recognition and sales.
This same concept can hold true for therapy – therapists can market directly to the consumer and
payer of the service as opposed to only the prescriber of the service. You need to get your name
out to potential customers, and gradually build your name recognition. Try to position yourself
for greater visibility in the marketplace, and continually educate prospective clients about the
benefits you can provide them.
A. TAPPING INTO PRINT MEDIA
One way to get information out to the public about your practice is by way of your local
newspapers. There are generally three ways to use the written media for marketing – they
can be used alone or in conjunction with each other.
CREATING A PRESS RELEASE
A press release tells the community about your practice, either directly or indirectly.
Therapists often overlook this option. As in most newspaper articles, you need to answer
the questions who, want, when, where, and why. The more creative you are in your
approach, the better the likelihood that the press release you send in will get printed.
Highlighting your treatment of a local person is always a good approach. At times a press
release will not be used verbatim but will generate enough interest on the part of the media
to assign a news reporter to create a segment or story about some aspect of your practice.
37
Some local papers will automatically offer you a press release for paid advertising. The
format for a press release and samples are included in the appendix. Make sure you send the
press release on business letterhead, double-spaced for easy reading, and mailing it to
specific recipients (i.e.. like the health editor). It is okay to send the same release to several
persons within the same organization.

ADVERTISING IN COMMUNITY AND SCHOOL NEWSPAPERS
Many therapists take out ads in local newspapers when they first open their practice, and
then never again. I recommend that once yearly, take out an ad – if your local paper has a
special health issue, as many do, take out an ad then, if not, I suggest taking one out either
in September or at the beginning of the calendar year.
 WRITING LETTERS TO THE EDITOR ON RELEVANT TOPICS
If there is some therapy related news that might impact your community (i.e.. new
Medicare caps) you can either try to write this up as a press release or standard article or as
a letter to the editor. When you write a letter to the editor, you can increase the likelihood
that it will be published if you make sure the letter is in consumer-friendly non medical
language, it is focused and brief and any relevant statistics or research are mentioned. Do
not be obvious in promoting yourself or your practice.
MARKETING MATERIAL FOR YOUR PRACTICE
Initially you will want to create coordinating business stationary, business cards,
announcement cards or postcards. It might also be helpful to create a simple one
page fact sheet about your practice, a “FAQ” (frequently asked questions) sheet
and/or a simple brochure. Always keep in mind the basics of:
Who are you trying to reach?
What are you offering?
How are you saying it?
B. INTERNET MEDIA: GETTING A WEB SITE / EMAIL ADDRESS
Healthcare sites are the single most visited destinations on the web. Having a web site is a
relatively easy, efficient and low cost way to get the word out about your practice, and what
you have to offer. If you do not want to start off with a web site, at the very least make sure
you are accessible via email.
An email address is a good marketing tool that provides consumers with an easy way to
make initial contact with you. Make sure your email address has a therapy related name. .
Other internet options to explore like blogging, social networking, getting reviewed online,
and sending e-newsletters all can help jumpstart an existing practice or launch a new one.
38
Both are interactive, help to maintain a flow of ongoing communication and establish a
direct innovative channel to you and your practice.
A blog (short for weblog) is a website in which items are posted on a regular basis and
displayed in reverse chronological order. It is a hierarchy of text, images, media data and
links that can be viewed in an HTML browser. Authoring a blog, maintaining a blog or
adding an article to an existing blog is called “blogging”. Individual articles on a blog are
called “blog posts,” or “entries”. A person who posts these entries is called a “blogger”.
Blogs use a conversational style of documentation and tend to have a main content area
with articles listed chronologically, newest on top, an archive of older articles, a mechanism
for people to leave comments and a list of links to other related sites, sometimes called a
"blogroll". While there are many applications for blogging as a private practitioner,
remember that the underlying goal is communicating some sort of message. Once a blog is
established and running, it can reach more potential clients or referral sources by using what
are called syndication tools, which are provided by the blogging sites and generate “feeds”
to which a consumer can subscribe. You will get notifications when new comments and
posts are added.
An active blog can be a great vehicle to draw potential clients to your main practice website
and can even improve your practices’ search rankings. Rather than just use blogging as a
tool for self-promotion, you can focus on a niche within your field of expertise, and publish
advice and commentary on it. It can help you position yourself and your practice as a
“thought leader” in the industry. In a forum where your main objective is not to sell your
services directly you can actually establish a more personal relationship between you and
your clients as well as your colleagues. Blogging give you an opportunity to join potential
clients’ discussions, provide insights into the therapy field and receive feedback about ideas
you may present.
There are many sites that will act as hosts for companies as well as individuals at no cost
including Six Apart’s Typepad.com, WordPress.com and .org, and Google’s Blogger.com.
Different blogging platforms offer different levels of service. Some like Blogger.com and
WordPress.com offer both the platform, domain name and hosting for free. Others like
Wordpress.org offer the platform for free but you then need to find and pay for your own
hosting and domain name.
Social networking including Facebook and Linkedin are now an integral part of the
healthcare arena, as the consumer/provider relationship becomes less passive and more
interactive. These web based social network services provide various ways to network and
share knowledge through the Internet. This can be a great way to meet new colleagues,
discover new referrals sources and share clinical information. In June 2011, Facebook
launched a new division, called BranchOut, aimed to compete directly with Linkedin. One of
the most popular sites for medical professionals are:
39
http://www.allbusiness.com/services/business-services/4515172-1.html
Ask a patient or colleague to write a review your practice online: This can be done on
Yelp, Citisearch, Urbanbaby etc.
Send out quarterly e-newsletters to patients, families, colleagues and referral sources:
Try using use ConstantContact.com or consider Mailchimp.com ( its free for up to
12,000 names)
CONNECTING DIRECTLY WITH THE COMMUNITY

Patient service organizations – When I started out, I began by going thru the alphabet
(and the Yellow Pages again), A to Z thinking about all the diseases that began with each
letter. It did not take long to realize that with each letter, many many diseases (and
potential patients) came to mind. For example A – arthritis, alzheimers, alcoholism,
amyotrophic lateral sclerosis, aged, amputee, arthrogryposis. For each disease, there is
now at least one and sometimes many more patient service organizations to serve
people with the disease. Very often, these organizations are thrilled to know of a
practice that can serve the needs of their constituents and are only too happy to keep
your information on file.

