NWPR Clinician HandbookV13.0 – Apr 2026
This document serves as a handbook for clinicians contracting with NWPR, addressing various policies,
procedures, and expectations that may not be explicitly outlined in your Service and/or Office Space
Agreement. These policies are dynamic and subject to change over time. Updates to this document will be
provided via email and can also be found on the nwpsych.com website and in a binder located in the
administration area of NWPR.
1. Details of Your Overhead Costs
Under the Practice Builder option, your monthly overhead fees paid to NWPR are 40% of the revenue you
generate in your first 30 days of practice. For months 2-6, it becomes the greater of $500 or 40% of
revenue generated. If you are located in a compact suite, your percentage will be 30% rather than 40% in
consideration for the reduced office space.
This contract lasts up to 6 months, or until you decide it is in your best interest to convert to a different contract,
typically a Standard Associate Contract. You have up until the 15th of the month to formally request a change to a
standard associate contract retroactive to the beginning of the prior revenue reporting period. Requests made after
the 15th of the month will become effective at the beginning of the next revenue reporting period. It is expected you
will convert to a standard associate contract no later than the expiration of the 6-month contract term, regardless of
your revenue at that time. Extensions of the Practice Builder contract are discouraged, but may be granted at
NWPR's discretion.
For Standard Associates, your monthly overhead fees paid to NWPR vary based on the number of associates
paying equally for monthly clinic expenses once other revenue sources have been calculated. The Clinic Manager
can provide the overhead history.
For all other contracts, such as Part-Time, Off-Site, Limited Practice, Suite A, and traineeships, please refer to your
own contract for specific details on your overhead costs and shared expenses. A list of currently available contract
options is available upon request. The following details apply to all contracts:
A.The clinic manager will calculate your overhead fee, which will be automatically deducted from
your revenue collected during the monthly reporting period.
B.If insufficient revenue is collected to meet your overhead demands, you will pay the balance to
NWPR within 7 days. In some cases, we may agree to give you a draw on funds arriving just after
the first of the month to pay off your overhead debt.
C.The revenue reporting period is typically from the 24th of one month to the 23rd of the next. Closing the books
on the 23rd allows for income accounting, and checks are issued on or before the 1st of the next month.
D.Clinicians using in-house, fee-for-scoring test materials (e.g., MMPI, MCMI) will have the cost of scoring any
such tests used that month deducted from their revenue. Please review the current fees for these tests with the
office staff, if applicable. Track these charges as business expenses for your personal tax accounting.
Page 2 – v13
E. Collecting co-pays, submitting insurance authorization forms in a timely and accurate manner, and promptly submitting day sheets are expected and will greatly improve your revenue flow. This is discussed further below.
2. Business Operating Expenses
Some costs extend beyond those covered by your overhead agreement. These include amenities you choose and
those necessary to operate your practice, and include a clinical ZOOM license and any add-ons to Therapy Notes,
such as Therapy Fuel AI. Unless you are providing your own NWPR-approved schedule software, your scheduling software license is a necessary monthly fee, as is your annual billing software license. These fees are separated from standard overhead to allow departing clinicians to continue utilizing these necessary services for revenue processing. Shared expenses are reviewed, discussed, and voted on in staff meetings. Except for unpaid trainees whose revenue contributes to overall clinic expenses, all clinicians using these services—regardless of contract type—share equally in these costs. These are typically deducted from your monthly revenue. Track these as business expenses on your taxes. When you leave NWPR, you will remain responsible for paying any remaining shared expenses until the end of what would have been your initial contract.
3. Your Responsibilities
A. Before beginning practice, obtain professional liability insurance consistent with the requirements outlined in
your contract.
B.You are expected to keep track of all continuing education hours needing to be reported to the licensing board, including hours in mandated subject areas.
C. Renew your professional license and liability insurance policies well in advance of their expirations
and due dates. Lapses in either will immediately halt your clinical activities, and you will still be subject to overhead obligations. Provide copies of your license and insurance face sheet to the Clinic Manager.
D. Once fully licensed and establishing your practice, you are expected to obtain business licenses as
a self-employed individual with the City of Longview and the State of Washington, and pay all required quarterly
business and occupation taxes associated with your individual business.
E. You are expected to independently track your income, tax-related expenses, and submit quarterly
estimated federal tax payments to the IRS via Form 1040-ES. Shortly after the first of the year, you will receive a
1099-NEC (Nonemployee Compensation) statement from NWPR listing all annual revenue recorded by NWPR for inclusion in your federal tax return. Consult with an accountant, an NWPR Partner, and/or the Clinic Manager for guidance as needed.
