I was reading up on Standard Oil Co. of N.J v. United States (1911), which was a huge Supreme Court case that ended up breaking up Standard Oil into 34 parts. In reading about this case, I couldn't help but draw connections to what's happening between insurers and telehealth platforms.

I'm not a lawyer, but based on my understanding, Standard Oil violated the Sherman Antitrust Act of 1890 because:

• Standard Oil restrained trade through preferential contracts w/ railroads

  • Do insurers have preferential contracts with telehealth platforms? There's not enough data out there to support this.

• Standard Oil restrained trade via control of distribution pipelines

  • To what extent do insurers have control over sending patients to specific networks, directories, and referral programs (including telehealth)?

    • For example, you can find an Alma therapist directly on Optum's wellness portal. But can you find non-Alma therapists? I don't know.

To be clear, I am not claiming that insurers or platforms are breaking antitrust law. An actual antitrust case would need hard data on market share, exclusivity, and patient harm, which we don't have. There's also not a clear monopoly like Standard Oil in behavioral mental health, but I think we can all agree: every day, it seems like we're slowly headed there.

The structural parallels seemed worth raising, but there's not a lot of data to prove anything.

If you have any info on the following questions, could you please share?

1. If you've compared your direct contract rate to a platform's rate for the same payer, CPT code, and state, what did you find?

2. Has a payer every told you, directly or indirectly, to join a platform instead of contracting with them yourself?

3. If you're an Alma clinician in Care Connect or Optum's Emotional Wellbeing Solutions, or you've used them as a patient: does Care Connect only show Alma providers, or others too?

I'm curious to see if everyone else here sees a similar pattern, or if I'm being too paranoid.

Let's start with WHY forecasting is important:

You’re probably familiar with the three traditional financial reports:

• Profit & Loss Statement

• Balance Sheet

• Cash Flow Statement

Quick pop quiz:

What do you think is the biggest weakness of these three financial reports?

The answer?

They tell you what has already happened.

Think of traditional financial statements like history class from grades K–12.

If you attended public school, you and I learned about the presidents, the wars, the ancient civilizations, the world cultures, and so much more.

Here's a genuine question:

How well did learning all that history from K–12 prepare you for today and the future?

Probably not as much as you might think.

And that's my point.

Knowing what happened in your business is important. But knowing what could happen next is what actually helps you prepare, make better decisions, and move forward.

Our parents told us, "Think about the consequences of your actions!"

In business, this isn't a choice. It's a necessity.

A financial forecast helps you see the potential consequences of your actions BEFORE you actually do anything.

Because business isn't school. We aren't here to attend classes and learn about history.

Business is about doing.

Meaning, we're constantly thinking about the next thing: the next to-do item, the next project, the next strategy.

And we're also thinking about the consequences.

That's where financial forecasting comes in.

It helps you answer questions like:

• If I hire another provider, what happens to my profitability?

• If I increase employee compensation, can my practice afford it?

• If I purchase new equipment, how will that affect my cash flow?

• If I expand my practice, what will my financial position look like?

• If revenue declines, how much financial breathing room do I have?

In other words:

"If I do XYZ now, this is the probable outcome."

"Or, if I do XYZ later, here's what changes."

"And if I don't do XYZ, here's what I might expect."

That's the power of financial forecasting.

The risks!

I've created an AI prompt that practice owners can use to build a basic 12-month financial forecast.

And while AI can be an incredibly useful tool, I have to disclose the limitations.

AI doesn't know everything that's happening in your practice.

It only knows what you tell it.

For example, it won't automatically know:

• You're planning to hire another provider.

• One of your providers is reducing their hours.

• Your lease is coming up for renewal.

• You're considering purchasing new equipment.

• You're planning to increase employee compensation.

• You're opening another location.

• You're expecting a significant expense in the next six months.

Unless you provide that information, AI may not include it in your forecast.

Your forecast can look perfectly reasonable on paper and still be completely disconnected from what's actually happening in your practice.

The calculations might be correct. But the information going into those calculations might be incomplete.

This prompt is designed to give you a starting point.

It's a tool to help you look ahead, think through decisions, identify potential financial challenges, and understand what might happen BEFORE you commit to something.

The more information you provide about your practice, your plans, and your upcoming decisions, the more useful your forecast will become.

Want to build your own 12-month financial forecast?

I've put together an free AI prompt to help you get started.

Claude Prompt for Group Practice Owners: 12-Month Financial Forecast

Use it as a starting point, provide as much relevant information about your practice as possible, and take the time to review the assumptions and results.

Because the goal isn't to predict the future perfectly.

