Frequently Asked Questions About Business Practices

Qualifications

What is the difference between ASHA certification and state licensure?
What credentials do I need to have to engage in private practice?

Starting Your Practice

How do I perform an analysis to determine the feasibility of my practice?
What are the different legal forms of a professional practice, and what are the advantages and disadvantages of each?
What other professionals should I consult before starting up my business?
What state and local agencies should I consult for more information about setting up a practice?
What are the steps involved in developing a business plan?
What should I know about professional liability, and what resources are available?
What types of technology can help me in my business practice, and what resources are available?
What resources are available about buying and selling a private practice?

Marketing Your Practice

What is marketing and how do I go about it?
What are the steps involved in developing a marketing plan?
What resources are available to help market my practice?
How do I establish a referral network for my practice?

Reimbursement

How do I determine what to charge for my services?
What do I need to know about billing and coding for reimbursement?
Do private insurers reimburse for audiology or speech-language pathology services?
How can I be a managed care provider, and what are the pros and cons?
Can I bill Medicare and Medicaid for my services?
I see patients who speak other languages in my practice. Can I get reimbursed for paying for an interpreter?

Contracts

In what situations will I need a contract?
What are some things that I might want to include in a statement of understanding?
What should I look for in an employment contract?

Resources for Business Practices

Qualifications

What is the difference between ASHA certification and state licensure?

Almost every state requires that audiologists and speech-language pathologists be licensed or otherwise regulated (i.e., registration, certification). Each state may have different eligibility requirements, fees, and continuing education requirements. Practicing without a license or outside the scope of practice of the state licensure law constitutes a legal violation.

ASHA certification is a voluntary professional credential which certifies that the individual has received a master's or doctoral degree in speech-language pathology or for audiology, a doctoral degree from an accredited program; has completed a clinical fellowship or the clinical requirements of their audiology doctoral program/final year of externship; and has passed the national examination.

ASHA certification provides these added benefits:

Reimbursement by some private insurers requires ASHA certification.
Some state Medicaid programs also require ASHA certification for reimbursement.
ASHA certification is required of audiologists in the military for promotion.
Many employers require ASHA certification.
ASHA certification is "portable." That is, it is recognized nationwide. Many states accept ASHA certification as evidence of meeting, in total or in part, licensure requirements.
ASHA provides the ongoing support and information expected of a national professional organization.

Clinical Fellows may engage in private practice if they are appropriately supervised per ASHA guidelines, and hold a state license (if required). They may need to apply for a provisional license in states where licensure is required.

What credentials do I need to have to engage in private practice?

There is no "special" level of ASHA certification or state licensing to engage in audiology and/or speech-language pathology private practice. ASHA certification and state licensure (where required) is sufficient for the private practice of either profession. State licensing information is available on ASHA's website.

An occupational license may be required at your city or county level in order to operate a business. Check with your local government.

Finally, if you are an audiologist planning to dispense hearing aids, check with your state licensing board to determine if your state requires that you also be licensed as a hearing aid dealer.

Starting Your Practice

How do I perform an analysis to determine the feasibility of my practice?

Conducting a complete feasibility study involves seven basic steps, as outlined here. Additional information is available from the Small Business Administration.

What are the different legal forms of a professional practice, and what are the advantages and disadvantages of each?

A private practice may assume a number of legal forms of organization, including:

sole proprietorship
partnership
limited liability company
corporation

Each type has different implications and requirements, as well as advantages and disadvantages.

What other professionals should I consult before starting up my business?

Private practitioners generally agree that it is important to work with an attorney and an accountant to help you develop your business. An accountant can advise you on the type of practice that will best meet your tax needs, set up a system for managing billing and accounts receivable, and advise you about paying withholding tax, if appropriate. An attorney specializing in business or contract law can also assist you in setting up your practice from a legal standpoint, and can review or help you develop a standard contract that you can use or adapt for different situations.

To locate qualified professionals, ask business people you know for a personal recommendation. Join local community service groups (Rotary Club, Kiwanis, etc.) or the Chamber of Commerce to network with business people. Invite a local attorney to speak at a professional meeting. You can also contact your state's chapter of the American Bar Association and the American Institute of Certified Public Accountants for referrals.