Local community organizations – such as religious institutions, senior centers, YMCAs
and YHCAs, community centers, and schools can be contacted and told about the
services you offer. Participate in events to provide support to the community while
promoting your therapy practice: scoliosis screening, pro bono care at athletic events,
presentations at career days, booths at street fairs etc. You can offer in-services,
lectures, fitness evaluations or self help courses, sponsorship of school teams, local
races, sporting events or participating in local street fairs. Sometimes there are
community bulletin boards where you can post your business card or flyer.

Marketing and Managed Care – Becoming part of certain HMOs, network plans,
preferred provider goes hand in hand with marketing to the public. Your name and
practice will appear in many plan books for people to see (consider this free advertising).
Physicians who refer their patients to you because of your participant in a plan can also
refer their “private” patients to you as you develop a relationship with them.

Direct Mailing To Physicians and Complementary Healthcare Providers
Direct mailings still remain an affordable and efficient way to tell people about your
practice. It is always still a good idea to send out announcements or letters of
40
introduction to physicians, other therapists (who may have complementary practices),
discharge planners in nearby hospitals etc. A sample letter of introduction is included in
the Appendix.

Make sure you get your practice listed on the Referral Directory that the APTA, ASHA
and the AOTA offer and check to see whether your statewide professional association
has the same.
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STEP 7: GROWING YOUR PRACTICE
Once your practice is up and running, you need to make sure it continues to grow. Your
success in the marketplace is really determined by the number of patients you have coming
into your practice. Your goal is to increase the number of referrals you receive each month by:
 PATIENT SATISFACTION –The best way to expand your practice is by word of mouth. If your
patients are satisfied with the treatment they receive, you can be sure that they will tell others
about your practice and what you offer. Especially in the beginning, giving each and every
patient individualized attention can go a long way. Even after you discharge your patient, I
always believe in a follow-up telephone call, email, or regular letter four – six weeks after
discharge. It’s a good way to see how they are doing, and keep your name and practice fresh
in their heads. Remember that PATIENT SATISFACTION usually leads to REFERRAL SOURCE
SATISFACTION, which should lead to more referrals. Now many practices do follow up
surveys- this can be done on line (check out www.monkeysurvey.com)
 FOLLOW-UP AFTER REFERRAL - It is always a good idea to send a thank you letter after you
receive a referral. It is an easy way to show that your practice is organized, responsible and
that you offer individualized attention to your patients. A sample thank you letter is included
in the Appendix.
 EMAIL OR MAILING TREATMENT NOTES - Regardless of whether your state has direct
access or not, it is always a good idea to send the patient’s physician a copy of your initial
evaluation, periodic progress report and discharge summary (make sure you have written
permission from your patient to do this, have the proper confidentiality statement attached
and use password protected documents). Again this is a vehicle to show the physician the
type of service you offer.
 FOLLOW-UP ON YOUR MARKETING EFFORTS- Initially you will be sending out your
announcements and letters introducing your practice. Keep in touch with your mailing list for
the first year, even if you have not received any patients from them. Think of “new” news you
can tell them: it may be in the form of expanded hours, a workshop you are giving, or that you
are now participating in a new plan. This can be done in the form of a one-page newsletter in
paper or email format.
 KEEPING A WIDE REFERRAL BASE – Never rely on one, two, or even three places to get
referrals from. Assume that someday one of your primary contacts will stop referring to you
because chances are they will. Always keep adding to the sources you get patient referrals
from.
 FIND WAYS TO KEEP IN TOUCH WITH FORMER PATIENTS – check up on them, send birthday
cards etc
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Adding Staff: There will come a point in time when you start to take off some of the many
hats you are wearing and will want to hire personnel to work with you. For most therapists
you usually will hire one person who will multitask and function as your office manager, biller,
and receptionist. Additionally you will probable consider at some point about hiring additional
therapist(s) to work with you.
Here it is very important to make sure you follow all the necessary guidelines of your state. For
the therapists, you need to do research about whether you will treat the therapists that you
hire as an independent contractor or as an employee. There are many pros and cons to each
that are outside the scope of this book. Make sure you become familiar with both the
guidelines of the IRS and the LABOR DEPARTMENT when you make decisions regarding this.
Details about this can be found at:
Department of Labor: www.dol.gov
Internal Revenue Service: www.irs.gov
In addition, before hiring any therapist in any capacity, make sure that part of your screening
includes going to the website of the Office of the Inspector General (OIG) where there is state
by state exclusion data base for screening therapists who should not be practicing. Make sure
you check, not only your home state, but also states in your surrounding area. Office of the
Inspector General: www.oig.hhs.gov.
When meeting with any potential employee, there are certain legal and illegal employment
inquires/questions you can and cannot pose during an interview. Before you schedule any
interviews, make sure you are familiar with the appropriate guidelines, which are clearly
spelled out at http://www.nolo.com. Please note that once you hire staff you will have to
comply with other HIPAA regulations for employees that are outside the scope of this book
but are detailed in the second workbook.
Health Care Reform and the Private Practitioner - Update Winter 2011
The health care dollar pie is a simple three piece pie – one piece for patients, one piece for
providers, and one piece for insurers. What has never been simple is understanding the
sizing of the pieces – over time, we have watch the patient and provider pieces shrink, while
the insurer piece grow. Now that the six month anniversary of the signing of the Patient
Protection and Affordable Care Act(PPACA), commonly known as Health Care Reform has
passed, we are beginning to see a number of its provisions take effect. The pieces of pie are
being reformatted. No one can say definitively how healthcare reform will ultimately
impact private practitioners, but all indications are that it should be a “boon” to providers
and patients alike. It is a good idea for therapists and patients to familiarize themselves
with the different provisions as they begin to unfold and take effect.
Here are some new provisions now in effect:
43
1) Insurance carriers can no longer exclude coverage for children / dependent policy
holders under the age of 19 with pre-existing conditions . This is a huge development,
because in the past, many children born with developmental delays were denied coverage
based on this premise. This also means families of children with disabilities can now change
their policy without fear of losing coverage for their child. The White House estimates 72,
000 uninsured will gain coverage because of this.
2) Insurance carriers can no longer impose lifetime limits on benefits. According to the N Y
Times, this will extend coverage to 20, 400 people that may exceed their limits each year.