F. We encourage you to purchase a business owner’s insurance policy covering accidents occurring within your personal suite (e.g., slip and fall). NWPR maintains such insurance for common areas only. If the building burns
down, your individual office furnishings are not covered by the NWPR policy. NWPR does not regulate how your
office is set up or the risks this may present (trip hazards, cords, rugs, etc.); thus, the NWPR policy does not extend to what occurs in your personal leased office space. Some agencies with whom we contract (e.g., Social Security Administration, DSHS)
Page 3 – v13
require proof of such insurance. These are standard and relatively inexpensive policies that most
insurance brokers can set up for you. We can offer a referral, as requested.
G. Your office will be clean and empty when you assume it. If repainting is necessary or desired, NWPR will
provide the required supplies with the approved wall color (Navajo White), and labor will generally be
negotiated between you and available NWPR staff to reduce costs. You may retain a professional painting contractor at your expense. As a licensed, independent clinician starting your business, you are expected to
furnish your office with items that suit your tastes and needs. This should be accomplished before seeing
your first client. Such items and services include:
a. Desk
b. Seating for yourself and your clients
c. File storage within your office (e.g., built into desk or freestanding cabinet)
d. Floor and/or desk lighting, including bulbs for these furnishings
e. Book shelving
f. Decor for walls and desk
g. Personal computer and monitor
h. Personal printer and ink. Note: Printing to the NWPR administrative copier/printer is by
permission and limited to very specific uses, and—due to high expense —color printing for
personal purposes is prohibited on this device.
i. Extension cords/power strips
j. Business cards 1
k. Professional personal letterhead. NWPR letterhead is only for official NWPR use.
l. Desk supplies such as staplers, etc.
m. Specialized tests, testing equipment, record forms, and scoring software
n. Therapy equipment and materials (i.e., games, sand trays, client workbooks, etc.)
o. Transcription, psychometric, or personal clerical services
p. Personal accounting and tax preparation services
q. Wi-Fi access point, if needed (internal network and Internet access are provided)
r. This building was constructed with maximum soundproofing available at the time. Loud clients or
telehealth speakers set at high volumes can sometimes be perceived through office doors. Additional
white-noise generators are not typically required but can be employed if desired. Such devices must be unobtrusive, pose no trip hazard, and be set at a minimally effective volume to avoid excessive noise
or distraction in common areas or irritation to those around you. Approved examples are available.
s. Fans or floor heaters for your own space
t. IT services to manage and repair your personal software and computer equipment 2
H. Refrain from printing “Northwest Psychological Resources,” “NWPR,” or any indication of your
affiliation with NWPR on personal marketing items, business cards, or letterhead. This is for two reasons:
a. NWPR is the name of the private company contracted to support your practice. NWPR is neither a
group practice nor the name of your individual practice, and it does not provide services to the public.
NWPR provides services to you, not to your clients.
1 Samples can be provided. We usually use VistaPrint, online. 2 NWPR contracts with an outside firm to service hardware and
software used for clinic operations, but not that owned by individual clinicians.
Page 4 – v13
b. As a consortium of independent practitioners, we do all we can to reduce the perception that this
is a group, clinic, or agency, and firewall ourselves from ethical and legal liability regarding the
actions of other clinicians. Promoting yourself as a member or affiliate of NWPR muddies the strictly independent nature of your practice and increases your liability risk to the behavior of others, as
well as their behavior to yours.
I. Some insurance companies and community agencies will require prior authorization to pursue
certain services or require you to request re-authorization for ongoing services at specific intervals
during a course of care. It is frustrating to learn that coverage was denied for lack of authorization,
and there is often no recourse to recoup this revenue. Both new and seasoned clinicians have been
impacted by this. NWPR will try to identify and flag such insurance requirements within the intake
information provided to you. Occasionally, this information is missing, and staff may be provided with
incorrect or incomplete information when checking benefits. Ultimately, it is your responsibility to watch
for pre- and re-authorization requirements, develop a system for tracking and reminders that works for
you, and submit the appropriate forms to obtain them before proceeding. Do not rely on NWPR staff to
track authorization requirements, session counts, date ranges, or to remind you of these. Develop a
personal system to track these issues.
J. Beyond what may already be provided within our electronic health information and scheduling
system at the time, you will need to obtain your own resources for securely sending and receiving
Protected Health Information (PHI). This method should meet HIPAA security requirements. As an
independent contractor, NWPR does not dictate what system or product you use. NWPR only requires
that any PHI you may share with consumers, staff, agencies, or other clinicians be done in a
HIPAA-compliant fashion.
