All right everybody, welcome back to another episode of The Testing Psychologist podcast. Good to be with you again as always. I hope that all of you are doing well, enjoying the summer, having some vacations, having some fun, and also maybe taking a little time to reflect, grow your practices, adjust things, and keep moving in the right direction.
Right now, I’m excited. I am standing at my desk, that’s right, standing at my desk. I got a new standing desk, which has been awesome as [00:01:00] far as I’m concerned and it’s made a huge difference in the amount of work that I get done. As a lot of us do, I have had some trouble in the past with sitting and getting reports done, and working for extended stretches, the standing desk has made a huge difference.
I’m using the VariDesk version. I know there are a lot of standing desks out there, but mine is a VariDesk and it’s cool. It sits right on top of your regular desk and then there’s a hinge system that you operate and it lifts itself. It’s easy to put back down and it’s made a big difference.
So it’s just a quick point of excitement for me. I’ve talked in the past about how you got to switch things up a little bit sometimes to keep things fresh with testing or else writing reports just gets so old and tiring. And so this is one of those [00:02:00] things, it’s a small thing but it’s made a big difference so far. So I’m pleased with it.
Aside from my standing desk though, we have some other things to talk about. Today, I’m doing a solo episode all about how to outsource in a testing practice. I think this is a really important topic that is pretty near to my heart because this is an ongoing process, certainly. I would not say that our practice is completely outsourced and optimized at this point, but I have had quite a journey over the years with going from doing everything myself to now having a lot of quality people and services in place to help take some things off my plate.
So when we think about outsourcing, I think that a lot of us start off by ourselves in solo practice and due to money or maybe having the [00:03:00] time to do it or maybe due to not trusting that others can do things as well as we can, it can be a long process to think about outsourcing some tasks in your testing practice.
And this was definitely true for me. I’m almost ashamed to admit that it took me about five years of being in practice before I started to outsource some of the administrative tasks. I’ve talked in the past about how I hired psychometricians pretty early in the practice to help with administering some of the testing. And that was a big deal. That freed up a lot of time for me, certainly.
But as far as the administrative side, that took me much longer to decide to hire someone else or get some help with some of those tasks. Just to set the stage a little bit, I looked back at some emails with my original admin [00:04:00] assistant and it was 2014.
I had been doing everything myself up to that point. So answering the phones, doing the billing, doing the scheduling, doing all the clinical work with writing reports and testing and interviews and things like that. Doing my accounting, my website, and marketing. So there had been a lot on my plate for five years.
I finally got to the point where I was, I think the breaking point was spending so much time on the phone with insurance companies because we were getting a lot busier. I’d hired a postdoc at that point. So we had officially become a group practice. There were multiple clinicians to be working with. And the administrative tasks, particularly the insurance piece just got out of control.
So I finally took the leap and put out an ad to find someone to help me tackle some of [00:05:00] these office tasks. At that point, I don’t think I had a great idea of what I was looking for aside from I knew that I needed someone to help me return my phone calls and check insurance benefits. Those were the two main tasks that I was like, I have to get rid of these. This is taking too much time.
So I put the ad out there. I put it on Indeed. I got a few applicants right off the bat. I was so excited. So I interviewed, I selected someone. My first applicant, she was so kind. She was a kind graduate student. She came to work the first day. I sat her down at the computer and told her what I thought was an accurate description of what the day’s tasks would look like.
Looking back, [00:06:00] that was not the case at all. It was terrible and it was vague. She, I’m sure, had no idea what to do. I basically told her, okay, so here’s some clients, here’s their insurance information, I need you to call and verify these benefits. And if the phone rings, just answer the phone. Here’s how you’d answer it and give me the messages. I don’t know if it was exactly that bad, but it was pretty close.
So she worked one day and then quit. I was disappointed, to say the least. I liked her and thought that she had a lot of potential, but it caused me to think about what I may have done in that process to contribute to her taking off so early.
And so I’m sure you’re guessing from the description that I could have been a lot clearer with job tasks, expectations, [00:07:00] training, any number of things could have been so much better. Luckily, I had a second applicant. This person was pretty amazing. Her name was Michelle.
