The SLP's Private Practice Playbook: Jill Shook on HIPAA, Insurance, and Building Around Real Life
Most SLPs who start a private practice do it because the math stopped working. Jill Shook is no exception. She moved somewhere the cost of living stayed the same but the salaries didn't. So she picked up a side hustle, then another, and then launched her own practice in 2015 while already juggling two jobs. And then she got pregnant with a baby she wasn't planning on.
Plans changed. But the practice survived. In fact, it bent around her life in ways a traditional job never could.
On episode seven of Clinic Chats, Jill walks through the real mechanics of starting and running a speech therapy private practice, from HIPAA email encryption to Medicaid reimbursement rates to why she spent ten months building a course she originally imagined as a one-page cheat sheet.
When Life Rearranges Your Business Plan
Jill didn't get the luxury of a clean transition. She was working full-time in the schools, picking up early intervention clients through an agency, and building her private caseload on the side. The plan was to go full-time in private practice eventually. Then the pregnancy happened.
Instead of abandoning the practice, she reshaped it. She sees clients in their homes during evenings when her husband can watch their daughter. She wakes up at 5 a.m. to handle administrative tasks and emails before mom life kicks in. One day a week, her daughter goes to daycare, and Jill fills those hours with sessions.
"With mom life, you work around what you have to," she says.
It's not glamorous. But it works. And it points to something a lot of aspiring practice owners overlook: private practice doesn't have to look like a full-time office with a waiting room. Sometimes it looks like evening home visits and early morning inbox management.
The HIPAA Question That Wakes You Up at 3 A.M.
Jill built a four-hour course called Private Practice Foundations (available through Northern Speech Services) after realizing there was no single resource that answered all the questions SLPs have when starting out. HIPAA compliance was near the top of the list.
"That was one of those moments where I woke up at three in the morning with a cold sweat," she says. "I was like, oh my word, I think my email is not HIPAA compliant."
Her advice is practical. G Suite and Microsoft Office 365 both offer HIPAA-compliant email options. You don't need end-to-end encryption (the CMS doesn't require it), but you do need your email provider to sign a Business Associate Agreement (BAA). For an extra layer of protection, password-protect any PDF you send through email, even through a secure provider. Because you can't control what happens on the other end.
"What if you accidentally send it to the wrong person? You don't want them seeing that protected health information."
If you want full end-to-end encryption, Hushmail is an option where the recipient has to enter a password to read the message. But for most practices, a BAA-backed provider plus good habits is enough.
$22.70 and the Medicaid Math Problem
Jill initially accepted Medicaid because she wanted to serve those families. In Pennsylvania, Medicaid (called Medical Assistance) works differently than most states. Patients choose from five different insurance companies as their Medicaid provider, and you have to credential with each one separately.
But the real problem is the reimbursement rate. Code 92507 (individual therapy, untimed) pays $22.70. Period. Whether you see a client for thirty minutes or two hours, that's what you get.
For a mobile therapist spending an hour round-trip driving to a client's home, that's not sustainable. Jill made the difficult decision to stop accepting Medicaid. And here's the part that stings: Medicaid contracts often prohibit providers from offering their private pay rate to those same patients. If you drop Medicaid, those families can't just pay out of pocket instead.
"You can't burn yourself out trying to help people and then not be able to help anyone because your business went under."
It's one of those decisions with no clean answer. Jill doesn't pretend otherwise.
Advertising on a Real Budget (Not $1,000 to Google)
Jill has a cautionary tale about marketing. When she first started, she jumped into Google AdWords without any guidance and spent $1,000. She didn't get a single call.
"I don't know anyone who has $1,000 to spend on marketing, because in general, you want your marketing to be less than 10% of your budget."
What actually worked was cheaper and slower. She gives free talks at local libraries about child development and milestones. She's built relationships with librarians across her area who casually refer parents her way. She connects with local pediatricians for referrals. And she networks with other SLPs who accept different insurances, creating a mutual referral system.
None of that costs $1,000. All of it builds trust in ways a Google ad never will.
Start With a Business Plan (Even a Simple One)
Jill's parting advice isn't flashy, but it matters. Do your market research before you open. Look at the demographics in your area, what insurances people carry, whether private pay is realistic given local income levels. Even a simple business plan that answers those questions will save you from expensive mistakes.