K. Note that it is unethical to retrospectively reverse write-offs or discount previously provided in an
attempt to erase a client's credit balance rather than refund them. Services charged to your clients
must be completely and successfully recorded for NWPR to bill out as soon as possible, preferably
within 24 hours of service provision. This is typically performed either by submitting a day sheet or
authorizing billing by verifying completed services and fees within the NWPR scheduling system.
Timely filing for most insurance plans is between 60 and 90 days. At your direction and only for the
purposes of correcting billing or coding inaccuracies to better represent actual services, fees, or
intended adjustments, NWPR may add, delete, adjust, and reprocess service codes, times, fees, and
write-offs up to 45 days from the date of service. This makes it very important to establish your write-off
or discount policy with your clients as part of your informed consent process, and to accurately record
your services and intended write-offs at the time of service in ways consistent with this policy. Exceptions
may be made on a rational, case-by-case basis, at the discretion of the Office Manager. You are
responsible for the integrity and accuracy of your recorded services and associated fees, which NWPR
will, in good faith, record and bill on your behalf. At no time will NWPR knowingly engage in billing or coding practices that are considered fraudulent or unethical.
4. What NWPR Provides for You
A. Office equipment and supplies provided for use in your business through NWPR include:
a. VOIP telephone with voicemail
b. Internal network and Internet access via Ethernet cable connected to your desk PC
c. Basic office supplies, including pencils, pens, paper clips, and file folders.
Page 5 – v13
d. Copy paper used in the central administration office
e. Envelopes and postage for business use3
f. Copy and fax machine for business use, black and white images only
g. Clipboards for client use
h. Paper cutter
i. Credit card processor
j. Laminating machine (Please buy your own supply of pouches)
k. One 4-drawer, locking file cabinet placed in a hallway near your suite for file storage4
l. Light bulbs for built-in wall sconces
m. Use of certain psychological test instruments and scoring assistance.5
B. If you are borrowing office furnishings from NWPR, these furnishings must either be returned or
purchased from NWPR at the cost of replacement at the expiration of your contract.
5. Work in Other Settings, High-Volume Practices, and Personal Assistants
As an independent contractor, you enjoy the flexibility to provide professional services wherever you wish.
Any services billed through NWPR must be delivered on-site or under an off-site service agreement. Full
and on-site associates may use their suite for personal or other business activities as long as these
activities do not place any burden on NWPR clinic resources. If you intend to offer professional services at
an alternative practice location outside the administrative scope of NWPR, you must manage these
services independently. It is inappropriate and likely fraudulent to see clients in different settings and bill
insurance companies as if the services were provided at NWPR. Under your user license, you may utilize
the scheduling system to notate and document these activities. However, it is incumbent on you to: 1)
work with staff so they know how to interpret these services in your schedule and to disregard them as
non-NWPR related, and 2) educate your consumers to work with and pay you directly, rather than NWPR.
NWPR is generally designed to support clinicians who provide hourly-based clinical services. Clinicians
may operate practices that allow them to see and bill multiple clients/patients within a one-hour period,
thus significantly increasing the volume of accounts, billings, mailings, and accounts receivable
requirements compared to other clinicians. For example, a prescriber might see 2 to 3 patients in a single
hour for medication checks. NWPR does not restrict your practice volume; however, if this becomes a
regular aspect of your practice, NWPR may negotiate additional overhead assessments to accommodate
staffing and materials requirements and ensure your practice is managed efficiently and effectively.
You may hire non-NWPR personnel to support your practice. This might be advisable if you have a unique
or high-volume practice that existing NWPR resources cannot adequately support. Any decision to hire a
personal assistant, employee, contractor, or to grant non-NWPR personnel access to your scheduling or
clinical documentation system must first be approved by the Clinic Manager in consultation with the
Executive Team. This process is not intended to restrict your practice but to help evaluate how this could
impact NWPR operations, determine ways to coordinate with outside individuals or entities when needed,
and allow you to consider any unforeseen benefits and potential liabilities before moving forward. If your
decision to contract with outside individuals or entities results in liabilities to office operations, appears
3 You are welcome to place outgoing personal mail in the mail basket for pickup, and receive personal mail and packages
at the NWPR address. The NWPR metered postage machine is for business use, directly related to your professional practice.
Give such mail to staff, who will stamp and mail it for you.
