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The Business of Private Practice
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Anticipate the Unexpected—And Plan for It!

By Deb Legge, PhD CRC, LMHC

When you’re ready to set up your private practice, you know the obvious things you have to take care of before you see your first client. For example you’ll have to set your fees, create billing and intake forms, and get familiar with HIPAA paperwork and policies. You may need a little help with some of those things, but they are on your to-do list.

Be sure not to overlook the less-obvious things that need your attention before you hang up your shingle. If you haven’t planned for these situations, you may 

Running a private practice can be exciting and rewarding. Visit for more helpful information on starting and growing a private practice, and to submit your questions and ideas for future articles in The Advocate.

be thrown off balance when one occurs—and it will occur. The danger is that when it does, if you haven’t planned for it, you may act too quickly—or not at all.

Here are some suggestions about situations to prepare for while you are getting ready to launch your private practice.

No-Shows and Late Cancellations

Hopefully you have published (in your client contract and on your appointment cards) your cancellation policy. (Mine says: This time is set aside for you. I require 24 hours advance notice to cancel or reschedule, or you will be billed for this appointment). Further, I do not schedule the next appointment until the missed appointment is paid, and I bill the same amount I would have received had we met.

So … how will you handle it when you don’t get the notice you require? Will you bill a general “no-show/late cancellation fee,” or will you bill for what you would have earned for the completed appointment? If you will charge a fee, stipulate the amount (or percentage).

There are no right or wrong answers—you just need to establish a policy, publish it, have your clients sign-off in agreement, and follow through!

Between-Session Calls and Emails

Generally, our business is a “dollars-for-hours” business. We get paid for our time (and energy). Many professionals will bill clients by the minute for emails and phone calls. You may not agree with that for your practice, and that’s okay! However, you do need to know (and let your clients know) your policy.

Will you limit between-session calls to emergencies? Will you use email for between-session check-ins, or will you use phone and email only for setting or changing appointments? Once you determine the parameters for which you will use these media, you should be able to come up with a fee scale (if any) for contact that is made within or outside of those parameters.

Requests for Paperwork

Eventually, you will be asked for information about your client. Social Security Disability pays $10 for completed forms—will that meet your needs and expectations? 

Attorneys will pay by the copied page—do you feel comfortable just printing out and mailing your case notes, or will you take time to write a summary? Private disability companies can be relentless with the amount of paperwork they require from clinicians who are treating their clients.

You may feel that the time involved in these efforts is part of doing business. You may, however, determine that you must come up with a fee for completing paperwork for a client under certain circumstances. 

If appropriate, you may determine that a client must come in for a session to collaborate with you in these efforts (if this is not a therapeutic session, you may have to bill privately). In any case, setting up a policy in advance will give clients a heads-up before you are faced with this scenario.

Legal Matters

You never know when you will be asked to provide detailed information, or even testimony, on behalf of a client. This can be very time-intensive, so it is wise to determine a policy up-front. Here are some things to consider:

  • Will you require a minimum of one or two phone sessions with the attorney before you prepare the necessary documents or before you appear in court?
  • Will you bill your client for any court dates for which you are asked to clear your schedule?
  • Will you bill for half-days or full-days?
  • Will you bill your client directly or through his/her attorney?
  • Will you expect payment for court dates in advance? How far in advance?
  • How much advance notice must you be given regarding any cancellations or changes in order for you to refund the payment?

You can’t every anticipate all the situations that will come up in the course of doing business in private practice. But the more advance planning (and notification) you can do right from the start, the better.

Setting policies for possible situations is not only professional; it also will help you avoid having to make a snap decision that you later regret.

AMHCA Private Practice Library

Getting the information and support you need on the business of private practice can help you to build a successful and sustainable business. AMHCA members are invited to log-in to AMHCA’s Private Practice Library to read articles by Dr. Deb Legge—for members only—on the business of running a clinical mental health counseling private practice.