Find your sweet spot for client volume. Factor in drive time if you're mobile (you can't charge a travel fee per ASHA, but you can account for it in your rates). And build your EMR workflow early. Jill started with a medical billing company, found it frustrating (faxing EOBs back and forth), and eventually moved everything into her electronic medical record system, which smoothed out the billing process significantly.
She even created a comparison chart of 15 different EMRs specifically for SLPs, available as a freebie on her consulting site, privatepracticeslp.com. Because that resource didn't exist either, and she's the type to build what's missing.
Starting a private practice means answering a hundred questions you didn't learn about in grad school. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, handling documentation, scheduling, and insurance billing in one place so you can focus on your clients instead of your inbox at 5 a.m. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist private practice podcast, a podcast full of personal journeys where we not only talk about success stories, but also real life struggles of small business startups. Clinic Chats is sponsored by ClinicNote, a HIPAA compliant cloud-based EMR platform used specifically by private practice owners and university clinics. I'm your host, Kadie Jackstat, and thank you for joining me today. Today I'm with Jill Shook, the owner of Jill Shook Therapy, and this is episode seven.
Kadie: How are you, Jill?
Jill: I'm great. How are you, Kadie?
Kadie: Good. I can't wait to hear a little bit about the many avenues that you are doing with a private practice. Go ahead and fill our listeners in a little bit about what you do and what your business is.
Jill: Sure. I started my private practice back in 2015, mostly because I had moved somewhere where the cost of living was the same as previously, but the salaries were not. I had to make up the difference somewhere. I was working full-time in the schools, contracted, and I also had some early intervention clients through an agency, and then I decided to start a private practice on the side as well so I could dip my toe in, get a little experience with that. My plan was to move into it full-time.
Jill: That plan was a little bit derailed because I got pregnant with my Mirena baby. We weren't planning on having kids for a while. That kind of changed everything, but looking back, it was definitely in a good way. I was able to continue seeing some clients at home. I was able to transition into part-time private practice. Since I see my clients in their homes, I'm able to see them in the evenings. I can see them when my husband comes home and he can watch our daughter. I've been able to work it out that way. As she's gotten older, she's gone to daycare one day a week, and I'll see clients that day. I've been able to work it like that.
Kadie: Wow. That is a really nice arrangement you have. Early during the day, you're primarily home with your daughter, and then the evenings is when your business is thriving.
Jill: Correct. Then I do get up around 5 most mornings so I can take care of all the administrative stuff and all the emails and set up things for the day. With mom life, you work around what you have to.
Kadie: Oh my goodness. How old is she now?
Jill: She's three. She just started preschool last week.
Kadie: Do you think that once she is in school full-time that your business might take a different route as far as schedule goes?
Jill: Oh yes. Once she's in school full-time, I'll be able to see more clients during the day. I just decided that while she's home, I wanted to be able to devote more time to her. We took the pay cut and looked at the budget and are making it work like that.
Kadie: Absolutely. You also are creating an income doing a little Teachers Pay Teachers. Tell our listeners about what your materials are and what you sell online.
Jill: I decided to jump into Teachers Pay Teachers about a week before my daughter was born. I do not recommend that because it's quite a bit of work as far as creating things, marketing them, securing them, all of that stuff. The materials that I put on there are some organizational materials, a lot of minimal pairs, a lot of interactive books. Basically, I just make materials almost as I need them for my clients and then I can put them on Teachers Pay Teachers.
Kadie: Absolutely. Help someone else to not have to reinvent the wheel.
Jill: Right. Right.
Kadie: Then do you also sell some business tools?
Jill: I do. I decided about two years into my private practice that there had to be an easier way to go about starting a private practice. It seemed like there was no place where you could get all of the information you needed in one place. I was looking at all different websites. I was trying to figure out stuff from ASHA, but they never had all of the things and knowing where to go and what I needed. It just didn't seem like there was information specifically for SLPs all in one place.
Jill: I was like, oh, I'll make a little cheat sheet, like a one-page cheat sheet and maybe do like a webinar or something. Then 10 months later, I had a four-hour course that I had created that went through pretty much everything you needed to start a private practice. Basically, I asked myself the questions that I had and then answered those questions. What is HIPAA? What do I need to be concerned about there? What paperwork do I need? What's an EMR and how do I use it? Do I even need one? What kind of insurance billing do I need to do? All those sort of things where I didn't feel like I had much guidance with that.
