How I billed $800,000 worth of services in 2022 and how I plan to reach $1,000,000 in 2023.

[deleted760483]

First, let me say that it will be essentially impossible to reach these figures without offering some form of group psychotherapy. One to one services cannot be scaled and therefore will always be hard-capped by the number of hours you’re willing to work. Groups have a cap too, but the cap is higher.



Let me start by showing you my daily schedule and the associated CPT codes:

8:30am – 9:00am Psychological Testing Feedback Session (90832)

9:00am – 11:00am Intensive outpatient group psychotherapy (S9480 x8)

11:00am – 12:30pm Psychological testing battery (90791 + 96130)

12:30pm – 2:00pm Psychological testing battery (90791 + 96130)

2:00pm – 4:00pm Intensive outpatient group psychotherapy (S9480 x8)

4:00pm – 5:00pm Individual psychotherapy (90837)



So in a 48 week calendar year I’m scheduled for:

240 units of 90832 (x$90) = $21,6000

240 units of 90837 (x$225) = $54,000

480 units of 96130 (x$250) = $120,000

480 units of 90791 (x$300) = $144,000

3,840 units of S9480 (x$135) = $518,400

Total = $858,000

x.925 (attendance) = $793,650



A few notes on this:



I have relationships with several local colleges and take 2-3 master’s interns each year to help run my IOPs. They are unpaid.

My rates may seem high. I have several specialties that are rare in my area and I re-negotiate them every year.

Most of my assessments are pre-surgical. MBMD + relevant symptom inventories and screeners. That's why they're so short and why there is no face to face testing code. I do paperwork while clients fill out their assessments.

My show rate may also seem high. I have a massive wait list and a strong reputation in my community. My clients are aware of my wait list and they make every effort to attend as consistently as possible.

I am always able to be reimbursed for 90837 for individual therapy (unless the time parameter is not met) because I specialize in severe conditions.

As you can see I don’t take breaks. I meal prep my lunches and eat in a few minutes between clients. I finish my paperwork at the end of the day. This is a very aggressive work schedule that is certainly not for everyone.

Having very good templates and an efficient EHR is crucial.

My plans for 2023:

Finish my second book. I released my first book in 2021 and to date have made about $5,000 on it which is nice but not great. However, I’ve become a much better writer and have a much wider audience and I believe my second book with find more financial success. I project $10,000-$20,000 from this.

I plan to incorporate remote CBT monitoring into the intensive outpatient program. This is a new CPT code involving shared biodata (sleeping, eating, etc). It pays around $50/month/client so with 16 clients that should add nearly $10,000 to my annual income.

I may phase out individual psychotherapy in favor of pre-recorded courses. I have a decent sized social media following and have had many requests for this. I legitimately believe I can make $100,000 a year from it which would be a net increase of $50,000.

I will be billing the colleges for supervision starting with my next round of interns. Previously I was providing these services in exchange for the assistance in running my IOPs, but both of my interns last year landed very prestigious and high paying jobs and I plan to leverage that into paid supervision services. At $250/hour and 2 hours/week that would be an additional $24,000/year.

I have several paid speaking engagements scheduled for the first half of this year totaling about $5,000. If I assume I can duplicate that for the second half of the year we can call it $10,000.

That doesn’t quite get me to $1,000,000 but very close. I suspect I’ll find one or two ways to eke out the remainder. App development and business consultations are also on my 2023 radar.

I just thought this might be interesting for people to see. I’m happy to answer any questions.

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[cara susanna]

Yeah, I could not do that. I need breaks and, especially, a proper lunch hour.

 

[Sanman]

Why are you billing 90832 instead of 96130/96131 for testing feedback? Also what hours are you doing paperwork and report writing?

 

[psych.meout]

First, let me say that it will be essentially impossible to reach these figures without offering some form of group psychotherapy. One to one services cannot be scaled and therefore will always be hard-capped by the number of hours you’re willing to work. Groups have a cap too, but the cap is higher.


I have relationships with several local colleges and take 2-3 master’s interns each year to help run my IOPs. They are unpaid.

Really burying the lede there.

 

[deleted760483]

Yeah, I could not do that. I need breaks and, especially, a proper lunch hour.