What state and local agencies should I consult for more information about setting up a practice?

If you wish to practice in a state that licenses audiologists and speech-language pathologists, you must have a license. You should also request a copy of the actual licensure law from your state licensure board.

If you wish to practice from your home or work from a business office, you may want to investigate whether your local zoning laws would permit you to open a home office, display advertising, or handle parking in a residential area. Contact your city or county zoning board. You should also check with your city or county administration to see if a business license is required. If you are renting commercial business space, your landlord should be able to provide guidance on these issues.

For assistance in starting your business, contact your state speech and hearing association.Take advantage of opportunities for mentoring and collaboration in developing your practice through the state convention, the association newsletter, or interest groups.

For loans and other information, contact the Small Business Administration.

To find out state regulations that may affect your practice, such as how long to retain medical records, contact your state health department.

Consider joining local service or business organizations such as Rotary, Kiwanis, or the Chamber of Commerce. Becoming a member may be a worthwhile investment to market your services and network with members of the business community.

What are the steps involved in developing a business plan?

A solid and detailed business plan provides the foundation for your business. It can always be modified as your business changes. If you are applying for a loan to start up your business, you must submit a detailed business plan.

The U.S. Small Business Administration suggests that a detailed business plan:

offers a path to follow (shows you how to achieve your goals);
may help in securing loans;
can provide useful information for suppliers, personnel, and others; and
can help you develop your management capabilities.

For a business plan outline, visit this ASHA webpage.

What should I know about professional liability, and what resources are available?

The type of legal action that a client may bring against a clinician is called a "tort." Types of tort may result from intentional harm , such as intentional emotional distress; negligent harm , where unintended damage was caused by a breach of duty or failure to conform to a standard of professional care; or strict liability , where harm is suffered by the client that is not the fault of the clinician, but may be related to use of devices, diagnostic and therapeutic tools considered inherently harmful.

A tort is a private or civil wrong or injury, other than a breach of contract, for which the court will provide a remedy in the form of an action for damages. It is a legal wrong committed upon the person or property independent of contract. Three elements of every tort action are: 1) existence of legal duty from defendant to plaintiff; 2) breach of duty; and 3) damage as proximate result.

Other types of liability include "vicarious" liability for the actions of one's employees, or criminal liability, such as battery, larceny, embezzlement, forgery, or fraud in billing and documentation. Clinicians practicing in states with licensure also face legal action for violating state regulations governing their qualifications and activities.

To reduce the risk of violating standards of professional practice, clinicians should be familiar with ASHA's scope of practice for their profession, the Code of Ethics, Preferred Practice Patterns, and relevant position statements. To maintain professional competence, clinicians should constantly educate themselves about evolving changes in practice.

Other potential areas of liability may be controlled by strictly observing and maintaining patient confidentiality, obtaining informed consent, and documenting all services and communication provided to the client and others in an accurate, thorough, and timely way.

If you are self-employed you should protect yourself by obtaining liability insurance. If you provide contract services in an institution, you may also be covered by their policy. It would be wise to have your own individual coverage in either case.

What types of technology can help me in my business practice, and what resources are available?

Basic equipment for a business office includes a telephone, computer with internet access, fax machine, and a copier/printer. However, the type of equipment will vary depending on the size and needs of the business practice.

Computer software is available for office management (i.e. billing, scheduling, accounting, maintaining a client database), clinical documentation, and treatment. Hiring a consultant with expertise in small business computer applications to advise you in hardware and software selection may be more cost-effective than trial-and-error purchase of systems or software that won't interface well or grow with your practice.

When considering the technology needs of your practice, keep in mind the HIPAA security rule and electronic data interchange rule if you are a HIPAA covered entity.

What resources are available about buying and selling a private practice?

Buying or selling a private practice is a big undertaking and requires careful thought and research. The purchase or sale of a practice is most successful when both buyer and seller have common goals and expectations. In the Private Practice Essentials: A Practical Guide for Speech-Language Pathologists a chapter is devoted to this issue. The Small Business Administration also has information about buying and selling a business.

Marketing Your Practice

What is marketing and how do I go about it?