I remember Michelle very fondly. When she ended up leaving after about a year or so, we had this big dinner and sent her on her way off to her next adventure. She was a graduate student in counseling. I said, Michelle, thank you so much for showing me that I could trust someone with my practice. It was a nice moment.
Michelle was incredible. Like I said, she was a counselor in training. She was kind. She got along with everyone. She had that gift of being able to talk on the phone without being awkward, which is a mystery to me, to be honest. She was super patient. She was able to roll with it when things were [00:08:00] not as well defined as maybe they could be from my side.
So that was my first foray into bringing on an admin assistant. I learned a lot along the way. So I wanted to talk with y’all about a few different aspects of outsourcing in a testing practice and how we might go about those things and some key tasks to outsource and how to do that.
When you’re thinking about outsourcing in general, the reason to do that boils down to having more time, so freeing up more time to do whatever you want to do. So that might be more clinical work, it might be being off with your family, it might be reading, studying, getting better at what you do, but either way, I think outsourcing is a great way to free up more time in your schedule.
The further I go in my practice and in my [00:09:00] career, the more I am settled on this idea that I wish that I had outsourced much sooner rather than let the administrative tasks fill up any extra time I had in my practice at that time. I wish I had just done it right from the very beginning and save myself all that time.
And so at this point, I’m a big proponent. I talk with my consulting clients a lot about outsourcing as early as possible and different ways to outsource. So that’s just my bias, and particularly with testing, I think that’s important because it can get so wrapped up in the time it takes to do evaluations and it goes by quickly. And the time gets eaten up quickly. And so being deliberate as early as you can about outsourcing and ways that you can do that.
So in those tasks that you might think about outsourcing, I [00:10:00] named a lot of them earlier, but it might be things like answering the phone, billing, scheduling, writing your reports, doing your accounting, doing your website, doing your marketing, the testing itself, you have to look at what things you are doing because you like to do them versus what things you’re doing because maybe you’re afraid someone else won’t do it well or you think it costs too much money to outsource it or one of those other reasons. And so that might give you a good idea of where to start with outsourcing.
So when you think about getting started with outsourcing, maybe you’ve identified some areas that you don’t want to do anymore. It doesn’t bring you joy. You are willing to take the leap and let someone else try it. I would advise taking at least two weeks before you put out an ad, before you [00:11:00] interview, before you bring someone on, take two weeks and start to write down everything that you do in your day. It’s important to be very literal with this log that you’re going to keep.
So everything that you do. You don’t have to talk when you check Facebook or whatever you might do like that but work tasks. Write down how long you spend on your notes. How long are you spending on testing? How much time are you spending on the phone? What do you say when you’re answering the phone?
What do you subconsciously or consciously have as your expectations when you are interacting with your clients? How much time are you spending on scheduling? Do you do your own billing? All of those pieces. So you get the idea to start with writing down just about everything that you do and trying to track not only [00:12:00] the time that you spend on those tasks, I think that’s important, but also tracking almost literally exactly what you say.
And the reason that I highlight that is because for me, developing scripts has been a huge part of outsourcing. I’ve joked around before in a not-so-joking way that I’m a bit of a control freak and so for me, it was scary to think about outsourcing answering the phone. I was thinking there’s no way that a non-psychologist could explain the testing process and sell that process to potential clients. There’s no way somebody could do that. I am the only one that can do that effectively.
Of course, that’s ridiculous. I’ve learned that since then, but one of the big things that helped alleviate my worries [00:13:00] about that early on was to write scripts. I sat down, and you could do this any number of ways; you could record yourself when you’re on an actual phone call and then transcribe it.
Speaking of outsourcing, you can go to a site like Upwork to transcribe audio recordings. You wouldn’t even have to do that yourself, but you can transcribe a phone call. You can simply sit down and imagine a phone call in your head and type out what you would say. Be as thorough as possible pretending that you’re having that conversation right there live and document everything that you would say in that phone call.
What I found after I did that was that naturally led to a bit of an FAQ section in terms of what clients typically ask, questions they had, issues that came up during those initial [00:14:00] phone calls. And then that led me to write out even scripts for some of these FAQs.
So that was one of the things that was really helpful for me when I thought about how to outsource answering the phone. So I wrote out a ton of scripts. I did walk through it with Michelle when she first came on and with my admin assistant after that.