Anyone who previously reached his or her lifetime maximum on an existing policy can reenroll. Restrictions on annual limits have begun, but will not be eliminated in full until 2014 .
Additionally, insurers will no longer be able to drop insurance contracts(technically called
rescissions) if they discover a technical error on their application. Rescissions now require a
30 day advance notice and are limited to fraud or intentional misrepresentation of material
fact.
3) Young adults can stay on their family health care plan until they turn 26 , regardless of
student or marital status. (Certain states have extended this until age 29).
These provisions alone clearly will redistribute the pie pieces and offer more to patients,
and in turn, providers. This new population, previously denied service, will seek out their
new benefits, and this can increase demand for our services. Remember though, that the
law is just one part of reform- there will be much needed regulatory work to be done to
implement the new coverage.
Another provision also in effect concerns preventative care. Now, certain measures,
recommended by a task force appointed by the U.S. Department of Health and Human
Services such as colonoscopies, immunizations and mammograms must be covered without
co-payment.
The parameters of preventative care, and what it will encompasses in the coming years
have not been fully defined ,and, at the moment, do not include “lifestyle intervention
services”. Many anticipate that lifestyle changes as a preventative measure will be among
the future initiatives. OTs and PTs are known to address prevention initiatives such as
reducing falls, improving physical activity to mitigate chronic disease and secondary health
conditions, and tailoring wellness programs for populations that have chronic conditions
and disabilities, so we are well positioned to lead in this area. We can provide insight and
interventions to increase physical activities among appropriate patients that will reduce
excess body mass, improve health status, and reduce associated chronic disease risk. On
the community level, we can work to offer evidence –based prevention and wellness . It is
44
key to stay informed so that we can fully participate in health care reform, and work to
carve out our piece of the healthcare dollar pie.
HOW FAR TO GROW?????
There are therapists who build their practice to the point that they have enough clients to
keep them busy, and they have all the patients that they can handle. When you arrive at this
moment and if you are content, then enjoy your success. On the other hand, some of you may
feel the need for greater challenges, and may want to transition from being a “practitioner”
to being more of a “proprietor”. Risk-wise, compared to when you are starting out and have
everything to gain and little to lose, at this junction you may be putting your hard earned
reputation, and everything you have accomplished so far on the line. The decision to grow
your practice to the next level should be made after carefully examining certain personal and
external variables. Certain questions/ areas to consider include:







Is this the right time and place to do this?
Do I have access to the money I need for expansion?
Am I prepared to spend less time with patients?
Am I prepared to spend the time necessary to make the expansion work, and feel
comfortable delegating responsibilities to other
Have I analyzed the marketplace and am confident there is sufficient demand to support
my expansion
Am I emotionally comfortable with this new risk?
Have I weighed the positive changes I expect from the expansion with the negative
consequences of expansion and feel comfortable with the balance?
45
Good luck to each and every one of you in your new endeavor. Regardless of the rate that
your practice grows, remember that in the service industry, you want to have sustained
controlled growth so that you can make sure the quality of the service you provide remains
high. While many therapists feel under a time constraint to make their practice a success in a
short period of time, I think it is far better to put away your “clock” and take out your
“compass” to make sure your practice is growing in the right direction, regardless of how long
it takes.
I have had the opportunity to work with therapists all over the country and truly enjoy the
successes that I help them accomplish. I am available for short term private consultations for
questions, problems, challenges, help on writing everything from business plans, proposals,
marketing letters, press releases, bidding on contracts, and ideas to sustain the growth of
your practice once it is up and running!
You can reach me at: 845 430 7749/ 212 343-0236
infonytherapy@aol.com
Or regular mail at: Iris Kimberg, MS PT OTR
NYTherapyGuide
105 Hudson Street 11N
NY NY 10013
46
APPENDIX:
SAMPLE NOTICE OF PATIENT INFORMATION PRACTICES FOR HIPAA COMPLIANCE TO GIVE
TO PATIENTS ALONG WITH SIGNATURE SHEET
NOTICE OF PATIENT INFORMATION PRACTICE
This notice describes how medical information about you may be used or disclosed by this
Practice and how you can get access to information. Please review it carefully.
LEGAL DUTY This practice is required by law to protect the privacy of your personal health
information, provide this notice about our information practices and follow the information
practices that are described here.
USES AND DISCLOSURES OF HEALTH INFORMATION This practice uses your health
information primarily for treatment, obtaining payment for treatment, conducting internal
administrative activities and evaluating the quality of care that we provide. We may also use
or disclose your personal health information for public health purposes, audits, emergencies
and when required by law.
In any other situation, our policy is to obtain your written authorization before disclosing your
personal health information. If you provide us with a written authorization to release your
information for any reason, you may later revoke that authorization to stop future disclosures
at any time.
We may change our policy at any time. When changes are made a new Notice of Information
Practices will be posted in our office and you will receive a new written notice as well.
PATIENT’S INDIVIDUAL RIGHTS You have the right to review or obtain a copy of your personal
health information at any times. You have the right to request that we correct any inaccurate
or incomplete information in your records. You also have the right to request a list of
instances where we have disclosed your personal health information for reasons other than
treatment, payment, or other related administrative purposes. You may also request in writing
that we not use or disclose your personal health information for treatment, payment and
administrative purposes except when specifically authorized by you, when required by law or
in emergency circumstances. We will consider all such requests on a case by case basis, but
the company is not legally required to accept them.
CONCERNS AND COMPLAINTS
If you are concerned that we may have violated your privacy rights or if you disagree with any
decisions we have made regarding access or disclosure of your personal health information,
please contact the Privacy Officer at the address listed below. You may also send a written
complaint to the US Department of Health and Human Services.
PUT YOUR NAME, ADDRESS AND TELEPHONE NUMBER OF PRACTICE
47
SAMPLE PATIENT INFORMATION CONSENT FORM FOR HIPAA COMPLIANCE
I have read and understand the attached Notice of Patient Information Practices. I
understand that the company may use or disclose my personal health information for the
purposes of carrying out treatment, obtaining payment, evaluating the quality of services
provided and any administrative operations related to treatment or payment. I understand
that I have the right to restrict how my personal health information is used and disclosed for
treatment, payment and administrative operations if I notify the company. I also understand
that this practice will consider requests for restrictions on a case-by-case basis, but does not
have to agree to requests for restrictions.
