Starting a Private Practice

How to Start a Therapy Private Practice in North Carolina

It's not that hard! Here are the basic steps to get you started with building a private practice.Take it slow...you can do it!

1. Find an office space or set up an office space for telehealth

  • You will need a business address for all of the various official and legal paperwork to establish your business. 
  • If you choose to do telehealth from home - consider if you are comfortable with your published office address being your home address.

2. Complete a business registration with the NCBLCMHC 

  • From the NCBLCMHC: “Any unrestricted licensee of the North Carolina Board of Licensed Clinical Counselors (NCBLCMHC) may apply for a Certificate of Registration of Professional Corporation (PC), Professional Limited Liability Company (PLLC), or Professional Association (PA). 
  • LCMHC-As may form a PC, PLLC, or PA. If the PC, PLLC or PA is formed with another professional, it must be another LCMHC-As or LCMHCs. Any other profession is strictly prohibited. 
  • Before submitting Articles of Incorporation or Organization to the Secretary of State’s office, you must obtain a Certification of Application from the NCBLCMHC as explained below. Additional information is available on the Secretary of State’s website at www.secretary.state.nc.us/ (Corporations Division), or you may call their office at (919) 807-2225.”

3. Complete business registration with the NC Secretary of State 

  • Go to Register Your Business Online. 

4. Complete an application for state privilege license

  • Privilege License Statutes regarding the Art of Healing Privilege.
  • Review additional information provided by the North Carolina Department of Commerce. 

5. Get an Employee Identification Number (EIN) 

  • An EIN serves as your unique business ID number so that you do not use your Social Security number for your business documents. (it's free) 
  • This number has to be provided to insurance companies, banks, etc., and for personal security, you want to keep your SSN off of those documents.

6. Get Liability/Malpractice Insurance 

  • There are two types of coverage - one for yourself as a therapist and one for your business. Be sure to talk through the options with the vendor you choose.
  • Some popular options: CPH and HPSO
  • Insurance companies will expect you to have minimum coverage of $1,000,000 per Incident and $3,000,000 per year.

7. Get credentialed for accepting health insurance (if you want).

  • If you decide to take health Insurance, start that process ASAP, it can take 3 to 6 months or more.
  • Getting on insurance panels is faster if you have a free CAQH account. 
  • CAQH is a widely-used registry that you’ll need to be a part of if you think you will work anywhere that takes insurance (both private insurance like BCBS or government-based like Medicaid).

8. Open a business bank account.

  • This will make tax time much easier. It’s beneficial to have a clear distinction between your personal money and your business money, even if you transfer money back and forth between the two.
  • Remember to use your EIN rather than your SSN to set up this account under your “official” business name however you listed it with the NC Secretary of State.

9. Get your office set up

  • It doesn’t have to be perfect before you open the doors, but it needs to be professional
  • Have two places to sit, a clock, some tissues, and curtains if necessary for privacy 
  • If you plan to do telehealth from home, get trained - some options are listed below 
    • https://personcenteredtech.com/
    • https://telementalhealthtraining.com/
    • https://www.zurinstitute.com/course/certificate-program-in-telemental-health/

10. Decide what video platform you will use for telehealth 

  • Some EHR/EMRs include video and there are many exterior services like Zoom, Doxy.me, and VSee
  • See this comprehensive review of the popular HIPAA-compliant platforms 

11. Decide what phone number you’re going to use

  • Will you use your personal cell number? Get a work cell? have a landline? Use a VOIP like Google Voice?
  • How does HIPAA factor in?

12. Set up how you will securely communicate electronically with clients 

  • Explore some of these popular secure email plans - GSuite email, Hushmail, ProtonMail

13. Create your necessary paperwork:

  • Professional Disclosure Statement - the NCBLCMHC determines what is needed and there is a sample PDS on their website.
  • Intake paperwork - Information you want clients to fill out about themselves before seeing you the first time. You will want to gather demographic info, basic reasons for wanting therapy, and insurance information at the very least.
  • Written Practice Policies - some examples of what to include: potential benefits & risks of therapy, cancellation policy, social media policy, boundaries for contact outside of sessions, telehealth policy, permission to seek Emergency Care In the case of a medical or mental health emergency, info for an Emergency Contact person.
  • Clinical Assessment -the form to use during the first session to gather the client’s psychosocial history, current symptoms, etc. 
  • Financial Agreement - specific costs of sessions and/or other services like documentation, policy about how you collect payments, if there is a requirement to keep a valid credit/debit card on file, statement that their signature authorizes use of the card on file (helpful if they ever try to challenge it), how unpaid balances will be handled.
  • Notice of Privacy Practices - this is the required HIPAA Statement about protecting private health information and can be rolled into your Informed Consent if you prefer. Free HIPAA statement template from Health & Human services
  • Authorization for Release Of Information (ROI) - so that you can get written permission from the client any time you need to talk/exchange information with providers, families, etc.
  • Superbill - this is for clients if you are not billing insurance. It’s a detailed receipt including diagnosis and procedure code, among other things. You can provide this to clients after they pay so they can file it with their insurance for their out-of-network coverage.
 

Some other practice building topics to put thought into

  • How much will you charge?
    • Do you want to have a sliding scale plan/policy?
    • Will you take insurance (see our separate page about the pros/cons and ways to get started)
  • How will you keep track of income and bills? Do you want an accountant?
  • What is your plan if you have a HIPAA breach? (we are supposed to have a written policy about this)
  • Do you want to use a Practice Management System (also called EHR/EMR Electronic Health Record/Management system)?
    • There are very many to choose from and all have pros/cons regarding features and prices.
    • A fellow counselor & techie has created a comprehensive list and reviewed them all so you can find what best fits your needs. Tame Your Practice
  • Do you need a credit card processor? Will you accept cash? checks?  
    • Most EHR/EMRs have this feature included as an option, with extra fees for processing.
    • Other outside options are Square, IVY Pay,  
    • Consider client privacy when you make these choices
  • Do you want to print business cards?
  • Do you want to have a website?
    • For a quick start, you can use something like BrighterVision or TherapySites who specialize in therapist websites
  • Do you want to buy your own domain name?
  • Do you want to join therapist directories like TherapyDen (free), PsychologyToday ($29.95/month) or GoodTherapy ($29.95+ per month)?