Kadie: Yeah. Before I dive deeper in questions, I don't want to forget to allow you to tell our listeners where exactly they can find that on Teachers Pay Teachers, under what name, because I'm sure there's going to be so many people intrigued by this. It sounds very helpful.
Jill: My resources are all evidence-based and they're under Jill Shook SLP on Teachers Pay Teachers. Then the course is on the Northern Speech Services site and that's called Private Practice Foundations.
Kadie: Awesome. Thank you so much. Obviously, your course is four hours. We're not going to get to cover all of that today, but do you think anything sticks out as far as questions that are most frequently asked or can you give me a quick, quick summary of some things that are included? I know you mentioned about HIPAA. You explained those guidelines. Anything else?
Jill: Yeah. I would say HIPAA and insurance-related questions are two of the biggest questions that I had and also that I get through people on my website or email or Instagram or Facebook. I cover what HIPAA is, what it entails as a private practice, and your options for what you have. As far as insurance, I list all the CPT codes, what CPT versus ICD-10 codes are. If you're coming from a background working on the medical side of speech therapy, you are familiar with those, but those of us, like myself, who were in the schools have no idea what the codes mean or how to bill. I go through everything that you'd need to know to start from the ground up.
Kadie: Exactly. I have a question for you that's pretty specific. I get this question frequently because our EMR system is working on developing a patient portal. In the meantime, I get questions from our customers on how to encrypt their emails. I've had to say, that's not our specialty, but I know a lot of them pay for G Suite and have their own email address through that. Do you have any advice for making sure their emails are HIPAA compliant?
Jill: Yeah. That's one of probably the biggest questions I get too. That was one of those moments that I had when I first started where I woke up at three in the morning with a cold sweat. I was like, oh my word, I think my email is not HIPAA compliant, and then I was madly trying to figure out how to do it.
Jill: With G Suite, I usually do recommend G Suite if you have Gmail. I believe Microsoft Office 365 also offers a HIPAA compliant email. It's not going to be encrypted on both ends. For that, you'd need something like Hushmail, but according to the CMS, Centers for Medicare and Medicaid Services, who talk about what the HIPAA requirements are, you don't have to have end-to-end encryption. You just kind of have to do your best as far as HIPAA encryption with your email.
Jill: So you definitely want to make sure that yours is secure, and G Suite will allow you to do that. You just have to make sure that when you are looking for an email provider, that they will sign a BAA with you, which is a business associate agreement, and that is one of the requirements for HIPAA.
Jill: So you can do Hushmail, which is a separate email provider, and then the patient would be able to log in to the message, so they would have to enter a password to get the message, whereas with Gmail, it just works like regular email. When you do that, you do want to be sure that you're using good practices. So if you're emailing something like an invoice or something to a patient, you definitely want to make sure you password protect that PDF, even if you're sending it through your secure Gmail, just because you don't know, I mean, it's the internet, so you don't know what could happen.
Jill: What if you accidentally send it to the wrong person, or what if someone opens their email, and you don't want them seeing that privileged information, that protected health information. So just make sure that you password protect that before you send it, and that usually is good enough.
Kadie: Okay, that is super helpful. Thank you for that resource. So back to private practice and your clients, what population do you primarily serve, and how have you advertised to those clients?
Jill: So I primarily serve pediatrics, so anywhere from 3 through 5th or 6th grade. Most of my clients are either homeschooled, so they wouldn't want to have to drive to a school or somewhere to receive speech services, or they're in daycare, and they're not in school yet, so they would want to receive services there. So those are kind of the clients that I see.
Kadie: And over the last, oh, you said it's been since 2015. How have you done advertising to those groups?
Jill: So I have a story in my course that I talk about in the budgeting section. When I first started, I heard, I knew about Google, and I knew you had to be on Google for people to find you, so I just kind of jumped into Google AdWords, which is their marketing advertising side, where you kind of pay them to appear in certain searches or whatever. And I did it without any guidance, and I ended up spending like $1,000 on that, and I didn't get one call from that, which is huge. Like, I didn't have $1,000 to spend.
Jill: I don't know anyone who does have $1,000 to spend on marketing, because in general, you want your marketing to be less than 10% of your budget, maybe 20% when you're first starting, and my budget was not enough to allow $1,000 to be spent. So I did use Google AdWords. Obviously, that did not work well.