I don't plan to do it forever. My long-term plan is to train and/or hire people to run the IOPs for me in a revenue split and spend more time on program development and administrative work. Also I'm a giant weirdo and I don't really like breaks.

 

[deleted760483]

Why are you billing 90832 instead of 96132/96133 for testing feedback?

It doesn't meet the time criteria. The testing batteries I am doing cannot reasonably take that long to review. The appointments are typically about 20 minutes.

 

[Sanman]

It doesn't meet the time criteria. The testing batteries I am doing cannot reasonably take that long to review. The appointments are typically about 20 minutes.

Gotcha, how much time on report writing, notes, and admin stuff are you spending in addition to the clinical day listed?

 

[Sanman]

So, doing this for based on Medicare national payment numbers gets you here:

240 units of 90832 (x$75.57) = $18,136.80

240 units of 90837 (x$174.86) = $41,966.40

480 units of 96130 (x$120.30) = $57,744

480 units of 90791 (x$174.86) = $83,808

3,840 units of 90853 (x$26.77) = $102,796.80

Total = $304,452

x.925 (attendance) = $281,618.10


The real trick is the specialty group rate and the high negotiated rates overall. There is your lesson folks. Negotiate your insurance contracts well.

 

[PsyDWannabe]

First, let me say that it will be essentially impossible to reach these figures without offering some form of group psychotherapy. One to one services cannot be scaled and therefore will always be hard-capped by the number of hours you’re willing to work. Groups have a cap too, but the cap is higher.



Let me start by showing you my daily schedule and the associated CPT codes:

8:30am – 9:00am Psychological Testing Feedback Session (90832)

9:00am – 11:00am Intensive outpatient group psychotherapy (S9480 x8)

11:00am – 12:30pm Psychological testing battery (90791 + 96130)

12:30pm – 2:00pm Psychological testing battery (90791 + 96130)

2:00pm – 4:00pm Intensive outpatient group psychotherapy (S9480 x8)

4:00pm – 5:00pm Individual psychotherapy (90837)



So in a 48 week calendar year I’m scheduled for:

240 units of 90832 (x$90) = $21,6000

240 units of 90837 (x$225) = $54,000

480 units of 96130 (x$250) = $120,000

480 units of 90791 (x$300) = $144,000

3,840 units of S9480 (x$135) = $518,400

Total = $858,000

x.925 (attendance) = $793,650



A few notes on this:



I have relationships with several local colleges and take 2-3 master’s interns each year to help run my IOPs. They are unpaid.

My rates may seem high. I have several specialties that are rare in my area and I re-negotiate them every year.

Most of my assessments are pre-surgical. MBMD + relevant symptom inventories and screeners. That's why they're so short and why there is no face to face testing code. I do paperwork while clients fill out their assessments.

My show rate may also seem high. I have a massive wait list and a strong reputation in my community. My clients are aware of my wait list and they make every effort to attend as consistently as possible.

I am always able to be reimbursed for 90837 for individual therapy (unless the time parameter is not met) because I specialize in severe conditions.

As you can see I don’t take breaks. I meal prep my lunches and eat in a few minutes between clients. I finish my paperwork at the end of the day. This is a very aggressive work schedule that is certainly not for everyone.

Having very good templates and an efficient EHR is crucial.

My plans for 2023:

Finish my second book. I released my first book in 2021 and to date have made about $5,000 on it which is nice but not great. However, I’ve become a much better writer and have a much wider audience and I believe my second book with find more financial success. I project $10,000-$20,000 from this.

I plan to incorporate remote CBT monitoring into the intensive outpatient program. This is a new CPT code involving shared biodata (sleeping, eating, etc). It pays around $50/month/client so with 16 clients that should add nearly $10,000 to my annual income.

I may phase out individual psychotherapy in favor of pre-recorded courses. I have a decent sized social media following and have had many requests for this. I legitimately believe I can make $100,000 a year from it which would be a net increase of $50,000.

I will be billing the colleges for supervision starting with my next round of interns. Previously I was providing these services in exchange for the assistance in running my IOPs, but both of my interns last year landed very prestigious and high paying jobs and I plan to leverage that into paid supervision services. At $250/hour and 2 hours/week that would be an additional $24,000/year.

