In this blog post, I share my experience with the Simple Practice Electronic Health Record (EHR).

Disclaimer: If you want the discount, you MUST begin your initial free subscription by using the Referral Code Link. Start your free first month of Simple Practice here and receive a credit for your first paid month with my referral discount code. – I get the same credit you get and it changes periodically. In February of 2023, the credit was $150.

UPDATE December 2022: There have been several improvements to the Simple Practice EHR since I last updated this post in detail in early 2022. Because I closed my private practice recently, I am not writing in much detail about any of these improvements, but here are a few of the 2022 updates in the system:

• Advanced calendar features
• Client-facing Portal Mobile App
• Easier Good Faith Estimates
• Updated billing features including the much-needed partial payment option
• Improved interactive whiteboard during telehealth sessions
• Billers and schedulers can send secure messages
• “Load last note” includes a list of all previous progress notes not just the last session
• Create your own To Do list
• Updated insurance payors page

The referral discount amount changes periodically. It increased to $150 during the 2022 Year-end promotion. The discount is credited to you when your monthly paid subscription begins (after your initial free 30 days).

If you are on the fence about trading in pen and paper for an EHR, you should check out my book The 14 Concrete (but not so hard!) Steps to Private Practice: Plus, Six More Steps to Consider – A Guide for Licensed Clinical Social Workers and Licensed Marriage Family Therapists. Step Thirteen – Choose Your Charting Method EHR vs Paper is a comprehensive discussion about the pros and cons. It also suggests links to additional resources to help you decide what’s best for you.

I’ve been using Simple Practice EHR for documentation and billing since October 2019 (psychotherapy and consulting). Although I closed my psychotherapy practice in the fall of 2022, I continue to use it for my consulting business.

I’ve found my way through some of the non-intuitive processes, which can be annoying at times, but overall I still appreciate what this platform has to offer.

In order to fully benefit from any EHR, I always recommend watching all of the training videos and taking all of the classes offered. Here’s a link to the Simple Practice list of classes: https://support.simplepractice.com/hc/en-us/articles/360058349331

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I highly recommend using an EHR over paper charts. Why stress out over not being caught up with notes or the quality of your notes when you can get it done more efficiently for less than (or equal to) the cost of one client session per month?

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With integrated billing and doing it myself, my expense for billing went from 9% of paid claims to .25cents per claim submitted using Simple Practice (billing fees may have changed so you’ll need to compare based on current claim fees).

To give some perspective, here’s some math:

• 25 sessions x $90 paid per claim: expense to a billing agency at 9% = $202.50
• 25 sessions x .25¢ per claim: expense to Simple Practice = $6.25

Using an EHR is quite possibly (it is!) the best investment I’ve made in private practice.

What is your charting process? If you are using an EHR, which one are you using? Do you recommend it?

Simple Practice Review originally published October 2020 (edited 2022) Changes in 2023 have not yet been added to this post.

I highly recommend simplifying your private practice by using an EHR as soon as you can afford it. You almost can’t afford NOT to.

For the cost of perhaps one session’s reimbursement per month (depending on your fees), you can present your practice to clients professionally with an EHR Client Portal with all of its benefits including e-signature forms, signatures on treatment plans and other documents, and streamline your practice management to save significant time, money, and stress.

If you have a telehealth practice (like I do), an electronic health record (EHR) with e-signature and a truly “paperless” office is the only practical way to go. Don’t worry, you can still use paper for those clients without access or skills to access the internet and their Client Portal.

During the coronavirus pandemic, using the Simple Practice EHR with e-signature for clients to complete documents made it possible for me to quickly adapt to telehealth only. I didn’t miss a beat in terms of appointments and scheduling new clients when the shelter-in-place directives came down in California in March 2020.

My experience with Simple Practice comes from using it as a solo practitioner since the Fall 2019, so I can’t speak to its benefits or downfalls for a group practice (the cost may be the biggest factor to consider).  It served me well in the office pre-pandemic and continued to be excellent for my telehealth practice. Despite some non-intuitive workflows and idiosyncrasies that take time to figure out (and honestly are kinda annoying), I still recommend Simple Practice. 

My Other EHR Experience

Previous to Simple Practice, I used TherapyAppointment.com (TA) the Legacy system for charting and electronic claims submission integrated with Office Ally (OA). 