The way that I did it, two times, I let her sit in and listen to me answer the phone and go through it while she was looking at the script so she could compare and contrast what I was saying with what was on the page and start to adapt it to her own words. After that, I let her take two phone calls while I was listening. We had a setup there where she could look at me and I could tell if she needed to know an answer. We had the [00:15:00] phone close enough where I could hear what the clients were saying.
So she took two calls and then I had confederates; relatives and family members call in and pretend to be a parent asking about testing for their child. And then they gave me feedback on how they thought she did. So as far as outsourcing answering the phone, that is how I went about it. Like I said, the script was super important.
Let me back up, before I totally leave answering the phone, I think that this is one of the easiest areas to outsource both in terms of logistics, so it’s very easy to write out a script but also in terms of cost. So there are any number of virtual assistant services that you could contract with.
There are a lot of folks at least here in our area [00:16:00] that would serve as a virtual assistant but local. So these are individuals who would like a stay-at-home job but they just have your practice phone or you set it up where the phone number rings to their phone. It’s easy to find folks to do that and it’s pretty cost effective.
I use Conversational, which has come up on some other podcasts for mental health folks and they do a great job. Right now, they handle our backup, and our overflow phone calls and they do a great job and it’s very cost-effective. And so you can potentially check that out.
I’ll just say that if you outsource anything, I would think about outsourcing your answering the phone pretty early on. I also think it lends quite a bit of professionalism to your practice. A lot of us who do testing, there’s a bit of a medical overlay to it where it’s a little more formal and there’s a level of professionalism that [00:17:00] we might want to represent and having an answering service helps with that. It’s like a real “doctor’s office”.
The next thing that dovetails well with that is, I’m going to skip billing for a second, but go to scheduling. I think scheduling is pretty easy to tie in with answering the phone. Those naturally go hand in hand.
If you have someone who can answer the phone, assuming you don’t want them to just take a message and pass that along to you, but if you want to go that next step, which I totally recommend, you can have them do the scheduling as well.
At least in our EHR system, which is TherapyNotes, it allows you to have an administrative account for free. So individuals can access the schedule and the billing. So that’s great. That’s a cool feature. You can give someone access to your EHR, I would imagine others have that feature as well. [00:18:00] They can set your schedule.
I am someone who has had any number of different schedules over the years and so my admin assistants have had to be pretty flexible in terms of keeping up with my schedule and my expectations for the schedule. This is a place where scripts and guidelines come into play. This is a place where it’s important to communicate your expectations.
In my case, it was things like, I only want to do three intakes in one day, no more, or I cannot go more than four hours without a break. I have to have at least 30 30-minute break somewhere in there, or I don’t like to see clients the last hour of the day so that I can return phone calls and do notes. So setting guidelines like that and setting the expectations [00:19:00] is super important. If you can do that, if you can nail that down, then be as explicit as possible, then that’s a great place to turn things over to people.
The one place that I still retain a little bit of control over is the scheduling of testing appointments only because it depends on the client and how much time they’re going to take. I suppose there are certainly a way that I could turn that over to our admin assistant, but I like having that interaction with parents at this point, just to describe what the testing day will look like and answer any questions and then it flows naturally to scheduling the testing day, but you could totally do that.
I think another big area that a lot of you might be wrestling with is billing. I have certainly wrestled with outsourcing the billing for a long time. [00:20:00] To be honest, I’ve taken baby steps over the years with outsourcing the billing. I’m still not totally there.
The solution that we have in place now is that we have, and this depends on if you take insurance or not, but we do take insurance, a lot of it. One of the big steps that I took was to have someone come onboard to verify clients’ benefits and coverage before they come in. I cannot say enough for how much this has made a huge difference in our practice mainly in terms of collections and getting paid for the work that we do.
With testing as you know, some of those outstanding bills can be pretty big. Testing is expensive even with insurance sometimes. What I was running into is that I would tell people on the phone that they were responsible for checking their benefits. They would say they did [00:21:00] or forget. I wouldn’t always ask about it. And then we ended up with many cases where clients owed more than they thought they would or maybe they never even had an idea of what they would owe which was my fault for not communicating it.
Anyway, you see where this is going. So we ended up with a lot of outstanding bills and I had to go through all sorts of acrobatics to figure that out. So getting a company to verify insurance benefits before clients come in has been so huge.