I have several paid speaking engagements scheduled for the first half of this year totaling about $5,000. If I assume I can duplicate that for the second half of the year we can call it $10,000.

That doesn’t quite get me to $1,000,000 but very close. I suspect I’ll find one or two ways to eke out the remainder. App development and business consultations are also on my 2023 radar.

I just thought this might be interesting for people to see. I’m happy to answer any questions.

You go girl/boy!! I love this!! It’s not for everyone, clearly, but you’ve clearly made it work for yourself. My only feedback is to pay your interns unless somehow forbidden by their respective training programs.

 

[deleted760483]

3,840 units of 90853 (x$26.77) = $102,796.80

Holy **** $26 for IOP. And that's per unit, not per hour. So $13/hour for a 2 hour program. That's corrupt.

 

[deleted760483]

Gotcha, how much time on report writing, notes, and admin stuff are you spending in addition to the clinical day listed?

Usually just 30-60 minutes and I can get some of it done while people are completing their assessments. It's usually just another 15-20 minutes a day after my last client. I am meticulous about my templates.

 

[Sanman]

Holy **** $26 for IOP. And that's per unit, not per hour. So $13/hour for a 2 hour program. That's corrupt.

That is for a standard 1 hour group. Medicare will not reimburse for intensive outpatient therapy.

 

[deleted760483]

Really burying the lede there.

It's an important part of the arrangement, but not a difficult or unusual situation. They need the hours for licensure and are currently receiving the supervision for free. Even if I were to pay them $15 an hour or so it wouldn't dramatically alter the bottom line. Both of my interns last year landed $100k/year jobs based largely on their IOP experience which is both lucrative and uncommon, at lease in this area.

 

[deleted760483]

That is for a standard 1 hour group. Medicare will not reimburse for intensive outpatient therapy.

Do they reimburse for inpatient treatment?

 

[Sanman]

Do they reimburse for inpatient treatment?

They do. They will reimburse for partial hospitalization program in certain circumstances (hospital/CMHC only; physician supervision). However, they will not allow billing for that code. As for any additional facility payments made by Medicare on top that, I am not sure.

 

[psych.meout]

It's an important part of the arrangement, but not a difficult or unusual situation. They need the hours for licensure and are currently receiving the supervision for free. Even if I were to pay them $15 an hour or so it wouldn't dramatically alter the bottom line. Both of my interns last year landed $100k/year jobs based largely on their IOP experience which is both lucrative and uncommon, at lease in this area.

That's not my point. Almost 2/3 of your revenue is from group therapy and those unpaid interns are helping you run them. And not only are you using their unpaid labor, you are now trying to charge their colleges for supervision. You are tangibly benefitting from their labor to the tune of hundreds of thousands of dollars without compensating them in any way. That they were able to get good jobs afterwards has no bearing on you not paying them for their labor, nor your magnanimous attitude about providing supervision for free. It's pretty rich for you to describe someone/something else as "corrupt" with this kind of arrangement.

 

[deleted760483]

That's not my point. Almost 2/3 of your revenue is from group therapy and those unpaid interns are helping you run them. And not only are you using their unpaid labor, you are now trying to charge their colleges for supervision. You are tangibly benefitting from their labor to the tune of hundreds of thousands of dollars without compensating them in any way. That they were able to get good jobs afterwards has no bearing on you not paying them for their labor, nor your magnanimous attitude about providing supervision for free. It's pretty rich for you to describe someone/something else as "corrupt" with this kind of arrangement.

Real talk, they’re observing me run the program 90-95% of the time barring maybe the last month of their placement. They are there to learn not to earn. If they would find more value in an internship site that pays them $15 an hour where they perform exclusively individual therapy sessions and have a supervisor meet with them once a week for an hour and listen to one random tape or video session and gave them feedback for next session rather than spending 8 hours a week observing and being observed in real time and learning skills that fewer than 1% of therapists in our area possess they have many such opportunities. This position is advertised as unpaid and we still had more applicants than spots this year because some people do understand how valuable this experience is. They learn skills from me that could make them hundreds of thousands of dollars over the course of their careers. I ran both programs completely by myself all summer long and am more than capable of doing so indefinitely. I am not “profiting” off my interns; we have a mutually beneficial relationship.