Switching to Simple Practice was a vast improvement over TA’s Legacy system in terms of charting, telehealth practice in general, and electronic submission to secondary insurances (which was not possible at the time I left TA.com). 

When I left TA, I had been waiting for over a year for the transition to the new TA 2.0. which would have been comparable to Simple Practice’s platform at the time. I got tired of waiting and I am so glad I made the transition to SP before the coronavirus pandemic turned everything upside down. 

Regarding Office Ally (OA). If you are looking for a billing-only option (using paper charts), check out OA. If I were to drop the use of an EHR (unlikely!), I’d go back to OA for billing. When I took over my billing to save money and serious aggravation but was still using paper charts, I used OA and I still recommend them.

I highly recommend using an EHR for time management (high on my list of priorities) and efficiency/accuracy of charting (also high on my priority list because, uuuuhhhhhmmmm, no, I do not want to give an insurance company any money back for insufficient documentation).  In addition, the ease of integrated electronic claim submission and client billing is a big time saver. Did I mention the money saved doing my own billing?  If you missed that paragraph, scroll up a bit.

Start your free first month of Simple Practice here and receive the current credit amount for your first paid month with my discount coupon code

Simple Practice Pros and Cons

This list is not exhaustive of all the pros and cons of Simple Practice. Some clinicians I know, really don’t like Simple Practice. Others love it or have decided it’s the best they can find, so far, but aren’t very enamored with it. Changing EHRs is an exercise in mental patience and takes mega time, so be sure to look at reviews of other EHRs, then decide how you want to proceed.

These are a few notes, in no particular order, from my experience. I haven’t used all of the features, and in early 2022 the plans changed, so please look carefully at the package you choose.

CLIENT PORTAL

Pros: 

• The Simple Practice Client Portal is great for getting documents electronically signed by clients, sharing .pdfs and pictures (to and from clients), secure text messaging with clients, sending invoices superbills and statements to clients, and receiving payments from clients (Stripe is integrated for online payments – the fee is comparable to Square).
• When a client shares an uploaded document with you or completes the documents you have sent to them, you get an email notification.
• Clients can “sign” their name now rather than just click the e-signature box.
• Clients can see their scheduled appointments, documents, and payments in the portal.
• There’s a client-facing app.

Cons:   

• Regarding creating the documents you send to clients for review, e-signature, and filling out, there are two distinct processes you must learn. Learning the difference between the two and which forms are under each heading takes time. It’s not 100% intuitive.
• Secure Messaging via the Client Portal can be inconvenient for the client to manage. The direct secure link is sent to the client by email when a clinician sends a message to the client. The link is time limited. If the time expires, the client has to figure out how to get into their client portal.  The system has been improved, but it is still a learning curve for the client.

SCHEDULING

Pros: 

• The schedule is relatively easy to manage and you can change the view to day, week, or month. 
• There is an option to allow clients to request appointments online via a booking widget. (I don’t use this so I can’t report on it)
• You can create multiple offices (such as for in-office visits, home visits, telehealth, etc). You assign the proper office to each individual client so the Place of Service (10, 02, 11, etc) prepopulates on the calendar (then on the claim form).
• You can change the office for each individual appointment on the calendar. So, if you usually see someone in the office (and have assigned this to their file), but you change to a telehealth appointment for that day, then you can easily change the Place of Service on the calendar just for that day.
• You can schedule Repeat appointments (multiple repeating appointments like weekly or every 2 weeks) for a set period of time.
• You can sync the calendar with your Google calendar (and possibly other calendars) but this service is now only included in the most expensive plan (the Plus Plan at $99 per month). (I don’t use this so I can’t report on it)

Cons: 

• The appointments on the calendar are not easy to identify in terms of which office the client is scheduled for (in-office vs home visit or telehealth, etc). There is a color coding line on the edge of each appointment on the schedule but it is difficult to see (this may have been improved since this review was updated). This means you need to memorize the color for each office type or open each appointment to see where the appointment is scheduled for. 
• If you assign the Simple Practice Telehealth Office (for a secure appointment-specific link to the video platform) to your client or to a specific appointment on the calendar, it automatically assigns the Place Of Service (it was originally 02 but may have changed to 10 as of January 1st, 2022) to claims. There is an icon indicating a video camera which is pretty much the only obvious office assignment.
  • Here’s the catch: The automatic Place of Service with the Simple Practice Telehealth Office can be a problem. If you assign SP’s Telehealth Office so that you can use SP’s video platform, but the client’s insurance requires a different POS for telehealth, (e.g., Medicare is different and remains 11 until at least March 2022), then you have to change the POS on each individual claim (too easily forgotten prior to submission and requires extra time/effort).