4 You must keep this cabinet locked at all times per HIPAA requirements. You may obtain a second file cabinet at your own expense
only if space allows and at the discretion of the Clinic Manager. This cabinet must be in new or good condition and match the
adjacent cabinets in color and size.
5 Seek information regarding availability and policies regarding psychological tests and scoring services at NWPR.
Page 6 – v13
unprofessional, fails to protect health information, or presents any potential or actual ethical violations as
determined by the Executive Team, it will be brought to your attention for correction. If left uncorrected to
the Executive Team’s satisfaction, this may result in grounds for contract termination.
6. Client Canceling and Rescheduling
If you become ill and need to cancel your clients for that day, please call and leave a message for the
administration staff so they are aware to intercept arriving clients. In almost all cases, you are expected to
personally call your clients to notify them and reschedule, as having staff do this creates significant
disruption in the office workflow. In the event of a minor illness, weather-related schedule changes,
decisions to take time off, electing not to see a client already scheduled, or if you desire to reschedule
clients to another time, you will be responsible for accessing the scheduling system and personally calling
your clients. If you are faced with an emergency, are too ill to reasonably complete this on your own, or do
not have ready access to the scheduling system, staff will do their best to contact, cancel, and reschedule
clients as a courtesy and as time allows.
7. Leaves of Absence, Disability, or Death
If you become ill, disabled, or incapacitated during the term of this contract and expect not to return to
practice within 90 days, we strongly encourage you or your personal designee to submit a notice of
termination as soon as possible. Your contract will remain in effect until such written notice is received.
Notice of intent to terminate your contract will be automatically accepted in the event of your disability,
incapacitation, or death. In such cases, management of your residual revenue, office furnishings, and
clinical and financial records will be directed by your next of kin and/or those you have designated in your
professional will. When seeking parental leave, it remains at the clinician's discretion whether to
terminate or maintain their contract. If you expect to resume practice within 90 days, we recommend
maintaining your contract to avoid disruption, displacement of furnishings, secure your office space, and
allow a seamless return to practice.
8. Sharing Office Space
Clinicians are not permitted to sublet their NWPR office space. Subject to NWPR Executive Team
approval, licensed and full associates leasing a suite from NWPR may share their suite with another
clinician. Both clinicians sharing the office must be vetted and approved by the Executive Team and sign
separate agreements with NWPR. While the office schedule is negotiated between the sharing clinicians,
NWPR will consider the space equally shared, representing 2.5 days of occupancy per clinician each
workweek. Although the physical space costs remain the same regardless of how many clinicians use it,
the administrative support requirements for two clinicians greatly exceed those for a single occupant.
Each sharing clinician will be charged a percentage of the Variable Associate Overhead fees for any given
month, as outlined in the current contract governing these agreements.
9. Leaving NWPR
A. The contract ends under the following conditions, whichever comes first:
a. If you are under a Practice Builder contract, 60 days after submitting your intent to vacate.
In cases where notice of intent to vacate is submitted within 60 days of the natural
Page 7 – v13
expiration of a Practice Builder’s contract, the contract termination date will automatically be extended
to accommodate the 60-day term of the notice.
b. If you are under a Standard Associate contract, 90 days after submitting your intent to vacate.
In cases where notice of intent to vacate is submitted within 90 days of the natural expiration of a
Standard Associate’s contract, the contract termination date will automatically be extended to
accommodate the 90-day notice term.
c. Unless otherwise negotiated, 30 days after receiving NWPR’s notice of intent to terminate
your contract.
d. Commission of an unethical or illegal act warranting immediate contract termination as
determined by the NWPR Executive Team.
e. For all other contracts, please review your contract details on termination notices.
B. When leaving NWPR, the Office Space and Service Agreement ends. This includes termination of
he individual license fees you pay for our billing and scheduling software. You will continue to
receive revenue from past billings, but you will also be subject to providing refunds as needed, and
many accounts will remain outstanding. Our experience has been that payments and refund requests
can continue to come in for up to 5 years after you leave. NWPR staff is required to extract these
payments for larger bulk remittances, copy insurance documents to demonstrate to whom the payment
was applied, print, and mail you a check. This all requires administrative time and resources. When
leaving NWPR, you will have the following two choices:
a. OPTION 1:
Administrative Services Contract. You will receive hardcopy printouts of your accounts as of the
last date of your contract and assume full control of your own accounts and accounts receivable. Any incoming revenue will be forwarded to you for your own accounting. Inquiries about your accounts will
be forwarded to you. This will continue as long as revenue or inquiries come in, making the contract indefinite. NWPR will not research insurance denials or perform accounts receivable activities for you beyond collecting and distributing income and passing along to you refund requests, which you will
personally reconcile.