I hereby consent to the use and disclosure of my personal health information for purposes as
noted in the Company’s Notice of Patient Information Practices. In doing so, I hereby release
______________________(insert your name and your company name if different from any and
all legal liability that may arise from the release of such information. I agree that a copy of this
authorization may be used in place of the original.
I understand that I retain the right to revoke this consent by notifying the practice in writing at
any time except for that action which has already been taken. It shall be effective only long
enough to answer the purpose of which it is given and no further confidential information will
be released without the execution of an additional written authorization.
Patient and Parent/Guardian’s Printed Name if Patient is under 18
_________________________________________________
_________________________________________________
Signature
___________________
Date
48
SAMPLE LANGUAGE ON CONFIDENTIALITY TO INCLUDE ON ALL FAXES/EMAILS
Notice of Confidentiality: Information included and/or attached in this fax/email transmission
may be confidential. This fax/email transmission is intended for the addressee(s) only. Any
unauthorized disclosure, reproduction or distribution of and/or any unauthorized action taken in
response or reliance on the information contained in this fax/email is prohibited. If you believe
that you have received this fax/email in error, please notify the sender by reply transmission and
destroy without copying or disclosing it.
49
Family Educational Rights and Privacy Act (FERPA)
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part
99) is a Federal law that protects the privacy of student education records. The law
applies to all schools that receive funds under an applicable program of the U.S.
Department of Education.
FERPA gives parents certain rights with respect to their children's education records.
These rights transfer to the student when he or she reaches the age of 18 or attends a
school beyond the high school level. Students to whom the rights have transferred are
"eligible students."



Parents or eligible students have the right to inspect and review the student's
education records maintained by the school. Schools are not required to
provide copies of records unless, for reasons such as great distance, it is
impossible for parents or eligible students to review the records. Schools may
charge a fee for copies.
Parents or eligible students have the right to request that school correct
records, which they believe to be inaccurate or misleading. If the school decides
not to amend the record, the parent or eligible student then has the right to a
formal hearing. After the hearing, if the school still decides not to amend the
record, the parent or eligible student has the right to place a statement with the
record setting forth his or her view about the contested information.
Generally, schools must have written permission from the parent or eligible
student in order to release any information from a student's education record.
However, FERPA allows schools to disclose those records, without consent, to
the following parties or under the following conditions (34 CFR § 99.31):
o School officials with legitimate educational interest;
o Other schools to which a student is transferring;
o Specified officials for audit or evaluation purposes;
o Appropriate parties in connection with financial aid to a student;
o Organizations conducting certain studies for or on behalf of the school;
o Accrediting organizations;
o To comply with a judicial order or lawfully issued subpoena;
o Appropriate officials in cases of health and safety emergencies; and
o State and local authorities, within a juvenile justice system, pursuant to
specific State law.
Schools may disclose, without consent, "directory" information such as a student's
name, address, telephone number, date and place of birth, honors and awards, and
50
dates of attendance. However, schools must tell parents and eligible students about
directory information and allow parents and eligible students a reasonable amount of
time to request that the school not disclose directory information about them. Schools
must notify parents and eligible students annually of their rights under FERPA. The
actual means of notification (special letter, inclusion in a PTA bulletin, student
handbook, or newspaper article) is left to the discretion of each school.
For additional information or technical assistance, you may call (202) 260-3887 (voice).
Individuals who use TDD may call the Federal Information Relay Service at 1-800-8778339.
Or you may contact us at the following address:
Family Policy Compliance Office
U.S. Department of Education
400 Maryland Avenue, SW
Washington, D.C. 20202-5920
51
SAMPLE PRESS RELEASES
(This is the press release I originally wrote 25 years ago that I modified and adjusted as I
opened new branches, offered new services etc. Although it is somewhat dated, it does
capture the essence of what to include in a press release, and the format to present the
information in)
FOR IMMEDIATE RELEASE
DATE:
CONTACT: Iris Kimberg, MS PT OTR
Office Address and Tel number
NEW COMMUNITY SERVICE OFFERS COMPREHENSIVE PHYSICAL REHABILITATION SERVICES
IN THE HOME
How do you crack on egg one handed, or tie a shoe or even light a match? Many New Yorkers
face these and similar problems managing everyday tasks. People who are partially paralyzed
from strokes, accidents or spinal cord injuries, those who have arthritis, amputations or
orthopedic conditions may not be able to function independently, or may need help that will
enable them to function better. These are not medical problems requiring a hospital stay or a
physician’s care, but the skills of a professional trained in physical rehabilitation.
The Home Therapists Association is a new community service offering comprehensive physical
therapy rehabilitation therapy services to children and adults in their homes. Created to meet
the growing need for these services, HTA offers therapy programs by qualified licensed and
registered physical, occupational and speech therapists. Therapy is carried out in conjunction
with a person’s physician, and in most cases is insurance reimbursable. Cases are now
accepted on Long Island in addition to all five boroughs of New York.
The goal of the program is to help a person regain as much function as possible, in order to
resume their daily routine and lifestyle. The therapy varies according to the need of the
individual, which is determined during the initial home visit and evaluation. For some, this
might mean learning to sit up or stand, walk with the aid of a walker or cane, or how to
maneuver into or out of an automobile. Treatment might include helping a homemaker make
her kitchen wheelchair accessible, or minimizing hazards throughout the home. Therapists
involve family members in the person’s rehabilitation program, teaching them more about the
disability, and how to carry out a home exercise program.
The services of a skilled physical, occupational, or speech therapist can be a valuable means of
decreasing recovery time and minimizing disruption to a family, while offering a person the
physical and emotional support that they need. For more information you can call or write:
Home Therapists Association
address/tel no.
52
Here is another created for a certified Hand Therapist
FOR IMMEDIATE RELEASE
Address
Date
CONTACT: Your Name/
WORKING HAND IN HAND TO CELEBRATE
NATIONAL OCCUPATIONAL THERAPY MONTH IN APRIL!
For ********* , a NYS licensed occupational therapist and specialist in treating people with
hand and upper arm conditions, National Occupational Therapy month in April is a great
opportunity to show Brooklyn consumers the benefits of the hand therapy profession.
************ has practiced in his hometown of Brooklyn for 8 years, treating hundreds
of neighbors, colleagues and workers whose hands and/or arms may have been afflicted by
an accident or trauma. People have turned to *********** when they are left with wounds,
scars, burns, injured tendons or nerves, fractures or in some cases, amputations of the finger
or hand. There are also times when a person who is disabled from the effects of repetitive
motion, such as tennis elbow or carpal tunnel syndrome, or those with chronic problems
such as arthritis seek out his services.
