Study guide

This guide condenses the lessons on this site into one reference: the operational, legal, financial, and clinical requirements for opening and running a private therapy practice in Oregon. It follows the five modules and is meant for review after you have read them. Each section links back to the lessons it summarizes.

Module 1: Business operations and financial structure

1.1 Forming an Oregon LLC in six steps

A single-member limited liability company separates your business debts from your personal assets and gives the practice a formal legal shape. It does not protect you from your own malpractice.

Step	What you do	Details and requirements
1. Name and structure	Pick the entity, check the name	Search name availability for free on the Oregon Secretary of State site. Choose between an LLC and a professional corporation (PC).
2. Registered agent	Appoint an agent	The agent needs a physical street address in Oregon; a P.O. box is not accepted. You can serve as your own agent for free, or hire a commercial service to keep your home address off the public record.
3. Articles of Organization	File online	File through the Oregon Business Registry. The filing fee is $100, and approval usually lands the same or the next business day.
4. Tax IDs	Federal EIN, then the state BIN later	Get an Employer Identification Number free at irs.gov (the online tool keeps limited hours). Hold off on an Oregon Business Identification Number (BIN) until you are ready to hire a W-2 employee.
5. Operations	Internal papers and banking	Write an operating agreement and keep it in your files; it is not filed with the state. Open a business checking account with the EIN and the approved Articles so the liability wall holds. Register with your city or county where required, and watch the FinCEN beneficial ownership reporting rules.
6. Renewal	Annual report	File the annual report on the anniversary of formation with the $100 renewal fee. Letting it lapse leads to administrative dissolution and loss of the liability shield.

1.2 Tax structure and the S corporation election

Default taxation. The IRS treats a single-member LLC as a disregarded entity. Income and expenses go on Schedule C of your personal Form 1040, and the profit carries self-employment tax of 15.3 percent on top of income tax.
S corp election (Form 2553). Under S corporation status you become an employee of your own company and draw a reasonable W-2 salary. Profit beyond that salary comes out as distributions, which are not subject to self-employment tax.
C corporation. Rarely the right fit for a solo behavioral health practice, because profit is taxed at the corporate level and again when paid out as dividends.
Qualified business income deduction. Pass-through owners may deduct up to 20 percent of qualified business income under Section 199A, but health services are a specified trade, so the deduction phases out above the income thresholds.
Oregon considerations. The Corporate Activity Tax (CAT) applies once commercial receipts pass the statutory threshold. The pass-through entity elective tax (PTE-E) lets the entity pay state tax at the entity level, easing the federal cap on state and local tax deductions.
Estimated payments. Solo practitioners pay quarterly estimated taxes to both the IRS and the Oregon Department of Revenue to avoid underpayment penalties.

1.3 Bookkeeping and retirement planning

Bookkeeping foundations

Keep business and personal money apart in a single dedicated business checking account.
Use cash accounting: revenue counts when it arrives, expenses when they are paid.
Run a 30-minute monthly close to reconcile accounts and read the profit and loss.
Know your local registrations, such as the Portland and Multnomah County business taxes where they apply.

Retirement and wealth building

SEP IRA. Contributions run up to a set percentage of net self-employment earnings, with high deduction limits and the freedom to change the amount each year.
Solo 401(k). You contribute as the employee (elective deferral) and as the employer (profit sharing), which reaches a higher cap at lower income than a SEP IRA.
Variable revenue. Keep a cash cushion in the business account to smooth seasonal drop-offs and take the pressure off your caseload.

1.4 Hiring, payroll, and employment taxes

W-2 employee or 1099 contractor. Classification turns on behavioral control, financial control, and the nature of the relationship. Calling an employee a contractor brings tax and labor penalties.
Before the first paycheck. Get the Oregon BIN, collect federal Form W-4, Oregon Form OR-W-4, and Form I-9, and set up direct deposit.
Federal cycle. Form 941 each quarter (income tax, Social Security, and Medicare withheld) and Form 940 each year (federal unemployment tax).
Oregon cycle. The combined Form OQ each quarter covers state withholding, unemployment insurance, the Lane and TriMet transit taxes where they apply, and Paid Leave Oregon contributions.

Module 2: Marketing and client acquisition

2.1 Search and answer engines

Google Business Profile and local search

Set up and verify a Google Business Profile tied to a physical practice location so you appear in the local map results.
Build service pages for specific local searches, such as anxiety therapy in Eugene.
Licensing boards restrict soliciting client reviews and testimonials. Visibility has to come from the site's own authority and directory links, not review campaigns.

AI answers and modern search

Google's AI Overviews and AI Mode favor high-authority expert health content.
An llms.txt file or FAQ schema on its own no longer moves visibility.
Health content sits in Google's "Your Money or Your Life" category, so it is held to a higher standard of experience, expertise, authoritativeness, and trustworthiness (E-E-A-T).