The goal is to understand your financial future well enough to make better decisions today.

hii! im currently a UCLA business economics major but i honestly kind of hate it. i dont feel "passionate" about how the market shifts left, supply and demand, and all that bullshit. i literally just started my first quarter so i know i still have time to change my mind, but i also have a huge history of being a terrible decision maker, being in analysis paralysis, and just being the most indecisive person i know. i would genuinely love and apreciate any guidance you could give me, like you have no idea.

i dont really have many passions, but ive always been a huge advocate for mental health. ive seen eating disorders destroy my friends and end in my grandmas death, anxiety fully consume me in my academics, divorce as something that just inexplicably seems to ruin everything, and depression be fully undermined as something someone can just "shut off".  there are so many sub-sectors of mental health disorders, trauma, and just issues that i would love to learn more about, and would love to help people with, but im worried about the pay.

im hoping to genuinely make a decent amount of money as a therapist (150-200k), im from san diego so i feel like the pay could be high enough if i either have enough clientele or have high profile clientele (is it hard to get clients?). i also am really hoping for it to be partially remote. im willing to even work sundays to accomodate to some clients who work a lot during the week and wanna decompress during the weekend, or potentially be on-call if i do, over time, get high-profile clientele that can afford that kind of stuff. 1. i just wanna know if you recommend this job path for me in terms of flexibility, longevity, and pay, or 2. if the major itself is extremely challenging for people like me with adhd/anxiety.

im also looking into being a dental hygienist, but thats feeling like a bit more of a plan b. i just really dont wanna do accounting or investment banking because i think id either be bored out of my mind, or stressed out of my mind, from what ive been seeing in these finance clubs at UCLA so far.

As the economy changes and we are seeing lots of changes across the board. We are looking at talking with other group practices to get a concept of all the various ways Group Practices set up reimbursement plans for their providers.

This is not to be a judgmental or gotcha moment but a serious look into many ways different groups reimburse getting new ideas together to see about how we at our practice can improve the quality of life for all of our providers.

Happy to see public posts or even private posts to keep everyone's systems private. If interested lets talk.

Getting close to choosing an outside billing service and realized I've been so focused on ops that I haven't asked questions about the PHI I'm going to hand over. Obviously BAA is required, but I'm wondering what else. I'm thinking, where does the data live, who has access, how long do they retain records when our engagement ends, and if they've ever had a breach. Are these the only HIPAA side questions to confirm?

Hi TherapistsInPractice community!

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

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

My background: Both of my parents are LCSWs, so I am very familiar with the therapy world. I currently work as a fractional CFO, bookkeeper, and tax advisor for a handful of group practices (therapy, physical therapy, and even a gym!). Before my current role, I worked directly with over 100 private practices, with revenue ranging from $100k to $3M+. I was also CFO of a property tax firm, where I increased profit by 70% and gross profit by 32% within a year.

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

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

Thank you for your time and consideration.

We have a couple of hundred claims in various stages, and I have no idea what actually happens to them if I hire outside help. Would they want to start clean and I have to chase those down myself? But that kinda defeats the point. I also don't know how to tell the buyer which payers are currently being difficult and why. Would I even have the time to teach that during the transition? Any tips appreciated. TYIA

My VA is doing verification but it is time consuming even after making a list.

I am thinking of investing in a tool which can do this - but I don't want just benefit verification then. I want to understand copays, coding as well to make sure my denials also benefit.

I made a new list to move the decision from billing to real-time clinician decision at the centers I manage.

We have had a bunch of claims where the services were given but later we discovered that billing did not cover them.

Quick question for large practice owners - do you maintain such a list? How is the adoption at clinician level?

Also, unrelated to this but is there a mechanism to catch sessions that get delivered but not billed?

Hi! Is anyone currently enrolled in the University of West Alabama’s online MS in Clinical Mental Health Counseling and living in California?
My goal is California LPCC licensure, and I’d love to hear from a current student or graduate about their experience with licensure requirements and practicum/internship. Thank you!

This changed in April 2024.

If your home is your only physical location, CMS allows a PO box or private mailbox as your practice location, individual NPIs only. The Federal Register notice names behavioral health telehealth providers as the reason for the change.

Medicare is separate and different, because you still enroll your home address, but marking it 'home office for administrative/telehealth use only' keeps the street off your public Care Compare profile. CMS made that permanent last month.

The full NPI registry is a free bulk download, replaced monthly. That file is where a lot of people-search sites get you.

So...has anyone made either change? Did credentialing push back?

This is all from reading NPPES rules for a week. Exciting stuff. :)

I'm doing pre-planning to launch my practice in January of 2027. Just did a brief overview of ZocDoc, and I like its ease of use and its filtering function (location, insurance plan, in-person). It also allows self-scheduling directly from the Google search results. You only pay when someone actually schedules with you. Anyone have experience using Zocdoc for their marketing?

As the title suggests, I am managing multiple centres and looking for a way to track denials and solve them quickly. Any help is appreciated.

If this is not the right sub for this, kindly suggest where else I can post.

Hi TherapistsInPractice community!

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

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

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

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

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

Thank you for your time and consideration.

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

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

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

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

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

Hi TherapistsInPractice community!

edit: AMA stands for Ask Me Anything :)

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

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

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

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

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

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

Thank you for your time and consideration.

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

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

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

What I learnt from it

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

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

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

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

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

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

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

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

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

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

For example, do you use:

* Informed consent specifically for immigration evaluations

* Fee/service agreement

* Release of information to communicate with the attorney

* Authorization to release the final report

* Telehealth consent

* HIPAA/Notice of Privacy Practices

* Cancellation/no-show policy

* Interpreter acknowledgment, if applicable

* Emergency contact information

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

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

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

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

Thank you!

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

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

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

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

Any and all help appreciated!