His Brooklyn office is filled with treatment apparatus that help to make a person’s hands
look and feel better, restore dexterity as well as get stronger. The most important goal of all
is to help a person regain as much function as possible, in order to resume their daily routine
and lifestyle. Therapy is always carried out in conjunction with a person’s physician, and in
most cases is insurance reimbursable.
During National Occupational Therapy Month, ************** is available to talk to
anyone who has a hand or arm problem that may require therapy services.
For more information, you can write, telephone, or e-mail him at:
53
SAMPLE LETTER THAT MUST ACCOMPANY PRESS RELEASE
It is necessary to enclose a letter to the editor: (here is the letter I used with the first press
release)
Name of Editor
Publication
Address
Dear
Enclosed is a copy of a press release regarding a new community service offering
comprehensive physical rehabilitation services to people in need right in their homes.
Our recently expanded our program now includes communities in Nassau and Suffolk
counties. We would appreciate it if you could publish the release and inform your readers of a
service that they might need. Previous releases have been published in local community
newspapers in New York City with excellent response from those readers in need.
Photographs of actual treatment sessions are available. In addition, I am available should have
any questions, or if you would like to do your own feature story. Please feel free to edit this if
necessary.
Thank you in advance for your consideration in this matter.
Sincerely,
Iris Kimberg, MS PT OTR
Director, Home Therapists Association
54
SAMPLE THANK YOU LETTER TO PHYSICIAN PUT ON YOUR LETTER HEAD
January 2011
Dr. Berger
2002 Joint Street
Brooklyn, New York 12401
RE: Jane Smith
Dear Dr. Handman,
Thank you for referring Jane Smith for a physical therapy evaluation and treatment. She has
been started on a twice weekly program of lower extremity strengthening, range of motion
exercises and gait training. I have enclosed a copy of her initial evaluation, and will forward
periodic progress notes as well.
I specialize in treating patients with a variety of neurological and orthopedic conditions, and
have two fully equipped offices conveniently located at ***************
. My patients
all receive individualized one on one treatment including joint and soft tissue mobilization,
therapeutic exercise, massage, muscle re-education, and use of all modalities as indicated. I
participate in and accept most major insurance plans, including worker’s compensation and
no-fault.
Please feel free to contact me if you have any concerns regarding Ms. Smith, or if any of your
other patients could benefit from my services. I look forward to hearing from you, and sharing
in the care of your patients.
Sincerely,
PS. I have enclosed an article recently published in the ***** about my services.
55
SAMPLE MARKETING LETTERS FOR NEW MD REFERRALS
All letters to be written on professional letterhead
Date
Name of Doctor
Address
Dear Dr.
I am writing to introduce myself and the services that are provided in my office.
My specialties for the past ****** years has been both neurologically and orthopedic based,
including extensive post graduate studies in ********** . I believe in a truly hands on, one
to one approach that includes manual therapy, joint and soft tissue mobilization, myofacial
therapy, muscle energy and trigger point techniques. I often combine the techniques of
Feldenkrais,********** and *********** in my work.
Most of my patients have neurological and orthopedic conditions. I have had great success
treating those patients that others may have had trouble attaining functional gains with in the
past. This includes patients with various radiculopathies, neuropathies, orthopedic sports
injuries, as well as chronic diseases including arthritis, spinal cord injuries, and post CVA’s. I
emphasis short term, effective one on one treatment programs specifically tailored to the
person’s needs.
In addition to providing individualized PT sessions, there is also a registered Swedish Massage
Therapist on staff and a fully supervised work out/gym area. Once we receive a referral from
you I will always follow up with an initial report to you as well as subsequent progress reports.
We are participating providers in many plans including __________________ and also accept
worker’s compensation and no –fault insurance.
I currently receive referrals from many physicians in the area including Drs. **********and
*********** . I have enclosed a brochure detailing our location, services, hours and hours. I
would also be happy to meet with you in person to further discuss my services. I would
welcome the opportunity to share in the care of your patients and hope to hear from you
shortly.
Sincerely,
56
Dear Dr.
I am an orthopedic physical therapist with 13 years experience, and have recently relocated
to ************** . Previously, I had a private practice in the city, serving a general
orthopedic population and have also practiced in sports medicine/ general orthopedic clinics
in the financial district of NYC. In addition, I am a master teacher of the Alexander Technique,
which teaches postural awareness and is an excellent adjunct for dancers, musicians and
writers, as well as all others.
The physical therapy work that I practice is truly a hands-on approach. The manual therapy
techniques include joint and soft tissue mobilization, specific therapeutic exercise and
movement awareness. Patients benefit from my expertise and the quality and quantity of time
spent. All appointments are individually scheduled and are a minimum of 45 minutes.
My new office will be open as of *********** . It is conveniently located on the ground floor
and there is ample parking. My office hours are************ .
Please note that I am currently a provider for ***************
and will do out of
network billing for all others. In addition, I do accept both no-fault and workers compensation.
Copies of all physical therapy initial evaluations and periodic progress notes will be sent
directly to you to help coordinate care.
I would be happy to visit your office at your convenience if you would like to meet with me. It
is my privilege to be part of your patient’s care, and I look forward to our future association.
Sincerely
57
SAMPLE GENERAL MARKETING LETTER for SCHOOL SERVICES
Put on professional letterhead
Date:
Name
Address
RE: AVAILABILITY TO PROVIDE SCHOOL/HOME-BASED OCCUPATIONAL THERAPY
SERVICES
Dear
,
I am writing to let you know that I am now available to treat students who have been
mandated for Occupational Therapy services either at school, or in their homes. I have been
an OT for over twenty years, and am certified by the Board of Education. I have a Master
Degree in Developmental Disabilities, and have almost completed the certification course in
Sensory Integration. I am currently working in the ******** High School, and anticipate
openings in my schedule beginning*************** should you have unserved students
who are mandated for OT. I am very familiar with the delivery of school based therapy
services, writing IEPs , as well as the importance of collaborating with teachers and other
team members. I also have experience in doing Initial Evaluations should the need arise.
Please feel free to contact me at the telephone number or email address above should you
have any questions, or if you think I can be of service to any of the students in your district
(or school depending on who you are sending the letter to).