Jill: I do talks at our local library, and I had written a blog post about how to do that, like marketing talks at libraries, where I go and answer questions from parents about development and milestones and that sort of thing. I do referrals with local pediatricians, and I have left my marketing materials at the libraries, and I get a lot of people calling about that. I've made good connections with local librarians at all different libraries around my area, so they're able to say, oh, if they're just chatting, and they can send someone your way, which is really nice.
Jill: And I also talk to other SLPs in my area who maybe don't accept the same insurance that I do. So if I have someone call who has the insurances that I accept, they can refer them to me, and I've done the same for them if they accept different insurances. So I'll refer on someone whose insurance I don't accept.
Kadie: Absolutely. It sounds like making connections locally has been a lot more beneficial than dropping money into Google AdWords, which I did a little bit of that myself, and it was a huge waste as well. So what insurances do you accept, and have you found certain insurances to be more beneficial to work with than others?
Jill: Definitely. And I know it varies not even by state, but even by area of the state, because there's so many different insurance plans and what they require. I initially had become a Medicaid provider, and in Pennsylvania, which is different than in some states, Medicaid is called medical assistance, and the patient can choose one of five different companies, insurance companies, as their Medicaid provider.
Kadie: Oh.
Jill: Yes. That's what everyone's like, oh, really? Because that's not normal, but it is for Pennsylvania. And then you have to be in network with that actual insurance provider, which is really frustrating, because you would have to be in network with all five of them, depending on which insurance the patient accepted.
Jill: But also in Pennsylvania, the rate for the reimbursement rate for the code that we usually use, 92507, so just individual therapy, is $22.70, and that's it. And as you know, 92507 is untimed, so it doesn't matter if you see the client for a half an hour or two hours or whatever, that's what you're getting paid. And unfortunately, I mean, I'm a mobile therapist. I go to my clients' homes, I go to their daycares. That's not sustainable for me. I can't spend an hour round-trip driving and half an hour in therapy and that be sustainable.
Kadie: Oh, no.
Jill: So, like I said, I initially did accept Medicaid because I felt bad and I wanted to be able to provide a service, but it's not sustainable, and I had to make the decision to no longer accept Medicaid.
Kadie: Which is sad for those clients, but also, you can't be losing money.
Jill: Right. So, like I said, I wanted to help these clients. I wanted to give them that option, but it really, it's not sustainable and you can't burn yourself out trying to help people and then not be able to help anyone because your business went under because it wasn't financially viable.
Kadie: Right. Right. I don't know if our listeners all know this, but Medicaid patients, you're not, as a provider, you're not allowed to say, oh, I'm not taking Medicaid anymore, but I will give you my private pay rate. They are really supposed to use their benefits.
Jill: Yeah. And that kind of seems odd to me that they could put that requirement on them, but yeah, in a lot of the contracts, Medicaid does specify that if you're not using your Medicaid benefits, you can't pay out-of-pocket. To kind of prevent that. So yeah, that's very frustrating.
Kadie: For them. Yeah. And you.
Jill: Yeah. I mean, Medicaid is like really, really poor. But I mean, my sister has Medicaid because she has severe CP. So it's often if there's a severe disability, depending on the disability, even if the client was able to pay out-of-pocket, they wouldn't be able to, wouldn't be allowed to per the Medicaid insurance. And that's really frustrating.
Kadie: Yeah. So you no longer accept Medicaid, but how many other private insurances do you accept?
Jill: Currently, I accept two. I accept Cigna and Highmark. Highmark is Blue Cross Blue Shield here in the Pittsburgh area. And I've heard from other people that Highmark is hard to work with, but I've never had any issues with them here. So that's been really helpful. They always pay regardless of the ICD-10 code. Like I can even use developmental codes like F80.0, F80.2, and they've paid that, which has been really helpful for me. I haven't had to fight anyone on getting paid.
Kadie: It's so crazy how it's different because, yeah, you hear someone from another state saying, I can't get any developmental codes reimbursed for. And then you're saying, no big deal. So that's good for you.
Jill: Yeah. And I have been trying to get in network with UPMC, which is University of Pittsburgh Medical Center, but it's also, it's expanded into nationwide insurance provision. So it's not just in the Pittsburgh area anymore. They don't like to accept any providers who don't work for them. So I've been applying every year for the past five years and I still haven't gotten in with them, but I'm holding out hope.
