Practice infrastructure

Building your practice infrastructure: Tech, legal, and financial structure

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Your practice infrastructure supports your business. In fact, your technology, legal, and financial structure hold your business together and lay the foundation for your daily work.

For example, your technology, i.e., your phones, internet, and website, allows people to find and connect with you. Your legal and financial structure facilitates all the business functions of a business–the charging and collecting of fees, the ability to bill and collect from insurance companies, etc. 

Most owners do not build their practice infrastructure because they love computers, law, or accounting. In reality, we often need help from professionals in those specialized areas to accomplish what we need.

I cover the topic of finding your professional support team in this post: Assembling your team of practice advisors.

Let’s take a more in-depth look at each part of your practice infrastructure, one at a time.

Phones 

When building a phone system, we are going for a functional system that handles calls and voicemail. Fortunately, we live in a time with many inexpensive options. Yet there are so many choices that it can be overwhelming.

One way to go is with companies like All Call Technologies and Phone.com. They have developed packages set up specifically for the mental health field. Just be certain that whichever system you choose, it complies with the HIPAA standards that guide us.

And importantly, you will want a system that allows you to transfer your phone number to a landline if needed. You may not think you will ever need a landline, but if you grow to a size requiring the hiring of support staff, you will need a landline and, eventually, a phone system.

Considerations in building a practice website

Every practice needs a website. Your site is a central part of your practice infrastructure. And yet, the task can be complicated, expensive, and give you an unsatisfying result. So how do we make the right choices?

Creating a website is both a technical and artistic challenge. Of course, we might want to build a DIY website. The challenge then is developing our own website-building skills to the level that our site looks professional. Most of us will need help from professions to get to a satisfying professional result.

Read a deep-dive into creating a practice website >

Billing and practice management software

I cannot imagine going back to the days of paper and pencil record keeping. Today, managing client information, billing records, accounts receivable, accounts payable, and scheduling is all done with the help of practice management software.

Most practices manage their data via several software apps, some of which are cloud-based applications. For example, we used one server-based application, MacPractice, for our scheduling, billing, collections, secure portal with clients, etc. We take summary data from income reports in MacPractice and put it in QuickBooks in order to do our payroll, Profit/Loss Statements and Balance Sheets. And we used Microsoft OneDrive, a cloud-based app, to set up and manage the agendas for our leadership meetings. Furthermore, we used spreadsheets, and word processing programs for additional documents or analyses.

My point is that most practices will use many software apps, some hosted on a computer you own and some hosted on the internet cloud.

Read more about specific applications for mental health practices >

Getting your legal details sorted out is a matter of meeting with an attorney and following her/his advice. Every state has different laws and rules for establishing a new corporate entity.

At a minimum and with your attorney’s help, you will select the type of corporation you are forming and get the start-up paperwork going. These details are important for determining how your taxes are handled and to register your company with your state and the Internal Revenue Service. Additionally, you will want legal advice before signing a lease or hiring any employees.

Read more about selecting an attorney, accountant and website designer/branding consultant, i.e. your practice advisors >

Liability insurance

Since you are establishing a new legal entity, your corporation will need to have liability insurance, also known as malpractice insurance. Most malpractice insurance policies allow you to elect coverage for both you as an individual and for your company. Likely you will have separate coverage limits. Using the same insurance company for both your company and for you is the least expensive option. 

All our mental health trade associations endorse providers of liability insurance. These rates and coverages are pretty standard. And the endorsement by a trade association gives you some confidence in the company and coverage. For example, here are the plans for APANASWACA, and AAMFT. One of these should do. You do not have to be a member to purchase these policies though members get a discount.

Getting your practice forms and policies set up

From day one, you will need to keep records for both yourself and for any audit that might occur. What these look like can be tailored to what you need for your software and your tastes. Our intake forms are several pages long and include these documents. Some of our forms are to collect information and some disclose policies clients should be aware of. Clients can download these forms from our website.

  • name, address, phone, insurance info sheet
  • symptom checklist
  • policies about psychotherapy 
  • consent to treat form
  • private notice
  • release form for contacting referral people and primary care MD

In addition to the forms, at a minimum, you will need to organize your data collection, scheduling, and rescheduling processes for intakes and continuing clients. Paper and pencil will work in the beginning, but you will want to get all your information into practice management software pretty early on. 

Join insurance panels or not?

You may wonder about which insurance panels to join, which to avoid, or whether to join any. This choice is about where you are practicing and the needs of your constituencies. I have written some of my thoughts on this issue here: Why join insurance panels

If you are joining insurance panels, start as early as you can. Insurance companies are notoriously slow in making these decisions. You want the insurance payments to begin when you open your doors.

Also read: Getting on Insurance Panels: Preparing for the process from the American Counseling Association. Here is another post from a company that helps with credentialling: New To Private Practice and Insurance Billing?

The whole practice infrastructure together

It may seem like there are a lot of pieces in your infrastructure puzzle. And there are. Yet when you put the pieces together, a whole picture takes shape in a coherent whole. Together, all the parts support all the daily activities that make your practice succeed. (Read more about Daily Core Activities here >)

Of course, some parts may need to be rebuilt as you outgrow one part or another. But that is an aspect of what makes building and running a practice simulating and rewarding. Grab hold and enjoy the process.

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