2.2 The practice website

A compliant therapy website needs six core pages:

Home: clear focus, location, and core modalities.
About: licensure, credentials, and approach.
Services or specialties: a page for each issue you treat, such as trauma, anxiety, or EMDR.
Fees and insurance: rates, accepted plans, and Good Faith Estimate information.
Contact: a secure way to reach you.
Privacy policy and terms: HIPAA disclosure and an accessibility statement.

Privacy and compliance on the site

Accessibility. Sufficient color contrast, screen-reader navigation, and alt text on images.
Contact forms. Do not collect protected health information or clinical detail through an ordinary web form. Keep the fields to basic contact details.
Tracking pixels. Under HHS guidance and federal court rulings, pixels such as the Meta Pixel or analytics tags that send visitor data from a page connected to PHI, without consent or a business associate agreement, violate HIPAA.

2.3 Directories and referral networks

This directory. Provider profiles carry most of the organic search traffic on this site, so a complete, verified profile is a steady referral source.
Oregon Health Plan networks. OHP routes Medicaid mental health care through 15 coordinated care organizations (CCOs), each covering a region. Credentialing with your regional CCO opens a large referral stream.
Peer networks. Local practitioner groups, consultation circles, and county mental health referral lists.

2.4 Paid advertising: Google Ads and LegitScript

Account structure. Separate search campaigns for high-intent queries (therapist near me) from specialty campaigns, and keep Google Consent Mode in place.
Who needs LegitScript. Advertisers bidding on drug and alcohol addiction treatment terms, prescription medication terms, pharmacies, and certain addiction telemedicine platforms.
Who does not. General outpatient mental health practices, solo counselors, and private practices offering ordinary therapy are exempt when running standard Google Ads.
The healthcare certification prompt. A solo therapy practice that receives an automated prompt to complete healthcare seller certification can leave it alone while the campaign stays within standard mental health terms.

2.5 Social media and board ethics

Meta ads policy (Facebook and Instagram)

Meta rejects ad copy that implies personal attributes, health conditions, or personal flaws, such as asking whether the reader is struggling with severe depression.
Meta's health data restrictions rule out sensitive health targeting.

Ethical practice on social platforms

Profile. Use a professional business account linked to a practice page, with a bio that states your license title, jurisdiction, and scope of practice.
Content. Never share clinical stories, client details, or identifiable scenarios, even anonymized.
Testimonials and comments. Board rules prohibit soliciting testimonials from current or former clients. Turn off or closely moderate public comments so clients cannot disclose PHI on your posts.

Module 3: Insurance credentialing and billing

3.1 Terms and the paperwork sequence

The words are used loosely in conversation and precisely by payers. In order:

Credentialing: the insurer verifies your license, education, malpractice history, and training.
Enrollment: the insurer enters you in its system under your NPI and tax ID.
Contracting: you sign the agreement that sets the fee schedule and terms.
Paneled, or in-network: the contract is executed and you can see covered members and be paid directly. Being credentialed on its own does not mean you will be paid.

The Oregon paperwork sequence

NPI and taxonomy code. A Type 1 (individual) NPI from NPPES, plus a Type 2 (organization) NPI if you bill under the LLC, with the correct provider taxonomy code.
CAQH profile. Complete and attest a full profile, and keep malpractice details, CV, and licenses current.
Oregon Practitioner Credentialing Application. The standard application Oregon payers accept.
Medicare PECOS. LPCs and LMFTs enroll through PECOS to bill Medicare, or formally opt out.

3.2 Oregon payers and coordinated care organizations

Commercial payers. Regence BlueCross BlueShield of Oregon, Moda Health, PacificSource, Providence Health Plan, Kaiser Permanente, Aetna, and UnitedHealthcare. Confirm each payer's current application path and whether it reads from CAQH.
Oregon Health Plan. Fee-for-service (open card) enrollment goes through the Oregon Health Authority. The 15 regional CCOs contract individually, for example Health Share of Oregon, Jackson Care Connect, and PacificSource Community Solutions, by county service area.
Medicare. Noridian is the Medicare administrative contractor for Oregon.

3.3 Billing: CPT codes, superbills, and the legal rules

Standard outpatient CPT codes

90791: psychiatric diagnostic evaluation, the intake, usually 60 to 90 minutes.
90834: psychotherapy, 45 minutes (38 to 52 minutes with the client).
90837: psychotherapy, 60 minutes (53 minutes or more).
90847: family or couples psychotherapy with the client present, 50 minutes.

Telehealth place of service codes

POS 02: telehealth provided somewhere other than the client's home.
POS 10: telehealth provided in the client's home.
POS 11: in the office.