CREATING DOCUMENTS, INFORMED CONSENTS, ASSESSMENTS, TREATMENT PLANS, AND PROGRESS NOTES – this is one of the best parts of Simple Practice!

Pros: 

• There is a large library of documents, assessments, progress notes, informed consents, etc., that are customizable (with Essential Plan) and/or you can start with a clean slate and create new documents from your own existing documents.
• Looking up diagnosis codes is straightforward.
• The Treatment Plan has been updated to make it easier to use (relatively speaking), including getting a signature from the client.
• Treatment plan reminders give you a head’s up according to the schedule you preset.

Cons: 

• There are two processes to learn when it comes to creating documents (this is part of the non-intuitive flow I mentioned earlier).
• Wiley Treatment Planner is now an extra $15 per month if you chose the Essential Plan (as of the March 2022 change in plans). 😦 Big downer because integrated Wiley makes it so much easier to create a comprehensive treatment plan without having to type everything from scratch (you still have to modify). It might be worth the $15 per month, but with insurance requiring more personalized treatment plans, that extra fee will only be worth it if you personalize each plan beyond the Wiley suggestions.
• After you Sign the treatment plan it is locked. You can’t edit it without unlocking it.
• At the time of writing this review, there was no built-in process for updating the plan properly (in particular, adding progress for each intervention, objective, and goal). You have to unlock the signed plan and edit each line item, which is labor-intensive and not intuitive to figure out. UPDATE 2023: You can now notate updated progress on individual items on the treatment plan. Definitely, a big improvement though I can’t yet speak to the efficiency of the new process.

REMINDER MESSAGES (voice, text, email)

Pros: 

• Included in the monthly price (not an add-on like other EHRs). 
• You can edit the email, text, and voice messages to include practice-specific information. For example, I use Doxy.me for telehealth rather than the S.P. Telehealth platform.  I’ve included my Doxy.me waiting room link in the reminder email and text messages for telehealth appointments.
• You can type out the exact words the Voice reminder will speak.
• Appointment Confirmations are a new feature but none of my clients have become accustomed to confirming, yet.
• Using appointment reminders has reduced No Shows in my practice but they still occur on occasion. 
• You can set up individual clients to receive both a text and an email reminder.

Cons – I can’t think of anything specific.

CLAIMS PROCESSING

Pros:

• Claim processing is optional.
• Inexpensive compared to paying a billing agency.
• Once set up, it’s fast to submit.
• You get to review the actual claim before submitting it.
• Current cost choices (no more discount packages)
  • 25c per claim (first 10 are included in Essential Plan)
• ERAs (Electronic Remittance Advice) are now available for download. This was a BIG improvement.
• You can grant your biller access to deal with billing without giving access to clinical documents like progress notes and assessments.

Cons:

• The Medicare ERA (electronic remittance advice) doesn’t tell you if and where the claim was forwarded for secondary insurance processing (for comparison, Office Ally’s ERA includes all information so you can verify the secondary claim went to the right insurance company).
• Clinicians/billers have no direct access to the clearinghouse that SP uses (Eligible, Inc).
• Claims processed from Medicare don’t automatically adjust the Contractual Obligation (CO). You must do this manually for each Medicare claim (big downer). Claims processed from other insurance companies do generally automatically adjust the CO (but not the Medicare secondaries).
• If there is an amount owed by the client after a claim comes through, deductible or coinsurance for example, there is no specific notification process to the clinician.  The information is there but it’s not obvious so you have to create your own practice management process look for it.
• If a Medicare Electronic Remittance Advice (ERA) includes only claims that were assigned to the deductibles for each client (in other words a zero payment), then there is no Payment that shows up in the usual place (tabs = Billing; Insurance; Payments). You need to go through another heading to find the information then manually enter a Zero Payment and add the details for each client. This is time consuming and frustrating. There’s no logic to it from the clinician point of view.
• The process to get set up with each insurance company for processing via SP’s clearinghouse is a bit labor-intensive.  By comparison, Office Ally and TherapyAppointment.com were much easier.
• Medicare + Secondary claims:  If a client has a secondary insurance to Medicare, when the secondary ERA is processed, it is listed in SP (tabs = Billing; Insurance; Payments) as being from Medicare (you cannot correct this in the client’s account but you can correct it under the Payments list).  This is a serious issue with inaccurate information being reported to the clinician. Each payment from a secondary in this situation has to be verified elsewhere (from the paper check sent to you, the other insurance company website, your bank statement – ACH, etc.), then corrected in the Payments part of the SP system. 
• Appointment Status feature is difficult to follow, often innaccurate in terms of Paid vs Unpaid appointment dates, nor is it easy to correct.
• You have to pay extra to give your biller access.