We work with a local company, they operate nationally and they happen to be local, but they are so good with calling, verifying coverage and benefits, and knowing if we need pre-authorization for testing or don’t need pre-authorization. They can sometimes get a handle on how many hours of testing are approved and it’s very cost effective. It’s something like $4 or $5 per patient and they turn it [00:22:00] around in 24, maybe 48 hours at most.
I’ve used that effectively to guide a conversation with clients in the initial intake about here’s how much testing is going to cost, here’s what you can expect, will that work for you? Here’s our payment schedule, things like that. Oh, it helps so much with collections and making sure that we’re getting paid for the work that we do.
I’m in the process now of transitioning over to a full billing service. When I say full billing service, I mean, totally handing over verification of benefits, submitting insurance claims, sending out bills, collecting bills, sending multiple statements, and eventually taking people to collections if need be for unpaid bills.
Up to this point, we’ve done it in-house. Our office manager has handled that task and has done so very [00:23:00] well but as we continue to grow, I found that the office manager is a lot better suited to other tasks around the office. And so I’m looking into a full-service billing company.
Billing companies will generally take between 6% and 9% of the total collected. It should be a pretty seamless process when you’re looking around for a billing company. Many of them have software or ways to integrate with your EHR. Many EHRs have ways to print off reports and client information so that you can easily transfer that information to the billing company to submit claims and keep track of balances and things like that.
I think this was huge, obviously. I can’t remember if I’ve talked before about some of our troubles with collections in the past, but there have been times when I’ve looked at our [00:24:00] 60-day overdue aging statement and it has been in the tens of thousands of dollars and have a bit of a freak-out moment. And that has led to a number of changes over the years.
I think billing is super important to help you run your business and make sure that you don’t feel like you have to work all the time because it’s a vicious cycle; if you’re not collecting the money, then you both spend time trying to collect the money. And if you’re like me, it felt like you had to work more to make up for the money that you weren’t collecting. So it was like burning the candle at both ends. Billing service, even though it seems like a lot of money, I resisted for a long time thinking that they would take 8% or 9% of our total collections, but when you do the math, it totally makes sense.
Those are the two main areas when I think about outsourcing. We could talk a lot about accounting [00:25:00] and website and marketing. We could go into each of those in a lot of detail. I will cover them a little bit more quickly here simply because I haven’t dove into those as thoroughly as the first two topics.
With accounting, I think that’s really easy. Of course, you have an accountant or you should have an accountant. Most of them will give you the opportunity to share your books with them. So QuickBooks Online, it’s about $20 a month. It on the one hand makes accounting so much easier so that when you get to the end of tax season, you have all your numbers right there in front of you. You don’t have to go combing back through credit card statements and receipts and all that kind of stuff.
I consider outsourcing because it is offloading a task that you would otherwise have to do to an external source. [00:26:00] I use QuickBooks Online. I do share it with my accountant. Many accountants will “do your books” for you each month where they reconcile payments and deductions and credits and all of that kind of thing.
I would totally recommend it again. The time that you would spend on it is not worth the time or the money that you would otherwise make. So that’s one option for accounting.
Website-wise, I know that websites have been covered ad nauseum on other podcasts or in different Facebook groups, but there are a ton of really easy, do-it-yourself options for websites. If you want to totally do it yourself, Squarespace and WordPress are great options, but we’re talking about outsourcing. So unless you’re really good at websites or you like doing it and [00:27:00] you’re willing to say, I’m going to trade clinical hours to do my website, then you maybe should look at other options.
One of the big ones here in the mental health world is Brighter Vision. Kat Love also does websites specifically for therapists. These folks, like I said, they’re very specific to the mental health world and they provide a great service. SlapShot Studio is another one. I use Legendary Lion.
There are a lot of options out there for folks who can do websites for therapists and can do a really good job.
And again, the likelihood that you would pay someone as much as you would make is very unlikely. People balk at the cost of a website, but there’s so many options out there to just do it.
I think you need a website of some sort. We’ve talked about that before in other episodes, but [00:28:00] finding some way to outsource that website creation is super important. So a lot of services, Brighter Vision, I know does a monthly fee of $59. For a lot of folks, it feels a lot more doable than a one-time fee of say $1,500 to $2,000. Either way, weigh it out, figure out what works best for you, and go that route.