Superbills and out-of-network billing

A superbill is the itemized receipt a self-pay client submits for out-of-network reimbursement. It needs:

Your name, practice address, license number, NPI, and tax ID (EIN).
The client's name, date of birth, and date of service.
The ICD-10 diagnosis code and the CPT procedure code, with modifiers where they apply.
The place of service code and the fee charged and paid.

Legal billing compliance

No Surprises Act and Good Faith Estimates. Federal law requires a written estimate of expected costs for uninsured, self-pay, and out-of-network clients before services begin, or within the statutory window after scheduling.
Oregon balance billing protections. In-network providers cannot bill clients beyond the contracted copay, coinsurance, and deductible, and out-of-network balance billing is tightly regulated.

Module 4: Clinical documentation and practice setup

4.1 Setting up the electronic health record

Setting up a secure EHR such as SimplePractice runs in this order:

Enter practice details, NPI, tax ID, and each office location, physical or virtual.
Upload your logo and document headers.
Set up client billing profiles and card processing, for example through Stripe.
Configure the client portal for secure intake delivery.
Upload the professional disclosure statement and consent forms.
Upload the informed consent for telehealth.
Configure the HIPAA notice of privacy practices.
Import or customize progress note templates (SOAP, DAP, or BIRP).
Set up treatment plan templates.
Set fee structures and default CPT codes.
Turn on appointment reminders by text and email.
Set up the telehealth video integration.
Sign the business associate agreement with the EHR vendor.
Configure secure messaging.
Set calendar availability and sync rules.
Run a test intake and a test claim to confirm the clearinghouse connection.

4.2 Progress note formats and board requirements

Common frameworks

SOAP: Subjective (what the client says), Objective (what you observe, mental status), Assessment (clinical impression and progress), Plan (next steps).
DAP: Data (subjective and objective together), Assessment, Plan.
BIRP: Behavior (presentation), Intervention (what you did), Response (how the client responded), Plan.

What the Oregon boards expect in the record

The Board of Licensed Professional Counselors and Therapists, the Board of Licensed Social Workers, and the Board of Psychology each require:

Clinical justification for every billing code used.
Documented risk assessments: suicidality, lethality, and safety plans.
A current, measurable treatment plan, updated on a regular schedule.
A current professional disclosure statement given to every client at intake, now that the boards no longer review statements in advance.

4.3 Solo practice onboarding checklist

To open without missing a compliance step, work in this order:

Confirm an active Oregon license and a clean board record.
Get the NPI (Type 1 for you, Type 2 if the entity needs one).
Secure malpractice coverage for yourself and for the entity.
Finish the business entity: LLC, EIN, and business bank account.
Draft the practice documents: professional disclosure statement, informed consent, telehealth consent.
Set up the HIPAA-compliant EHR and sign the business associate agreement.
Put the Good Faith Estimate workflow in place.
Finish the secure office, physical or virtual.

Module 5: Telehealth and regulatory compliance

5.1 Telehealth rules across jurisdictions

Where therapy happens. A session takes place where the client is physically sitting at the time. You must hold a license in that state or country.
Oregon and the compacts. Oregon is not a member of the Counseling Compact or PSYPACT. An Oregon license does not carry across state lines without full licensure or a formal temporary practice exemption in the client's jurisdiction.
Working from abroad. Treating clients located in Oregon while you are out of state or out of the country needs deliberate risk management: keep the Oregon license current because the client is in Oregon; check the legal and tax rules of the place you are working from; set an emergency protocol for every session (local dispatch number, emergency contact, and crisis team for the client's location); confirm the malpractice policy covers services delivered from outside the United States; and know that OHP rules restrict care delivered from outside the country.
Oregon rules. OAR 833-100-0011 adopts the ACA Code of Ethics standards on distance counseling, technology, and social media. OHP telemedicine rules require synchronous audio and video on a platform that meets the security baseline, the right place of service and modifier, and documented telehealth consent.

5.2 HIPAA and record retention

The HIPAA framework

Who it covers. Any covered entity that transmits health information electronically in connection with a standard transaction, such as a claim.
Privacy Rule. Governs use and disclosure of protected health information and gives clients rights over their records.
Security Rule. Requires administrative, physical, and technical safeguards for electronic PHI, including a written risk analysis.
Business associate agreements. Written contracts with every vendor that handles PHI: the EHR, secure email, the virtual phone service, cloud backup.
Breach Notification Rule. Sets the deadlines for notifying affected people, HHS, and in larger breaches the media, after unsecured PHI is exposed.

The federal clock and the Oregon clock

Who sets it	Rule	Retention
Federal (HIPAA)	Administrative safeguards	Six years for HIPAA paperwork: signed privacy notices, business associate agreements, risk analyses, and policies.
Oregon boards	Oregon Administrative Rules	Seven years for clinical records: progress notes, treatment plans, and charts. For minors, seven years or until three years after the client turns 18, whichever is longer.

To satisfy both, keep clinical records for at least seven years and HIPAA administrative records for at least six.