 

[R. Matey]

This position is advertised as unpaid and we still had more applicants than spots this year because some people do understand how valuable this experience is. They learn skills from me that could make them hundreds of thousands of dollars over the course of their careers. I ran both programs completely by myself all summer long and am more than capable of doing so indefinitely. I am not “profiting” off my interns; we have a mutually beneficial relationship.

OOC, are these master's level interns or doctoral level interns?

Edit: Oh, I see. You said master's. FWIW, I was paid $21/hr doing this exact thing as an intern when I was getting my master's degree in counseling ten or so years ago.

 

[cara susanna]

Real talk, they’re observing me run the program 90-95% of the time barring maybe the last month of their placement. They are there to learn not to earn. If they would find more value in an internship site that pays them $15 an hour where they perform exclusively individual therapy sessions and have a supervisor meet with them once a week for an hour and listen to one random tape or video session and gave them feedback for next session rather than spending 8 hours a week observing and being observed in real time and learning skills that fewer than 1% of therapists in our area possess they have many such opportunities. This position is advertised as unpaid and we still had more applicants than spots this year because some people do understand how valuable this experience is. They learn skills from me that could make them hundreds of thousands of dollars over the course of their careers. I ran both programs completely by myself all summer long and am more than capable of doing so indefinitely. I am not “profiting” off my interns; we have a mutually beneficial relationship.

Or you could give them this good training while still paying them. It's not an either/or thing.

 

[IceOnTheDune]

I have a decent amount of experience working in IOP and PHP. As I’m reading your breakdown, I have a lot of questions…

When are intakes for IOP occurring, and who is doing these intakes? Who is doing all the “case management” stuff in IOP, and how is that accounted for in the finances? (i.e., communication with referral sources and new referrals, orientation of new patients, making referrals back to providers, addressing crisis and milieu issues that inevitably arise)?

 

[IceOnTheDune]

And if you have 2-3 interns at a time, where is supervision time accounted for in the daily schedule?

 

[boomshakalaka]

Real talk, they’re observing me run the program 90-95% of the time barring maybe the last month of their placement. They are there to learn not to earn. If they would find more value in an internship site that pays them $15 an hour where they perform exclusively individual therapy sessions and have a supervisor meet with them once a week for an hour and listen to one random tape or video session and gave them feedback for next session rather than spending 8 hours a week observing and being observed in real time and learning skills that fewer than 1% of therapists in our area possess they have many such opportunities. This position is advertised as unpaid and we still had more applicants than spots this year because some people do understand how valuable this experience is. They learn skills from me that could make them hundreds of thousands of dollars over the course of their careers. I ran both programs completely by myself all summer long and am more than capable of doing so indefinitely. I am not “profiting” off my interns; we have a mutually beneficial relationship.

The italicized alternative you listed here actually sounds like an ethical, common supervisory relationship. The portion I have bolded seems like you acknowledging that you are likely not meeting the supervisory requirements for wherever you practice, but rationalizing your unscrupulous practices as "on the job" and "real world" training.

Also, I didn't know that EMDR was so lucrative.

To the moderators, I apologize if my tone is unnecessarily antagonistic, but I think this is a prime example of how students can be exploited, and how the proliferation of diploma mills has ushered in a wave of these types of practices. I am going to speculate that this practice is comprised of students from those same institutions.

edit: before the ninja privacy change, OP noted they attended one of the main for-profit offenders in the past.

 

[R. Matey]

Also, I didn't know that EMDR was so lucrative.

Wait, this was EMDR?! I want to go on the record that I've never done EMDR--even as a master's student. Previous post refers to the treatment structure (e.g., direct supervision of co-led group treatment with individual supervision) not the modality.