Same thing with marketing. When I say marketing, I mean online marketing or print marketing, I’m not talking about the kind of marketing like networking. I don’t think you can outsource that. I haven’t found a way to do that, nor do I want to, I like meeting with people.
In terms of online and print marketing, this is an area I learned the hard way that it’s really easy to lose a lot of money very quickly if you don’t know what you’re doing. I can’t remember if I’ve told the story, but there was one point [00:29:00] I was trying to get some clients for a men’s group that I was doing and I put up a Facebook ad. I was really proud. I got so many clicks on this Facebook ad. Of course, clicks on a Facebook ad mean paying money for those clicks and I paid a lot of money really quickly and didn’t get a single client from that Facebook ad.
So if you think about online marketing or print marketing, it is definitely worth outsourcing the setup to someone who actually knows what they’re doing. Alternatively, you can spend the time to learn how to do it, but just know, you have to spend the time to know how to do it because it’s a science in and of itself and you can do a bad job easily.
Lots of resources, there’s a Facebook group for online marketing for therapists. Michael for Micah does a lot of this. I think John Clark at Private [00:30:00] Practice Workshop has an SEO and online marketing team. Two great resources to outsource marketing.
Aside from that, we’ve talked in other podcasts about how to outsource the testing itself as far as report writing, therefore a long time, I had graduate students or undergraduate students writing the clinical histories. They would take my clinical notes from the intake and write up the histories from those, type them up or transcribe them. That worked really well.
Over time, I’ve circled back around where I’m writing my own histories because I’ve gotten efficient at it and that time versus money trade-off doesn’t make quite as much sense anymore. So I do write my own histories now, but if you don’t have a [00:31:00] graduate student doing it, and that would be a great place where scripts and expectations are very important. I use templates. I used to do as many dropdown options as possible so as to keep things standardized.
If you don’t want to go that route, I would consider dictation software, a version of outsourcing. It does make things a lot quicker. Of course, a lot of you have run across dictation software and Dragon is a big one.
So testing itself, I’ve covered that in other podcasts, but certainly worth considering psychometrician work if that fits with your philosophy and with your practice model. And just to put in a plug that if you do go the psychometrician route, that I think almost more than anything else is a place where the scripts and the expectations and the standardization process is so important.
I talked in a previous [00:32:00] episode about how we hire and train our psychometricians. You can refer back to that episode if you want more information with that, but I’ll just leave it today by saying that that’s one of the places where standardization is obviously important.
I hope that you have enjoyed and learned a little bit from this episode around how to outsource in your testing practice. Many of these things are common to a number of practices, but I think in my experience that when you do a lot of testing, there’s something about the process, the describing it to people, the billing for it, the scheduling, there are a lot of nuances that go beyond maybe a typical therapy based practice and so just a few extra things to consider as you’re [00:33:00] thinking about outsourcing.
Like I said at the beginning, my feeling at this point and my bias is that outsourcing is important. I wish I’d done it a lot earlier. I would definitely recommend that each of you consider outsourcing as early as you can in your practice. Don’t shut that door just because it seems expensive or because someone might not be able to do it as well as you can. There are a lot of great options out there.
As always, thank you for listening so much. I’m going to be out of town the next two weeks, so there is a chance I may not be talking with you for two weeks. One of those trips, like I’ve talked about before, I’m really excited about. I’m going to upper Michigan to Traverse City to hang out with Joe Sanok, Kelly Higdon, and a bunch of other cool people for Slow Down School. We’re going to do some business coaching and practice [00:34:00] development work. I’m really excited for that.
So I may not be able to record a podcast for the next two weeks, but either way, I will look forward to talking with you the next time that I do. In the meantime, if you would like to connect with others doing testing, please come check out our Facebook group. It’s been amazing. This group just continues to grow. We’re up to 140 members or so. We keep gaining steam.
You can find The Testing Psychologist Community on Facebook just by searching The Testing Psychologist Community. If you’re interested in doing any consulting or even trying to figure out if consulting is the right option for you, you can shoot me an email at jeremy@thetestingpsychologist.com or go to the website, thetestingpsychologist.com.
Thanks as always, y’all. Take care. Talk to you next [00:35:00] time.