I look forward to hearing from you and working together in the future.
Sincerely,
P.S. I hope to open my facility, Pediatric Therapy Center, Inc. by the Spring and will be able
to offer center based evaluations and treatment as well.
58
SAMPLE INITIAL INTAKE FORM
Welcome to: _______________________________________________
Please take a moment to fill out the following information.
Today’s Date _____/_____/_____ Referred by: _____________________________
Last Name, First Name _______________________, __________________________
Home Address __________________________________________________________
Email address:___________________________________________________________
Mailing address if Different:
________________________________________________________________________
Home Phone # ( ) _______________ Work Phone # ( ) ________________
Cell phone: ___________________
Social Security # _____________________Date of Birth ________________________
Insurance Company _______________________Ins. Phone #____________________
Insured Name _________________ S.S.#__________________ D.O.B_____________
(if different from above)
Insurance Policy # _________________________Group # _____________________
Terms and limits of Therapy coverage: __________________________________________
Employer ______________________________________________________________
Employer Address _______________________________________________________
Emergency Contact _____________________Phone #__________________________
Primary Care M.D. _________________Referring M.D. _______________________
Diagnosis/Nature of Problem /Current Medications / Treatment prescription
______________________________________________________________________________
____________________________
How did you hear about us?____________________________________________________
Please Note: Your health information will be kept confidential. Any information that we collect about you on this form will
be kept confidential in our office. Please note if a claim is submitted to an insurance company on your behalf, the health
information on this form will be shared with your carrier.
59
SAMPLE ASSIGNMENT OF BENEFIT FORM
Patient’s Name: ___________________________________ Date: ____________
I _______________________ understand that my insurance company will be sent an itemized
bill for each session in accordance to the reasonable and customary charges for such services.
I agree to assign benefits directly to ______________________for all therapy services
rendered. I also agree to remit any monies sent to me in error from my insurance company for
services rendered to ______________________. I agree to pay for all services rendered
should my insurance company deny payment for services rendered, and will be responsible for
any deductible, co-insurance or co-payment, to be paid at the time of my visit.
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
For patients who pay privately or have out-of-network benefits, payments are due at the time
of your visit. The fee for service for an initial evaluation is __________. The fee for service for
all follow-up visits is _______. If requested, _____________________ will assist you in
submitting claims to your insurance company.
CANCELLATION and DISCONTINUANCE FROM SERVICES POLICY
This office requires 24 hours notice for cancellations. Otherwise, you will be charged the full
fee of the session. In addition, you will be charged the full fee for the session if you do not
show for a confirmed appointment. Should you miss three consecutive visits it will be
considered that you are not in adherence or compliance with your plan of care, and will be
discharged from this office. Your primary physician will be notified and you will be given the
names of three like professionals for your future use should you decide to begin therapy
services again.
I have read and agreed to the above policies and procedures.
Patient or Responsible Party Signature___________________________ Date_____________
**** Make two copies of this form: one for your records and one for the patient
_____________________________________(Signature) Date: ______________
60
SAMPLE ADVANCE BENEFICIARY NOTICE
Patient’s Name: _________________________ Medicare # ________
ADVANCE BENEFICIARY NOTICE (ABN)
NOTE: You need to make a choice about receiving these health care items or service
We expect that Medicare will not pay for the item(s) or service(s) that are described below. Medicare does not
pay for all of your health care costs. Medicare only pays for covered items and services when Medicare rules
are met. The fact that Medicare may not pay for a particular item or service does not mean that you should not
receive it. There may be a good reason your doctor has recommended it. Right now, in your case, Medicare will
probably not pay for:
Name of Service:
Because:
The purpose of this form is to help you make an informed choice about whether or not you want to receive
these items or services, knowing that you might have to pay for them yourself. Before you make a decision
about your options, you should read this entire notice carefully.


Ask us to explain, if you don’t understand why Medicare probably will not pay.
Ask us how much these services or items will cost (Estimated cost: $ ) in case you have to pay for them
yourself or through other insurance.
PLEASE CHOOSE ONE OPTION. CHECK ONE OPTION. SIGN AND CHECK YOUR CHOICE.
_____Option 1. Yes. I want to receive these items or services. I understand that Medicare will not decide to pay
unless I receive these items or services. Please submit my claim to Medicare. I understand that you may bill me
for items or services and that I may have to pay the bill while Medicare is making a decision. If Medicare does
pay, you will refund to me any payment that I made to you that are due to me. If Medicare denies payment, I
agree to be personally responsible for payment. That is, I will pay personally either out of pocket or through
any other insurance that I have. I understand that I can appeal Medicare’s decision.
______OPTION 2. NO. I have decided not to receive these items or services. I will not receive these items or
services. I understand that you will not be able to submit a claim to Medicare and that I will not be able to
appeal your opinion that Medicare won’t pay.
_____________ _____________________________________________
Date Signature of patient or person acting on patient’s behalf
NOTE: Your health information will be kept confidential. Any information that we collect about you on this
form will be kept confidential in our office. If your claim is submitted to Medicare, your Health information on
this form may be shared with Medicare. Your health information which Medicare sees will be kept confidential
by Medicare.
61
Common Codes for Occupational and Physical Therapists
The codes most often used when billing for physical and occupational therapy are listed
below. They are taken from the AMA Current Procedural Terminology. To interpret the
descriptions accurately, remember that when a code contains a descriptor that has a
semicolon(;), then the wording prior to the semicolon applies to all indented codes
immediately underneath.
Therapeutic Procedure – A manner of effecting change through the application of clinical
skills and/or services that attempt to improve function.
Therapist is required to have direct (one on one) patient contact.
97001 – Physical Therapy evaluation
97002- Physical Therapy Re-evaluation
97003 – Occupational Therapy evaluation
97004 – Occupational Therapy re-evaluation
97110 - Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to
develop strength and endurance, range of motion and flexibility
97112 – Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense,
posture and/or proprioception for sitting and/or standing activities
97113 – aquatic therapy with therapeutic exercises
97116 – gait training (including stair climbing)
97124 – massage, including effleurage, petrissage and/or tapoment(stroking,
compression,percussion); (for myofacial release, use 97140)
97139 – Unlisted therapeutic procedure (specify)
97140 – Manual therapy techniques (i.e.. mobilization/manipulation, manual lymphatic
drainage, manual traction), one or more regions, each 15 minutes.