TELEHEALTH BY SIMPLE PRACTICE

Pros:

• The telehealth platform gives you the ability to send reminder messages with secure appointment unique links to your client.  
• You can share your screen during session and the features have been updated recently.
• The format looks professional. 

Cons:

• The Essential Plan which is currently $69 (previously known as the Professional plan which was $59) now automatically includes the SP Telehealth Platform. If you use another platform like I do, you are still stuck with paying for this feature with SP.
• The Telehealth by Simple Practice client-facing app must be downloaded by your client.  Some clients don’t have this option on their device or they don’t know how to do it. 
• Some clients are not able to download the app on their devices for various reasons.  If the client is using their cell phone for video appointments and is not tech-savvy or unable to add apps to their phone for any reason, you’ll have to use another platform for online video conferencing. This is the main reason I switched back to using Doxy.me.  
• You might have some clients on a different platform because they can’t get Telehealth by Simple Practice on their device (which means you need to remember what each client is using and modify the office assignment accordingly).
• The client must click on the Appointment Unique Link to access each appointment. No using an old link anymore which increases security but can be a problem if the client can’t find the email or text reminder or is using a device without incoming email attached to it (you must remember to send the Reminder by Text if they are using a cellphone in this case).

CUSTOMER SERVICE

Pros:

• Help is obtained primarily via chat and email. 
• The Help system has tutorials and a Community Forum.
• In the Community Forum, you can ask questions and get information and answers from other SP users.
• You can also make suggestions for improvements or vote on other customer suggestions.
• Friendly Reps.
• There is now an option to request a phone call in their Help request widget.

Cons:

• If email and text chat hasn’t solved your problem, you might need/want to talk to someone. It can be difficult to get someone on the phone for customer support, but it is possible by communicating with the person you’ve been emailing and text chatting with. There is no phone number published but they will send it to you if you ask.
• Online tutorials are not always updated to new workflows Simple Practice creates.

GENERAL 

Pros:

• Couples and Minor Management recently upgraded (I haven’t used this feature).
• Billing “Ask the Biller” blog series – one example: (https://www.simplepractice.com/whats-new/insurance-payments-ask-a-biller-4/)
• Community listserv for asking questions and getting useful information from other users.
• Earn credit for referring others (thank you for using my link!).
• Appointment Status Reports are helpful for finding Medicare clients in particular whose manual write-offs you may have missed when updating Payments. CON: The report is inaccurate for other purposes unless you’ve manually done the CO (Contractual Obligations) write-offs ahead of time. 
• Daily Agenda emails sent in the early AM and Evening Summary emails from the system are helpful. The Evening Summary email lets you double check in a matter of seconds that you’ve written your notes for the day.
• They offer a website landing page for your practice much like Psychology Today. It’s called Monarch.
• They update processes and features frequently (unlike Therapyapppointment.com whose updates are announced but then drag on for years).

Cons:

