First 10 Steps to Starting Your Private Practice

A few weeks ago, I wrote a blog post about preparing yourself for full-time private practice. I realized afterwards that I hadn't included a post about getting started with your private practice! So, while this is just slightly out of order, I have included a lot of links and resources for getting yourself set-up for private practice. Some of these resources I used when I was first starting out and others I found out about afterwards. I actually ended up doing some of the steps out of the order mentioned below; however, this is what seems to make the most sense for me now.

1. Get an NPI --> LINK
Even if you decide not to accept insurance, it is still something you want to get. It doesn't even take long to register for one. Excerpt from the website: "The Administrative Simplification provisions of HIPAA of 1996 mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information."

2. Get a Tax ID Number or EIN --> LINK
Your EIN is your federal tax ID number that is used to ID your business entity; generally businesses need this. This was a pretty simple process as well. You will need to choose a business name. Here is a LINK for information on registering your fictitious name. For my business I am Felicia Porrazza doing business as PorrazzaNutrition. If you are doing business under your full and proper name, you are not required to register your personal name as a fictitious name. I think I spent maybe 2 hours initially trying to figure out if I needed to further register my name in PA. This may vary state-to-state so be sure to check your individual Department of the State website to see what regulations are in place. You will also need to choose your business entity or business structure in this form. Here is a great LINK explaining the types of business structures by the US Small Business Administration, a great resource!

3. Get Professional Liability Insurance --> LINK
I am a member of the Academy of Nutrition & Dietetics and the one they recommended is Proliability by Mercer. I am pretty sure they still offer a discount for AND members. It is reasonably priced and covered the basics for what I needed as a Dietitian.

4. Insurance Vs. Self Pay Acceptance 
I am not going to go into too much detail here because this will be featured in another post; however, one thing to think about is if you will be accepting insurance or only self-paying clients (or both). If you will only accept self-paying clients, you can move to step 5. If you will accept insurance, I would highly suggest getting yourself set-up with CAQH ProView. This is a free resource that allows you to decrease paperwork for becoming a provider with insurance companies. It will ask for your professional and practice information, credentialing info, directory services, etc. When you go to apply to become a provider for a particular insurance company, they will ask for your CAQH number. It has really helped me to streamline the process and avoid entering the same information 10 times. The application takes a bit of time; however, it was very much worth it! I started working on this step while I was still working a full-time job since it took a few months to get credentialed anyways.

5. Deciding Pricing 
This is again going to be another blog post; however, setting your fees is often the hardest step. I find it difficult to put a number on the valuable service I provide. Needless to say, it has to be done. One way to get started on this is by checking out what other Dietitians or health professionals are charging in your area. Factor in your expertise, years of being a dietitian, etc. If you choose to accept insurance, they will have a contracted amount that you will be paid per unit (15-minutes per one unit and you can have multiple units per appointment). You could also use this as a guideline for how you charge self-paying individuals. I found it to be helpful to include counseling packages for savings with self-paying clients.

6. Payment Acceptance
Along with deciding your pricing, you will need to figure out how you will accept payment. Will you set-up an account with PayPal? Get a merchant account through your local bank? There are a lot of different options out there. You can choose to do only checks or cash; however, I would suggest getting a separate business banking account regardless of the route you choose.

7. Decide Your Online Presence
When developing your online presence, you can choose from a number of sites and hosting services. For your website, you can choose to go with companies like Wix, Squarespace, GoDaddy, etc. You could also use WordPress and update your account to have a .com address. I am not going to get too far into website design and such; however, I am going to just touch on what you may want to include on your site --> information page about yourself and your business, location, services offered (you may or may not include pricing too), contact information, pictures, blogs (or link to blog), testimonials (may come later), newsletter opt-in, etc. I created my website about a year before registering my business and accepting insurance. I didn't have much on the site and I basically just linked it to my blogs where I was much more active. This is a step you can do at basically do at any time in creating your practice.

8. Decide on Office Space/Set-up
This is definitely a step that you can do earlier in the ballgame. There are a few options for how you choose to see clients. You can do in-home counseling appointments, where you basically go to the client's home. You will need to make sure insurance will cover this if you are a provider. You can rent office space for yourself or sublet from another provider (doctor, chiropractor, etc), which is usually cheaper. Other options for renting office space can include using a shared office where you schedule times to come in and pay either monthly or on a single-use basis. You can see clients in your own home; however, you will need to need to check to see if there are stipulations or zoning laws. Here is a LINK for some more information on that. You can also provide virtual counseling services, which again have stipulations especially in the insurance provider realm. Here is a great article from Today's Dietitian on the TOPIC. If you are a member with the AND, you can also check out this LINK. 

9. Create Office Forms
One of the last things you will need to do before seeing clients is to get your office paperwork in order. You will need an initial client form, privacy notices, privacy consents, HIPAA forms, release of information form (for you to speak to family members or doctors), and a policy form relating to your business (for information on cancellation fees, rescheduling, non-payment, etc). I would also suggest thinking about how you will log business income and expenses too. EatRightPro has a great section on HIPAA with education and forms --> LINK.