97150 – Therapeutic procedure(s), group (2 or more individuals) (report 97150 for each
member of group); (group therapy procedures involve constant attendance of the physician
or therapist, but by definition do not require one on one patient contact by the physician or
therapist); (For manipulation under general anesthesia, see appropriate anatomic section in
Musculoskeletal System); (For osteopathic manipulative treatment (OMT), see 9892598929)
97504 – Orthotic(s) fitting and training, upper extremity(ies), lower extremity(ies), and/or
trunk, each 15 minutes; (code 97054 should not be reported with 97116); (For casting and
strapping of fracture, injury or dislocation, see 29000,29590)
97520 – Prosthetic training, upper and/or lower extremity training, each 15 minutes
97530 – Therapeutic activities, direct one on one patient contact by the provider (use of
dynamic activities to improve functional performance), each 15 minutes
97532 – Development of cognitive skills tp improve attention, memory, problem solving
(includes compensatory training), direct one on one patient contact by the provider, each 15
minutes
97533 – Sensory integrative techniques to enhance sensory processing and promote
adaptive responses to environmental demands, direct one on one patient contact by the
provider, each 15 minutes
62
97535 – Self care home management training ( i.e. activities of daily living and compensatory
training, meal preparation, safety procedures, and instruction in use of assistive technology
devices/adaptive equipment) direct one on one contact by the provider, each 15 minutes
97537 – Community/work reintegration training ( i.e.- shopping, transportation, money
management, avocational activities and/or work environment/modification analysis, direct
one on one patient contact by the provider, each 15 minutes.
97542 – Wheelchair management/propulsion training, each 15 minutes
97545 – Work hardening/conditioning, initial 2 hours
FOR SPEECH-LANGUAGE PATHOLGY CODING
92506 – Evaluation of speech, language, voice, communication, auditory processing and/0r
aural rehabilitation status
92507 – Treatment of speech, language, voice, communication, and/or auditory processing
disorder(includes aural rehabilitation); individual
92508 group, two or more individuals
92510 – Aural rehabilitation following cochlear implants ( includes evaluation of aural
rehabilitation status and hearing, therapeutic services) with or without speech processing
program
92526 – Treatment of swallowing dysfunction and/or oral function for feeding
96105 – Assessment of aphasic (includes assessment of expressive and receptive speech and
language function, language comprehension, speech production ability, reading, spelling,
writing, i.e. by Boston Diagnostic Aphasia Examination) with interpretation and report, per
hour
96110 – Developmental testing; limited ( i.e.. Developmental Screening Test II, Early
Language Milestone Screen), with interpretation and report
96111 - Extended (includes assessment of motor, language, social, adaptive and/or
cognitive functioning by standardized developmental instruments, i.e.. Bayley Scales of
Infant Development) with interpretation and report
96115 - Neurobehavioral status exam ( clinical assessment of thinking, reasoning, and
judgment, i.e.. acquired knowledge, attention, memory, visual spatial abilities, language
functions, planning) with interpretation and report, per hour.
CPT Codes Most Frequently Used in Pediatrics
97001 - Physical Therapy evaluation
97002 - Physical Therapy Re-evaluation
97003 – Occupational Therapy evaluation
97004 – Occupational Therapy re-evaluation
97110 - Therapeutic procedure, one or more areas, each 15 min; therapeutic exercises to
develop strength, endurance, ROM, and flexibility
97112 – Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense,
posture and/or proprioception for sitting and/or standing
97113 – Aquatic therapy with therapeutic exercises
97116 – Gait training (including stair climbing)
63
97124 – Massage
97140 – Manual therapy techniques (myofascial release, mobilization…one or more regions,
each 15 minutes.
97150 – Therapeutic procedure(s) for group (2 or more - report 97150 for each member of
group); group therapy procedures involve constant attendance of the physician or therapist,
but by definition do not require one on one patient contact by the physician or therapist
97504 – Orthotic (s) fitting and training, upper and/or lower extremity, and/or trunk, each 15
minutes
97520 – Prosthetic training, upper and/or lower extremity, each 15 minutes
97530 – Therapeutic activities to improve functional performance direct one on one patient
contact by the provider, each 15 minutes
97532 – Development of cognitive skills to improve attention, memory, problem solving
(includes compensatory training), direct one on one patient contact by the provider, each 15
minutes
97533 – Sensory integrative techniques to enhance sensory processing and promote
adaptive responses to environmental demands, direct one on one patient contact by the
provider, each 15 minutes
97535 – Self care home management training (i.e. activities of daily living and compensatory
training, meal preparation, safety procedures, and instruction in use of assistive technology
devices/adaptive equipment) direct one on one contact by the provider, each 15 minutes
97542 – Wheelchair management/propulsion training, each 15 minutes
92506 – Evaluation of speech, language, voice, communication, auditory processing and/0r
aural rehabilitation status
92507 – Treatment of speech, language, voice, communication, and/or auditory processing
disorder (includes aural rehabilitation); individual
92508 - Treatment in group, two or more individual
92510 – Aural rehabilitation following cochlear implants (includes evaluation of aural
rehabilitation status and hearing, therapeutic services) with or without speech processing
program
92526 – Treatment of swallowing dysfunction and/or oral function for feeding
96105 – Assessment of aphasic (includes assessment of expressive and receptive speech and
language function, language comprehension, speech production ability, reading, spelling,
writing, i.e. by Boston Diagnostic Aphasia Examination) with interpretation and report, per
hour
96110 – Developmental testing; limited (i.e. Developmental Screening Test II, Early Language
Milestone Screen), with interpretation and report
96111 – Developmental testing; extended (includes assessment of motor, language, social,
adaptive and/or cognitive functioning by standardized developmental instruments, i.e.
Bayley Scales of Infant Development) with interpretation and report
96115 - Neurobehavioral status exam (clinical assessment of thinking, reasoning, and
judgment, i.e. acquired knowledge, attention, memory, visual spatial abilities, language
functions, planning) with interpretation and report
FYI: AMA holds all rights to CPT codes.
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Questions and Answers about National Provider Identifier Standard
What is a National Provider Identifier? This is a 10 digit number officially referred to as an
“Intelligence free numeric identifier”. “Intelligence free” means that the number does not
carry information about health care providers such as the type of provider they are, or the
state in which they practice. NPIs are required as part of the HIPAA ACT of 1996, which
included the adoption of a standard unique identifier for health care providers. The NPI will
replace any currently existing health care provider identifier in use today.