b. OPTION 2: (recommended) Extended Services Contract (ESC). This contract allows NWPR to
maintain your license on our billing system, continue receiving, accounting for, and distributing
revenue and refunds on your behalf, and engage in accounts receivable activities. NWPR will
continue to work on your accounts just as if you were present. This contract is also indefinite, as incoming revenue and outgoing refunds may continue for years after your departure.
i. You may request termination of the ESC at any time, which will immediately transition to an Administrative Services Contract. NWPR will cease all accounts receivable activities and provide you with hard-copy printouts of your accounts, current as of the time of ESC termination, for your records and reference. You may pursue any outstanding balances at your own discretion and expense.
C. The cost of the Administrative Services Contract will be 10% of the revenue collected. Once entered
into, this contract will remain in effect without expiration until NWPR ceases business operations.
Page 8 – v13
D. The cost of the Extended Services Contract will be 25% of the revenue collected on your behalf
each month during the contract period, plus the cost of maintaining your billing user license fee. If
the user license fee renewal date falls within the Extended Services Contract term, the annual fee
will be assessed to ensure service continuity.
E. You may, at your discretion, also continue to pay for your scheduling and/or billing licenses on a
month-to-month basis at your own expense.
F. Note that your departure from NWPR also terminates any insurance provider panels you may have
acquired while at NWPR. You may choose to reapply for these panels using your own tax ID and
new practice information.
G. While your Office Space and Service Agreement will terminate, you also agreed to a series of
shared expenses for the term of your contract. These were spread across 12 months. Not paying for
these expenses may unfairly shift the burden to the remaining associates. Clinicians who depart may
pay the balance due on their share of costs for the time remaining under their original contract. This
payment may be made in cash, by check, or extracted from residual revenue.
H. NWPR reserves the right to withhold revenue as it arrives to meet your financial obligations to NWPR
under the terms of your current or previous contract, and provide for any refunds needed to settle your accounts with clients and/or insurance companies.
I. You may submit late or previously unrecorded day sheets under an Extended Services Contract, but
not under an Administrative Services Contract. Day sheets not recorded by NWPR for any reason by
the time of contract termination will no longer be processed, making it essential to audit your charges to
ensure everything has been billed out before you leave. If it is demonstrated that NWPR was at fault for
failing to accurately process your correctly submitted day sheets before contract termination, NWPR will
make a timely and good-faith effort to retroactively bill these specific services and collect resulting funds
on your behalf. However, NWPR will not be liable under any circumstances for denials based on late
claim filing or clients failing to pay balances.
J. It is critically important to vigorously clean up your accounts receivable as soon as notice is given.
This includes issuing any necessary refunds and corrected insurance claims to resolve and balance
accounts before you leave. It is common for both payments and refund requests to come in for you,
even years after leaving NWPR. Under the terms of the ESC (Section 9.B.b, above), NWPR will continue collection action on outstanding debts owed to you long after you leave. However, refunds to consumers
and insurers should be resolved before you exit. You are personally responsible for refunds, insurance
take-backs, and any debts, regardless of when they arise after your departure. During your contract, this
is typically handled by deducting funds from your ongoing revenue. It may be wise to keep funds in trust
with NWPR to accommodate refund requests. When all foreseeable debts have been cleared, any
remaining funds held in trust will be distributed to you. If no funds remain available, refund requests or
notice of an insurance take-back will be directed to you at your new location. You will need to pay such
refunds or take-backs from your funds within 30 days of NWPR's notification. Insurance companies may conduct audits that reveal past claims paid in error and demand a refund from the clinician rather than the client. While rare, insurance take-backs of this sort are often handled by reducing bulk payments for
claims generated by current NWPR clinicians. This means your colleagues must forfeit personal
Page 9 – v13
income to pay your debt. Fairness and decency dictate that you respond immediately to prevent
this, even if it happens years after you leave.
K. You are expected to keep NWPR informed of your updated contact information, including email and
mailing addresses, for at least seven years following your departure. Payments and requests for records
may be received years after termination. We need to know where to forward these.
L. You may take with you your nameplates from the doors and signage.
M. You may continue to provide clinical services within NWPR and receive all contract-defined
services until the date of termination. You may partially or completely vacate your office at any time
before contract termination. As noted in Section 5, if you intend to transition to a new practice
location independent of NWPR, any services provided in that location fall outside this contract as they
occur in an office not defined by the terms of this contract. NWPR cannot support the services you provide
in your new location, and will not submit inaccurate or misleading insurance claims on your behalf.