 

[cara susanna]

What about EMDR? Sorry, I must have missed something

 

[boomshakalaka]

Real talk, they’re observing me run the program 90-95% of the time barring maybe the last month of their placement. They are there to learn not to earn. If they would find more value in an internship site that pays them $15 an hour where they perform exclusively individual therapy sessions and have a supervisor meet with them once a week for an hour and listen to one random tape or video session and gave them feedback for next session rather than spending 8 hours a week observing and being observed in real time and learning skills that fewer than 1% of therapists in our area possess they have many such opportunities. This position is advertised as unpaid and we still had more applicants than spots this year because some people do understand how valuable this experience is. They learn skills from me that could make them hundreds of thousands of dollars over the course of their careers. I ran both programs completely by myself all summer long and am more than capable of doing so indefinitely. I am not “profiting” off my interns; we have a mutually beneficial relationship.

Wait, this was EMDR?! I want to go on the record that I've never done EMDR--even as a master's student. Previous post refers to the treatment structure (e.g., direct supervision of co-led group treatment with individual supervision) not the modality.

What about EMDR? Sorry, I must have missed something

LOL you didn’t miss anything. I was being cheeky because the way this specialty training and supervision was being packaged sounded very similar to the sales-pitches for EMDR, brainspotting, and the like.

 

[ThatPsyGuy]

So what does all this look Net if you don't mind me asking? I'm curious about the costs that go behind having a space to conduct testing and hold groups at that capacity.

 

[TrackCPD]

I’m not an expert but I’m pretty sure EMDR can’t be done in a group setting.

That being said, will you be able to provide us with information about what type of work you do that’s so specialized yet in such high demand?

 

[mypointlesspov]

It's an important part of the arrangement, but not a difficult or unusual situation. They need the hours for licensure and are currently receiving the supervision for free. Even if I were to pay them $15 an hour or so it wouldn't dramatically alter the bottom line. Both of my interns last year landed $100k/year jobs based largely on their IOP experience which is both lucrative and uncommon, at lease in this area.

You should absolutely pay them.

 

[psych.meout]

I have relationships with several local colleges and take 2-3 master’s interns each year to help run my IOPs. They are unpaid.

Real talk, they’re observing me run the program 90-95% of the time barring maybe the last month of their placement. They are there to learn not to earn. If they would find more value in an internship site that pays them $15 an hour where they perform exclusively individual therapy sessions and have a supervisor meet with them once a week for an hour and listen to one random tape or video session and gave them feedback for next session rather than spending 8 hours a week observing and being observed in real time and learning skills that fewer than 1% of therapists in our area possess they have many such opportunities. This position is advertised as unpaid and we still had more applicants than spots this year because some people do understand how valuable this experience is. They learn skills from me that could make them hundreds of thousands of dollars over the course of their careers. I ran both programs completely by myself all summer long and am more than capable of doing so indefinitely. I am not “profiting” off my interns; we have a mutually beneficial relationship.

"Real talk," I like how the goalpost moved from the interns "help run my IOPs" to "they're observing me 90-95% of the time" once you received pushback on it.

 

[Sanman]

You should absolutely pay them.

I mean people on the internet told him he should. I can't imagine anyone not doing what the internet said.

I am a little confused though. Are these interns or externs? How far into training are they? I was never paid for any externship rotations at my program. Internship was APA accredited and paid obviously.

 

[R. Matey]

I’m not an expert but I’m pretty sure EMDR can’t be done in a group setting.

They do have group protocols.

 

[R. Matey]

I am a little confused though. Are these interns or externs? How far into training are they? I was never paid for any externship rotations at my program. Internship was APA accredited and paid obviously.

IME, it's a little more common in master's programs for interns to be paid especially if they're doing an internship in a private practice because they can bill for Medicaid patients with a paraprofessional credential. Less so in psychologist training programs.

 

[WisNeuro]

I mean people on the internet told him he should. I can't imagine anyone not doing what the internet said.

I am a little confused though. Are these interns or externs? How far into training are they? I was never paid for any externship rotations at my program. Internship was APA accredited and paid obviously.

Yeah, no one was getting paid for externships/practica in grad school where I was, either. Now, some people would do a rotation at a site, and maybe stay on as a paid psychometrist, or something like that. But, I made most of my grad school money working as an evaluator on research grants.