For audiologists and speech-language pathologists, marketing means reaching your clients, referral sources, media, school board members, legislators, the general public, and anyone else who could want or need your services. If you think about it, any time you tell someone and tell them what you do and how you do it-you're marketing!

There are two primary reasons why marketing is an essential part of your practice: (1) economic, and (2) professional identification.

Economic. The economic reasons are self-evident. You need to market to make money. Marketing helps you bring in new clients or retain existing clients. But economic considerations refer not just to the money you earn in any single year, but also the amount of money you lost as a result of not tapping your potential market or not tapping the market effectively.

Professional Identification. Marketing builds a greater awareness of yourself and your services in your community. Many people underestimate the importance of marketing as a way to increase public awareness. Ultimately, some of the most effective marketing tools (e.g., one-to-one meeting, speeches before community groups, media outreach) are never utilized. A good way of approaching this is to view your public as stakeholders-that is, that your public has an investment in your success.

What are the steps involved in developing a marketing plan?

The marketing plan is a means to develop your marketing programs by turning marketing concepts into a written and usable guide. In the plan you assess of your strengths, weaknesses, opportunities, threats, and overall market competitiveness. In addition, your marketing plan develops a strategy for communicating your message to external audiences, and it provides you with an instrument for monitoring ongoing processes in your marketing activities.

What resources are available to help market my practice?

ASHA offers a variety of marketing products and services designed especially to help audiologists and speech-language pathologists promote their services. ASHA products include:

brochures, preprinted newsletters, posters
specialty products
marketing and public relations resources

Products can be ordered at the Online Store.

How do I establish a referral network for my practice?

One way to reach potential referral sources is to enroll in ASHA ProFind. This is ASHA's premiere database for connecting consumers to members. If you are a bilingual service provider, you also have the option of registering in the ASHA Bilingual Service Provider Database. Send an e-mail to bilingual@asha.org for additional information.

Reimbursement

How do I determine what to charge for my services?

Fees for services may vary by region as well as by setting. ASHA does not provide information to members about what is "typically" charged, as this can be interpreted as "price fixing," a violation of antitrust laws. Certain private insurance companies and Medicare set fee schedules that establish reimbursement for specific services or CPT codes. It is critical that you be aware of such fixed charges and determine what percentage of your caseload should be drawn from these reimbursement sources.

The primary consideration for full-time private practitioners is to ensure that their fees will be sufficient to meet both direct and indirect costs of the service. These include monthly costs for equipment, office space, taxes, insurance, supplies, continuing education, licensing, membership fees, etc. An estimate of available hours to generate revenue should be based on a realistic assessment of the number of sessions that can be provided in a day, allowing for travel time and cancellations, and time off for illness, vacation, and continuing education.

Fees should also be set keeping in mind the different lengths of direct or indirect time or specialized equipment used for specific types of procedures. An evaluation, for example, typically takes longer to administer, and requires additional time for scoring/analysis, patient/family counseling, phone calls, report writing, etc., that may not be directly billed.

See Billing, Coding, and Calculating Fees: Finding Success [PDF] for more information.

What do I need to know about billing and coding for reimbursement?

First you need to understand the difference between procedure codes and diagnostic codes. Procedure codes are called Current Procedural Terminology (CPT) codes and diagnostic codes are called ICD-10 codes. Then you need to know which codes speech-language pathologists and audiologists can use to bill for their services. ASHA has developed a number of resources on billing and coding, including model superbills for audiology [DOC] and speech-language pathology [DOC].

Do private insurers reimburse for audiology or speech-language pathology services?

Some do, but there are restrictions on the scope of coverage. For example, some benefits plans will only reimburse for speech "therapy" if due to accident or injury and will not reimburse for developmental speech-language pathology services. Audiological services are usually covered but may be limited to diagnostic testing, and not evaluation or treatment. Hearing aids are not routinely covered by health plans, and testing that results in normal hearing may also not be covered by health plans. See the private health plans page for more information.

Considering a practice that does not accept insurance contracts? It is possible to prosper, if you weigh the pros and cons and adjust your practice accordingly.

How can I be a managed care provider, and what are the pros and cons?

Some managed care organizations may be looking for audiologists and speech-language pathologists to become providers on their panel. The provider relations department will normally answer inquiries about becoming a provider and send out applications to those interested. Credentialing will also be performed by provider relations personnel.