Telehealth services may be an exception, provided your NWPR office remains available to you. Plan well
and coordinate with NWPR far in advance of establishing or transitioning to an alternative and separate practice location. This includes establishing a series of important considerations:
a. Carefully and clearly communicate with each of your clients to explain this transition,
including where to find you, who to call, and how scheduling and payments will be handled.
NWPR will not schedule services at your new location, but will kindly direct inquiries to your new
contact information.
b. Implement the scheduling, billing, and accounts receivable system you wish to employ in your new practice location and use this for any services provided there.
c. Coordinate with insurance companies to establish contracts with them that list your new location
and disassociate you with NWPR. This will avoid errant and fraudulent billing, and ensure payments
go to you, not NWPR.
10. Noncompetition Policy
A. If you leave NWPR to pursue practice elsewhere, we cordially request that this practice be located
outside of a 30-mile radius of NWPR, except in cases where you contract with NWPR as an off-site
provider. This is a request, not a requirement.
B. NWPR policy prohibits you from privately contracting with any current NWPR administration staff
person to provide you with administrative services in support of your relocated practice.
C. You may be able to contract with NWPR as an off-site provider to provide full administrative support
while using your own office space. This is negotiated on a case-by-case basis.
11. Multiple Relationships and Professional Boundaries
Clinicians are independent practitioners who accept or reject consumers at their discretion. You are
expected to exercise sound ethical judgment in this matter. NWPR expects clinicians to uphold the
highest standards of ethical and professional conduct, as outlined in the ethical codes governing their
Page 10 – v13
discipline. NWPR clinicians maintain collegial, social, professional, consulting, and supervisory relationships
with other NWPR trainees and clinicians, as well as with employed NWPR administrative staff.
A multiple (or “dual-role”) relationship occurs when a clinician provides professional services to an NWPR
colleague, trainee, or staff person, or to a person closely associated with them, such as an intimate
partner or dependent child. Such multiple relationships may be more commonplace in medically-oriented
settings, but mental health settings routinely adopt more conservative and prohibitive policies on this
issue.
All mental health and most medical professional organizations recognize the inherent dangers of multiple
relationships and urge clinicians to appreciate how providing care for a fellow colleague or subordinate
creates special challenges for objectivity, open exchange of information, privacy and confidentiality, and
informed consent. Breaches of confidentiality are inherent when administrative staff access services, charges, diagnoses, and process protected health information (PHI) as part of their regular duties. This compromises the affected person's PHI. Multiple relationships also pose threats to the functioning and emotional tenor of the
NWPR work environment. Any multiple relationship that the Executive Team judges to substantially interfere
with office operations, staff well-being, or to compromise PHI may be grounds for termination of the providing
clinician’s contract. NWPR may not be able to strictly prohibit you from entering into these relationships, but
can move to terminate your contract with NWPR if we deem your decisions reflect compromised ethical decision-making, create harm to efficient administrative office operations, the well-being of staff or your colleagues, or the
overall office milieu.
For these reasons, NWPR strongly discourages you from providing clinical services to other NWPR-affiliated
clinicians, trainees, or those closely associated with them.
A. Providing Services to NWPR Colleagues: If you are considering entering into a multiple relationship with
a current or future NWPR clinician-colleague, again, we urge you to consider the ethical and personal
ramifications of such a decision, including the potential compromise of PHI, and the potential impacts on the
office milieu. If you choose to proceed regardless, we expect you to clinically document the rationale for your treatment decisions, devise a mutually agreed-upon plan to protect PHI, and remain in strict compliance with
the established ethical codes of your profession throughout the course of care.
B. Providing Services to NWPR Employees: NWPR employee policies prohibit current administrative staff
members or their immediate family members from seeking services from an NWPR clinician.
If a professional relationship existed before the contracting or hiring of a new clinician, staff person, and/or their partners or dependent children, we expect, in most cases, that the professional relationship will appropriately and
successfully terminate before the contracting or hiring date. Possible exceptions to this policy include:
1. If a professional relationship existed before the implementation of this policy (7-1-2024) and is not
currently considered problematic or likely to be a breach of ethical conduct, NWPR will not disrupt that course
of care. However, NWPR expects the clinician to resolve and terminate the course of care as soon as clinically appropriate, and to refer out if another course of care becomes medically necessary in the future.