 

[ThatPsyGuy]

IME, it's a little more common in master's programs for interns to be paid especially if they're doing an internship in a private practice because they can bill for Medicaid patients with a paraprofessional credential. Less so in psychologist training programs.

In my master's program, practicum and internship were not paid. The only way to get around that was to be employed at a place that met your internship requirements and to negotiate those supervision terms. This also seemed to be the case with peers at different programs in the area.

 

[WisNeuro]

More than a decade ago, so I am not sure if the rules are different now, but employed hours were not counted in official APPIC clinical hours, you had to add them on and explain them in another section.

 

[PsyDr]

It’s an impressive use of billing codes and insurance negotiations. Since supervision is federally defined as being on site, and OP isn’t committing insurance fraud by not being on site, the real estate requirements must drastically eat into the net.

 

[R. Matey]

In my master's program, practicum and internship were not paid. The only way to get around that was to be employed at a place that met your internship requirements and to negotiate those supervision terms. This also seemed to be the case with peers at different programs in the area.

Right, so that's how that would work. I know people who are this situation presently in my locale so maybe there's regional variance or something.

 

[Shiori]

Several of the prac sites we worked with gave tuition remission and a stipend.

 

[R. Matey]

More than a decade ago, so I am not sure if the rules are different now, but employed hours were not counted in official APPIC clinical hours, you had to add them on and explain them in another section.

As of a few years ago when I went out, this was still the case. I had some summer employment at my first prac site, which I didn't count on my APPI.

 

[WisNeuro]

As of a few years ago when I went out, this was still the case. I had some summer employment at my first prac site, which I didn't count on my APPI.

Ah, alright. The hours are still useful. Several of my sites talked to me about the massive amount of hours I had accrued during my paid assessment work, in a positive way.

 

[R. Matey]

Ah, alright. The hours are still useful. Several of my sites talked to me about the massive amount of hours I had accrued during my paid assessment work, in a positive way.

I think that makes sense with assessment hours. These hours would've been individual intervention hours on top of a huge pile of supervised individual intervention hours so, at the time, I didn't think that more of a lot already was particularly useful.

 

[cara susanna]

My training program only had paid practica. That was how we were funded our third and fourth years. You could do additional unpaid opportunities, but formal practica were paid.

It’s an impressive use of billing codes and insurance negotiations. Since supervision is federally defined as being on site, and OP isn’t committing insurance fraud by not being on site, the real estate requirements must drastically eat into the net.

How does that work for remote/tele-supervision then?

 

[PsyDr]

How does that work for remote/tele-supervision then?

Unless there has been a VERY recent change in the law, federal law does not allow that.

 

[cara susanna]

Unless there has been a VERY recent change in the law, federal law does not allow that.

The VA does it all of the time. You have a regular supervisor who may not always be on site, and then an on-site supervisor for as-needed issues.

 

[PikminOC]

It’s an impressive use of billing codes and insurance negotiations. Since supervision is federally defined as being on site, and OP isn’t committing insurance fraud by not being on site, the real estate requirements must drastically eat into the net.

I know many psychologists who are on vacation while the interns work without them.

 

[BuckeyeLove]

Real talk...this seems like a ticking litigious time bomb just waiting to go off.

 

[R. Matey]

My training program only had paid practica. That was how we were funded our third and fourth years. You could do additional unpaid opportunities, but formal practica were paid.

That's interesting. Was this at an in-house clinic?

 

[BuckeyeLove]

That's interesting. Was this at an in-house clinic?

We had some prac sites that were out of house that paid. I think it was like 10k a year or something like that. enough to cover rent at a midwest state school.

 

[cara susanna]

That's interesting. Was this at an in-house clinic?

One was the department clinic, but the rest were external sites. My program had arrangements with them. They all paid us, but some didn't pay very well--that was a separate issue.

 

[Sanman]

The VA does it all of the time. You have a regular supervisor who may not always be on site, and then an on-site supervisor for as-needed issues.

However, there still needs to be an on-site supervisor. The supervision rules were relaxed as a result of the ongoing public health emergency. However, supervisors will need to return at the conclusion of the public health emergency. This came up when the government waited till the last minute to renew the public health emergency last year.