Kadie: Oh my goodness. And have you always done all of the applying yourself?
Jill: Initially, I had a medical billing practice that did it for me, but it was really complicated. And I had to, I got the EOBs and then I had to fax them to them. And it was like this huge pain. So I just ended that with the medical billing company and started doing it myself through my EMR, did the Medicaid process, which took literally like a year and a half. And I try UPMC every year and stuff.
Kadie: But that's great. Now billing seems fairly smooth through your EMR system.
Jill: Yeah. It's much smoother.
Kadie: Good. And what are you using?
Jill: I use SimplePractice. And one of the freebies on my private practice SLP site is a comparison chart of a bunch of different, actually 15 different EMRs. Because another thing I noticed when I was looking for EMRs is there's no comparison chart specifically for SLPs or a chart that had more than like two or three EMRs on there. So I just organized them all. I did demos with quite a few of them and I organized them into a chart that you can look at, like which fees they have, how much it is per month, what their client portal is like, if they offer a client portal and that sort of thing.
Kadie: Yes. That's so helpful. That's really nice to have a comparison for everyone.
Jill: I tried to do that because I looked at what I wanted and then I tried to make that thing.
Kadie: Let's see. Any advice for our listeners that you can think of in starting a private practice, managing the finances, any advice you could give?
Jill: I would say definitely make your business plan, even just a simple business plan. It doesn't have to be crazy, a bunch of pages, but definitely do a little bit of research in your area about the demographics, what kind of insurances are in your area, because that'll get you really far toward figuring out what insurances to accept, whether you have the ability to offer private pay, because some areas they just, you won't be able to find the clients to sustain a private pay clinic.
Jill: So look at some of the market research in your area, even if it's just Googling like the Bureau of Labor Statistics and seeing what the demographics look like in your area.
Kadie: Yeah, that's great advice. As far as your own business plan, did you find that number, that sweet spot in clients?
Jill: I did. Yes. I had very limited time when I first started because I was already working on two other jobs. So I had to find a number that worked as far as getting my money back with the time that I spent. So yeah, I decided, these are how many clients I can feasibly take. And this is kind of what I can look at charging because of what I have to do and what the rates in the area are. And because I'm, again, since I'm mobile, you can't per ASHA and per the law, you can't charge your clients because you're mobile. You can't charge them more, but you can take that into consideration when you are setting your rates.
Kadie: Exactly. No travel fees, that is.
Jill: You can't charge them a travel fee in their rate. I know some clinics who do have a separate travel fee that they can get people to pay outside of their rate.
Kadie: Right. Right. Did you continue working your other jobs as you began and then waited until you reached a certain point to make that cutoff?
Jill: I did not only because I got pregnant and it was kind of decided for me.
Kadie: That's true.
Jill: It was difficult too, because I had a pretty difficult pregnancy with morning sickness and stuff. So I just, I couldn't take on more clients at the time. So yeah, sometimes you have plans and then things change and that happens. And that's what I love about private practice is you can kind of work around that.
Kadie: So it was a total leap of faith along with your knowledge that you already had and it worked out.
Jill: It did. And I'm hoping through my resources and my courses to help people be able to make that leap of faith with a little more padding than I had.
Kadie: Exactly. Well, I'm glad it worked out and I appreciate all of your advice. It's been super helpful. Where can our listeners find you on social media? You told us about Teachers Pay Teachers. What about any other avenues of finding you?
Jill: Sure. So I'm on Facebook and Instagram as Jill Shook SLP. So they can look for me there. And then on the web, my clinic site is Jill Shook Therapy. So if someone wanted to look up and see, get ideas as far as website design and stuff. And then my private practice kind of consulting site is privatepracticeslp.com.
Kadie: Perfect. Well, I really appreciate you joining me today. I wish you the best in all of your future endeavors and continuing your successful business.
Jill: Thank you so much, Kadie. It was great to be here.
Kadie: Thank you for joining me and listening to Clinic Chats, the speech therapist's private practice podcast. If you have a moment, please leave a five-star review for Clinic Chats to help other SLPs find our podcast. If you'd like to share your own personal journey through private practice, please email me at kadie at clinicnote.com, that's K-A-I-D-E at clinicnote.com.