2. The requested clinical services are so specialized that they cannot be reasonably accessed through existing community or regional resources outside of NWPR.
Page 11 – v13
3. The clinician documents how the multiple relationship is not reasonably expected to cause impairment,
risk exploitation or harm, or interfere with the efficient execution of staff duties,
4. In coordination with the Office Manager, special safeguards are established to protect the personal
health information (PHI) of the affected individual.
With appropriate consent in place, the Executive Team will serve in a confidential consulting and mediating
role to assist the clinician in resolving conflicts arising from this policy and/or considering the above-
mentioned exceptions. This should be sought before entering into services or before contracting or hiring
is accomplished. If the multiple relationship and/or accommodations necessary to support it are
considered by a majority vote of the Executive Team to compromise workflow, efficiency, emotional tenor
of the office space, and/or become exploitive or harmful in some fashion, NWPR reserves the right to
intervene and potentially pursue proceedings as outlined in Section 12 of this Handbook.
12. Contract Terminations
NWPR must be able to take action to protect its reputation and integrity, as well as those of its affiliated
clinicians. The termination provisions within your contract include the following statement:
“If required insurance coverage lapses or Practitioner commits an unethical or illegal act, NWPR may terminate this
Agreement immediately and without notice. In such cases of termination, the minimum payments due
hereunder shall be payable by Practitioner to NWPR for the balance of up to 60 days after the date of
termination.” Some clarification is offered:
A. If you allow your license or liability insurance to lapse, you will be unable to continue practicing.
Cancel all services until this is fixed. Your contract with NWPR will remain in effect during the interim unless otherwise specified. You are responsible for immediately reimbursing any payments later taken back for
services rendered without an active license.
B. What constitutes an unethical or illegal act often involves a degree of discretion. Either can range
from trivial to egregious. On a basic level, you are considered to have acted unethically when such
judgment is officially rendered by the state board governing your license. This investigation process can
take many months. NWPR reserves the right to make reasoned and immediate judgments about actions
violating accepted codes of professional and ethical conduct. NWPR will rely on guidance from the current
APA Ethical Principles of Psychologists, as well as the ACA, AANP, or AMA codes of ethical conduct, in
deciding whether your conduct warrants contract termination.
C. NWPR may terminate your contract under this provision if the violation is, at NWPR’s discretion,
considered so blatant and serious as to warrant immediate action. Termination may also occur if
the violation represents a repeated pattern of unprofessional behavior that has not been corrected
despite past collegial confrontations. This is described in more detail, below.
D. Legal violations will be considered on a case-by-case basis. Less serious violations that accumulate
to establish a pattern of behavior may also be cause for termination. This includes behavior and infractions incurred as a private citizen that are injurious to your personal reputation and, thus, indirectly to NWPR.
E. The NWPR Partners may convene a meeting of other Associates when making judgments regarding
unethical and illegal behaviors and decisions to terminate a contract.
Page 12 – v13
F. There may be situations where specific ethical or legal violations are not observed, but a clinician persistently engages in a range of behaviors that could be considered a potential cause for
contract termination. Examples may include ethically substandard or questionable practices,
financial fraud or misdirection, improper billing practices, behavior considered persistently
adversarial and disruptive to the health of the work environment, exploitative, disruptive, and/or
harmful multiple relationships, demeaning behavior toward administrative staff, and behavior
negatively impacting the reputation of NWPR. Among these behaviors would be hostile, threatening, or offensive language or actions within or outside of NWPR, as well as an unprofessional demeanor, dress,
or practice style. Section 17 of this document provides additional examples.
In most cases, the clinician will first be approached personally and privately to address the concerns,
request remediation, and clarify expectations moving forward. If this fails, the clinician will meet with
the Executive Team in a private session to address the concerns and establish a remediation plan. If
these step-wise efforts to correct such behaviors have failed, the Executive Team or two or more
Associates may formally request an executive session of all current full Associates to review the
context and history of these concerns. Associates will take a binding majority vote to sustain, sustain
under certain corrective and mandatory stipulations, fail to renew, or to summarily terminate a clinician’s contract. The meeting will proceed without the offending clinician present; however, the clinician may
submit a brief written statement for consideration by their colleagues.