The advantage of being a participating provider with a managed care organization is that you may receive numerous referrals from the health plan that will result in an increased patient population. The disadvantage may be, however, depending on your compensation package, that you may see more patients than are economically viable, based on the revenue you receive from your contract with the managed care organization.

Can I bill Medicare and Medicaid for my services?

Medicare

Audiologists: An audiologist can receive a Medicare provider number (and payment) by applying to the local Medicare carrier. There should be no barrier to receiving a provider number as long as the audiologist is licensed (in states with licensure) or certified by ASHA. The carrier is the same organization that processes Medicare claims for physicians. The scope of coverage is limited to diagnostic testing unrelated to hearing aids and requires a physician referral. Services are billed by a health care facility or agency if the audiologist is a contractor or employee.

Speech-Language Pathologists: As of June 2, 2009 SLPs will be able to enroll as a Medicare provider and receive a provider number. Billing will begin as of July 1. This will allow the SLP to receive payment from Medicare as a private practitioner. Speech-language pathology services can also be billed to Medicare when the SLP is a contractor or employee of a health care facility or rehabilitation agency. In this case, it is the facility or agency that is issued a provider number and not the practitioner. A speech-language pathologist can establish a Medicare rehabilitation agency and render only speech-language pathology services. The SLP, as a rehabilitation agency owner, may also hire physical and/or occupational therapists. State health departments process applications to become a rehabilitation agency.

Medicaid

Services to children through age 20: Although each state can determine the scope of outpatient services to adults, children must be covered for comprehensive services based on medical necessity. Whether adult or child services, each state can regulate in what provider settings services are covered. Both audiologists and SLPs must contact their state Medicaid agency to determine if they can receive a provider number for direct billing.

I see patients who speak other languages in my practice. Can I get reimbursed for paying for an interpreter?

Third-party payers do not reimburse for the cost of an interpreter. However, you should talk to your tax advisor about possible tax write-offs for business-related expenses, such as paying for interpreter services. Also, ASHA's Practice Portal has information regarding collaborating with interpreters available.

Contracts

In what situations will I need a contract?

If you are providing services to an institution such as a school, agency, or hospital, you may have a standard employment contract that you have developed, or the institution may already have an employment contract it uses. If you are providing services to individuals privately, you may want to draw up a statement of understanding (see below) which will provide disclosure of pertinent and important information to the client.

Contracts should be written with the advice of an experienced employment or transactional attorney. Check the Martindale-Hubbell Directory for your state to locate such an attorney. Martindale Hubbell alphabetically lists the names and addresses of law firms in a given locale and the various specialties of the attorneys in those firms.

You can also review books on contracts and form contracts. These can be found at all law school libraries. However, you should be certain that these sources are applicable to your jurisdiction. Ask the advice of colleagues who have previously used contracts in their businesses. Any forms you procure should be reviewed by an attorney who practices in the field.

Remember that contracts can be negotiated, and that either party can request and negotiate changes (additions, deletions, etc.) to portions of the contract.

What are some things that I might want to include in a statement of understanding?

Anything that is important to you should be clarified in the statement. Problems arise between the professional and client when the meaning and understanding of important contract terms are left to one's imagination and guesswork. Put yourself in the client's position and write down what you would like to know. Items that may be specifically addressed are: charges for services, billing arrangements, payment schedule, payment for an interpreter, confidentiality, access to records, type and frequency of documentation, and cancellation policy.

What should I look for in an employment contract?

An employment contract should specify whether the person whose services are desired will be an employee or an independent contractor. There are significant tax implications associated with each category, and therefore the advice of an attorney and/or accountant can be helpful. The contract should plainly state whether the person will be: (1) hired for a specified period of time, or (2) serve at the will of the employer.

The contract should be in writing and should set forth the duties required, the rate of pay, and any other important conditions, including any covenant not to compete with or not to solicit clients of the employer. If a covenant not to compete and/or not to solicit is included, the person should ask an attorney to review the proposed contract to be sure of the exact obligations set forth in the agreement and whether those contractual limitations are reasonable and enforceable under applicable state law.