• You might have to upgrade to the most expensive plan in order to add Billers, Schedulers, Supervisors, and extra clinicians. The cost can be shocking.
• Auto Pay has some significant glitches, according to complaints I’ve read. I don’t use it. I manually send invoices and statements after I’ve created and reviewed them. PRO: It only takes a minute or two per client.
• With the least expensive (Basic) plan, you cannot customize your note templates. This is a huge disappointment because this is probably the most important part of using an EHR.
• Learning the “back office” particulars such as how to process clients’ invoices and statements can be frustrating.  The setup is not ideal in terms of billing clients after insurance claims have been processed. You must create Invoices before creating the Statement.
• Invoices and Statements don’t include the insurance payment information. This is confusing for client and practitioner.  Invoices and Statements lack information that should be there and is normally included by your medical providers (insurance payments and contractual write-offs). 
• There is no documentation within the client’s chart regarding emails sent (you can find an email list in the practice Reports section but not the actual emails and doesn’t include the content of the words you typed in the notification emails you sent).
• There is no way to directly email your client within the system (e.g. “We need to change your scheduled appointment.”). The system will send only specific notification emails such as appointment reminder messages, invitations to access the client portal, notification the clinician has shared document(s), notification of an invoice or statement, and notifications of overdue invoices.  You can modify some of the email notification messages you initiate, but, again, the system doesn’t save them for you to look at later.
• To document any emails sent and received outside the system, you need to copy and paste them into a Note (non-appointment Note) in the chart.
• The system saves the secure text messaging you do with a client, but not inside their actual chart. So, you have to copy and paste them into a non-appointment chart note.
• Some of the Reports are useless because the information is inaccurate.
• Sometimes new features like Monarch appear to be higher priority and marketed heavily to clinicians when fixing problems that have been longstanding should be more important.
• Starting in early 2022, Simple Practice updated its plans. In doing so, the cost increased. Things like Monarch and the Telehealth by Simple Practice video platform are included on the plan that allows you to modify/customize your forms. You pay for them whether you use them or not. This has enraged many of us including me. I hope for a “grandfathering” in to soften the blow of increased cost (this hasn’t happened as of Dec 2022).
• Wiley Treatment Planners now cost an extra $15/month if you chose the Essential Plan.
• You can’t carve out things you don’t need in order to save money on the Essential Plan.

ON-BOARDING

Pros:

• Uploading a client’s records (in .pdf form) from another EHR system is fairly straightforward with the choice of uploading to individual client records or all client records as a whole. It’s tedious work no matter what platform you use, but it’s doable.
• There are tutorials, videos, customer service, and a community forum to help you get through the setup and learning process.
• There’s a Help chat service available during normal business hours.
• Email requests for help are answered within a business day (my experience) and include detailed instructions with screenshots.

Cons:

• The system for getting insurances set up for claim submission is clunky and time-consuming (depending on the specific insurance e.g., Medicare or Medicaid).  Before you can set up a particular insurance for electronic claim submission, you have to enter a client with that insurance.  You can’t just get set up with all panels you are on ahead of time, which could mean a delay in submitting claims and receiving payment when you do get the first client with that insurance. Office Ally and TA’s systems were much easier. A workaround could be to add all the panels you are on to the fake client(s) in the system. That way when you get a real client with that insurance, you will have gone through the clearinghouse connection process and be ready to submit immediately after seeing your real client.
• The tutorials for setting up your office need some updating.
• Initial setup is not as intuitive or as guided as it could be but there is support.
• No customer service phone number advertised. Waiting for email or chat help to get set up might be frustrating, but you can now ask to speak to someone in the Chatbox or request a phone call.

MOBILE APP for General Purposes (for the clinician only) Keep an eye out for a Client Facing App to show up

Pros:

• For in-person visits, you can securely take a photo, upload, and store your client’s insurance card directly from the SimplePractice mobile app (for the clinician only). There’s no need for a separate scanner, HIPAA-compliant software, or computer.
• You can perform many everyday practice tasks from the clinician mobile app (scheduling, charting, secure messaging).

Cons:

You can’t deal with back office things like certain billing things via the clinician app.

BOTTOM LINE

If you are not already familiar with billing practices, Simple Practice might be somewhat confusing until you learn the idiosyncrasies of their system in relation to the billing process. If you are naive about billing, it’s best to start out with someone with experience doing your claims and billing until you learn the ins and outs.

It has been totally worth the sometimes frustrating learning curve to switch over to Simple Practice for all that it offers for a price comparable to other EHRs. 

Simple Practice far exceeds TherapyAppointment.com’s Legacy system in terms of options and basic operations.  TherapyAppointment’s 2.0 system looks comparable to Simple Practice, but TA’s website still has a lot of old information related to their Legacy system, so it’s not clear where they are at with the rollout of their new system.

TherapyNotes is also highly rated by clinicians but you will need to investigate this closely to compare costs and options.

Office Ally’s EHR 24/7 is another option to look at. I haven’t used it though, so, like TherapyNotes, I can’t comment on specifics.

Click here to go to the Simple Practice website to see their current plans.

Featured Image by Luis Ricardo Rivera from Pixabay Modified.

If you are struggling with your private practice, check out my book on Amazon.