10. Additional Tips 
There are a lot of free resources out there for starting your business. Some may not be related to the Dietitian realm; however, they can still prove to be quite useful. Check out your local Small Business Administration for tips on building your business. Network with other Dietitians or health professionals in your area to see how you can help one another. I purchased this AND book and found it to be really helpful when I first started out. The AND published another book on credentialing and billing that is free for members; however, I didn't find it useful at my stage of practice (it may be for those just starting though). I also discovered that the Free Library of Philadelphia had a lot of free online and in-person resources for business owners, so I suggest checking out your local library too.

This is by no means intended to be an all encompassing list. I am sure there are additional steps that you may have heard of or wish to include in starting your own private practice. This was simply from my point-of-view and how I thought might be helpful for others. You can jump around with the steps I have included and even eliminate those that may not apply to your business. Regardless of how the information today was presented, I hope that this helped you in some aspect of starting your business!

Leave me a comment to let me know what I missed, what you found helpful, or where you are in your private practice :)

A Day in the Life of a Private Practice Dietitian

I have been getting asked a lot lately how I structure my day and what does a day looks like for me now that I am full-time. Pretty much no day is ever the same for me since I never know who is going to call for an appointment, what important email comes through, or what last minute change in my schedule needs to happen. I broke down my day into two options: seeing clients/having classes and a "work" day so you can see what it looks like to be me all day long :)

A Day With Appointments (My Wednesday)
6:45am - Get ready for the day, eat, make coffee, pack my bag, check emails
8:00am - Head over for a committee meeting that I am Vice-Chair for, send out committee emails
9:30am - Chat with a fellow entrepreneur post meeting
10:00am - Leave to head downtown for my cooking class
10:45am - 1:45pm - Prep, have class, clean-up, chat with staff in the building, etc
2:15pm - Home. Eat lunch, check emails, log class information/expenses.
2:30pm -4:00pm - Make any insurance-related calls before offices close. Call back voicemails (if any). Work on posts for FB & IG. Follow-up with clients for paperwork needed for appointments.
4:00pm - Gym
5:30pm - Make and eat dinner. Usually, I take this time to also clean the kitchen.
7:00pm - Follow-up on emails. Work on committee related minutes/events. Prep for the next day. Sometimes I will have a late-night appointment at 6pm. If so, I will bill and write the reports right after.
8:30pm - Continue working on business-related items (could be accounting, billing, lesson plans, blogs, handouts, etc) or watch Netflix or read a non-business book.
10:00pm - Bed

If there is one thing I have learned while being in private practice it is to not overbook yourself. Even the days where I don't see clients I try not to overbook. Something always comes up to rock the boat! Going along with this, I have learning to go with the flow a lot more. Appointments change. Classes get rescheduled. Things in life just happen. If I get all stressed out and worked up about something, it just makes my day chaotic and negative. I take things as they happen and simply move on.

A Day Without Appointments (My Monday or Friday)
8:30am - Get ready for the day, make coffee, check emails, make pancakes (because why not), make my to-do list (prioritize)
9:30am - 1:30pm - Followed-up on calls. Booked a new class so I had to submit an invoice + signed contract. Write lessons for the new class. Follow-up on unpaid insurance claims. Follow-up on missing paperwork for upcoming appointments. Chat with another RD about insurance issues. Plan blog and social media posts. Brainstorm ideas for business. Input any paid claims into my accounting software. Usually Fridays I do laundry and vacuum in the midst of all of this.
1:30pm - 2:00pm - Make and eat lunch. Some days, this ends up just being a smoothie for convenience.
2:00pm - 5:30pm - Follow-up on more insurance-related issues. Chat with other RDs about insurance. Send appointment reminders to clients. Prep for appointments/classes for next week. Answer emails. Follow-up on patient calls. Schedule appointments as they come + send initial emails with paperwork. Mondays are my food shopping day normally so I also hit the food store mid-day too.
5:30pm - May go to the gym or if not eat dinner a bit earlier. Usually, prepping dinner involves emptying the dishwasher, putting dishes/groceries away, cleaning, etc, all while cooking.
7:00pm - Follow-up on emails. Work on committee related minutes/events. Prep for the next day.
8:30pm - Continue working on business-related items or watch Netflix or read a non-business book.
10:00pm - Bed

My days where I don't see clients usually end up being the "busiest" since I push everything office-related off until then. Sometimes, checking my emails takes 2-minutes and other times I end up back and forth about something for 10-minutes. As I mentioned earlier, I never really know how a day is going to go. Some days, I get through everything I needed to and can relax by 3 or 4pm. Other days, I work until 7 or 8pm, eat a late dinner, and pretty much go to bed right after. There are some days that I need a mental break so I will go out for a mid-day walk or watch a show. Again, just going with the flow really helps my sanity and productivity.

If you are in private practice, what does your day look like? Anyone reading this surprised at what I do all day?