Why do we need the National Provider Identifier? The goal of the program is to enhance
and simplify the coordination of all HIPAA benefit transactions, and to create a standard
unique health identifier.
Who can apply and who needs to apply for the NPI? Anyone who is a health care provider
(including OTs) are eligible for NPIs. Any health care provider who is considered a HIPPAcovered entities (whether you are an individual or an organization) must obtain an NPI to
identify themselves in HIPAA standard transactions. A solo practitioner would be considered
an individual and a group practice would be considered an organization. A sole proprietor
would be considered an individual and must apply for an NPI using his or her own SSN even
if he/she has an EIN.
A health care provider who transmits any health information in electronic form for which
the HHS has adopted a standard is considered a HIPAA-covered health care provider. (IF
YOU ARE UNCERTAIN WHETHER YOU ARE CONSIDERED A COVERED ENTITY GO TO:
WW/CMS.HHS.GOV/HIPAAgeninfo/Downloads/CoveredEntitycharts.pdf )
When and where can I apply for an NPI? There is no cost associated with getting an NPI and
the CMS has contracted with Fox Systems Inc. to serve as the NPI Enumerator. The NPI
Enumerator is responsible for dealing with heath plans and providers on issues relating to
unique identification. Applications can be done online or downloaded at
https://nppes.cms.hhs.gov/NPPES/Welcome.do. If you have specific questions you can
contact the Fox Systems at: 1-800-465-3203, by email at customer
service@npienumerator.com or regular mail at: NPI Enumerator PO BOX 6059 Fargo, ND
58108-6059
Remember, getting an NPI does NOT replace becoming a Medicare provider.
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RESOURCES AND WEBSITES
(Please note that I try to keep this as up to date as possible but web address constantly
change)
PROFESSIONAL ORGANIZATIONS
1. American Physical Therapy Association (APTA) www.apta.org
2. New York Physical Therapy Association www.nypta.org
3. American Occupational Therapy Association (AOTA) www.aota.org
4. New York State Occupational Therapy Association www.nysota.org
5. American Speech Language Hearing Association www.asha.org
6. New York State Speech Language Hearing Association www.nysslha.org
7. Long Island Speech Language Hearing Association www.lisha.org
MEDICARE / STATE EDUCATION GUIDELINES
1. Centers for Medicare and Medicaid Services (CMS)
http://www.cms.gov/home/medicare.asp
CMS Program Integrity Manual –www.cms.gov/manuals
2. Office of the Inspector General (OIG) www.oig.hhs.gov
(compliance issues/guidelines, fraud and abuse,
exclusion data base for screening)
3. Office of the Professions- NYS Education Dept www.op.nysed.gov
EQUIPMENT NEEDS FOR START UP
Rhys Filmer
Rehab Sales Consultant
Sammons Preston - a Patterson Medical Company
(347) 537-8594 - Mobile
(718) 228- 9694 - Fax
Rhys.Filmer@PattersonMedical.com
(631) 244-3600 - Jackie in customer service
BUSINESS HELP
1. www.sba.gov
2. www.lectlaw.com
3. www.cnnfn.com/smbusiness
4. Dept of Labor: www.dol.gov
5. Internal Revenue Service www.irs.gov
(staffing issues – independent contractors vs. employees)
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6. Proper and improper pre-employment questions: http://www.nolo.com
7. American Association of Health Plans www.aahp.org
8. Coding Books
http://www.aapc.com/onlinestore/medical-codingbooks/2011/index.aspx?gclid=CNeI8syF6qkCFYeD5Qod2nExaA
http://www.shopingenix.com/
Universal Customized Billing Forms – www.filerx.com
FINANCIAL ASSISTANCE
Small Business Assistance: www.sba.gov/financing
INSURANCE CARRIERS FOR MALPRACTICE/GENERAL LIABILITY
CM & F GROUP, Inc.
Serving Healthcare Professionals for over 50 Years (PTs OTs STs and Group Practices)
99 Hudson Street 12th Floor
NYC 10013-2815
Contact person: Martin J. Liston, CIC
(212) 233-8911 ext. 346 or 1-800 397-3008
email: mliston@cmfgroup.com
www. cmfgroup.com
HPSO
159 East Country Road
Hatboro, Pennsylvania ,19040-1218
1 -800-982-9491
SEABURY AND SMITH (formally Maginnis and Associates)
332 South Michigan Avenue Suite 1400
Chicago, Illinois, 60604-4372
1-800 621-3008
1-312-894-5200
HIPAA INFORMATION
http://www.hhs.gov/ocr/privacy/hipaa/administrative/
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NYC/NYS Specific Information
WORKER’S COMPENSATION AND NO FAULT IN NY
Contacts in NY Worker’s Compensation Board: 1-800-877-1373
www.wcb.state.ny.us
City of New York
Worker’s Compensation Division
350 Jay Street 9th Floor
Brooklyn, NY 11201 (718) 222-5100
In New York State, the largest worker’s compensation carrier is the State Insurance Fund.
They have their own case management unit and you can apply to become one of their
approved vendors.
Contact:
State Insurance Fund
Nursing Supervisor
199 Church Street 4th Fl.
New York, New York, 10013
Include a letter of introduction about yourself and your practice, as well as your license
number and tax identification number.
(For NJ/Conn therapists, remember that there may be patients who work in NY, and are
covered by NY State Worker’s Compensation, but live and will seek treatment in your state).
NYC Department of Education Website: http://schools.nyc.gov/Offices/default.htm
Medicare Provider Enrollment https://www.cms.gov/MedicareProviderSupEnroll/
Early Intervention – New York (A) New Jersey (B)
A. Early Intervention Program
Bureau of Child and Adolescent Health
NYS Dept of Health
Empire State Plaza
Corning Tower, Room 208
Albany, NY 12237-0618
Form: DOH 3736 – Application for Approval of Agencies or Incorporated Groups of Individuals
as Evaluators, Service Providers and Service Coordinators
Form DOH 3735 – Application for Individuals
B. New Jersey New Jersey Early Intervention System (NJEIS)
Department of Health and Senior Services EIS 609-777-7734
http://www.nj.gov/health/fhs/eis/
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