G. NWPR may not be a good “fit” for certain types of clinician practices. NWPR may pursue contract
termination if—at the judgment of administrative staff in consultation with the Executive Team-- a
clinician’s needs for unique or specialized administrative support exceed what NWPR can realistically
and sustainably provide. This judgment may be made if these needs are considered to place persistently excessive demands on staff resources to accommodate, and/or persistently contribute to error, misunderstanding, and undue stress or workplace conflict. If this is judged to occur (or likely to occur),
NWPR will notify the clinician of the intent refuse or withdraw support for specific forms of administrative services. If a mutually agreeable and amicable solution cannot be found, the contract may be terminated unilaterally or mutually based on the conclusion that NWPR cannot accommodate a clinician’s unique practice needs.
H. Persistent noncooperation, unresponsiveness, or disengagement may ultimately lead to contract
termination. Examples include, but are not limited to, failing to return contracts in a timely fashion,
neglecting to turn in needed forms or documents necessary to efficient office operation, placing onerous
time burdens on staff or creating injury to NWPR’s reputation, or consistent neglect of opportunities to
engage personally and professionally with fellow clinicians and NWPR business activities. As noted in
Section 16, clinicians who consistently self-isolate tend to be at higher risk for both negative behavior
and poor experiences with NWPR, and those whose noncooperation or neglect disrupts clinic operation
or reputation may be encouraged to relocate their practices. If collegial support does not remediate these issues, termination may be pursued.
Page 13 – v13
13. Returning to NWPR
On occasion, 1) a clinician having left NWPR in good standing may wish to return, 2) a clinician having
submitted a notice of termination may wish to rescind this notice, or 3) a clinician whose contract was
terminated by NWPR may have taken corrective actions in ways to allow re-affiliation with NWPR. In any
such case, the clinician will be required to submit written notice to NWPR explaining their interest in re-
affiliation. Upon receipt of this request, the NWPR Executive Team will meet as soon as reasonably
possible to discuss it. If appropriate, NWPR will convene a meeting of managers and all current Associates
to discuss and vote upon the clinician’s request. A two-thirds vote of all attendees is required for
reinstatement approval, and under what conditions. Persons unable to attend this meeting may vote in
absentia by submitting a written ballot to either the Clinic Manager or the Office Manager, who will
represent them during the meeting. The result of this vote and any conditions of reinstatement will be
presented to the requesting clinician in writing. If the vote passes by a two-thirds majority and includes
specified conditions, the clinician will be offered a three-month Probationary Associates Contract to allow
time for the stated conditions to be observed and met, with the option for an additional three-month term
at NWPR's discretion. As determined by the NWPR Executive Team, clinicians successfully meeting the
conditions will then resume a normal Associates contract. Clinicians who fail to meet the conditions will
receive a 30-day notice of termination. Appeals to this notice may be considered again by a closed
meeting of executives, managers, and current associates, requiring a two-thirds vote. The result will be
binding and not subject to appeal.
14. Moving from Resident/Associate to Licensed Status
For post-graduate clinicians obtaining supervised hours for independent licensure, obtaining an interim
Associate license (e.g., LMHCA, LICSWA, etc.) will allow you to bill selected insurances that provide
benefits for what is termed “incident-to” billing. This allows you to bill under your supervisor’s name and
license. While the reimbursement rate may be a bit lower, income potential is much higher than only cash
pay. In almost all cases, incident-to billing ceases the day your own full license becomes active. This leads
to a “paneling gap.” You can only bill under your own name at that point, even though you will not yet be
independently paneled for another 60-90 days. This timeline assumes there are no snags or actions in your
practice history that might prompt the company to flag your application and delay it.
There are three steps to take to plan for this:
1. Well before your license becomes active, work closely with the NWPR paneling specialist to map
out a plan of attack for what insurance applications will be needed, and have these prepared to
submit immediately once your license to practice becomes active.
2. Well before the paneling gap, identify any affected clients and discuss with them how you will
negotiate your services and fees during this time. Options could include termination planning,
pausing care, reducing visit frequency, negotiating cash-pay discounts, etc. NWPR does not dictate
how you manage this, only that you handle it assertively and professionally with your client’s
welfare as priority.
3. Plan ahead for a reduction in income during this gap time, and for an additional 2-4 weeks for your
revenue to begin coming in once insurance billing is able to resume.
Page 14 – v13
15. Client/Patient Records
Your contract deals with client record maintenance. NWPR provides you with one locked file cabinet to
hold archived records. These records are yours and under your sole control. When you leave NWPR, you
must take all client files with you and securely maintain them in accordance with state guidelines. NWPR
does not store your records, manage, or process records requests beyond forwarding these to you. While
time-consuming, we recommend downloading EHI/PHI for each of your clients and retaining it in secure
data storage for easy access. NWPR staff cannot be tasked to do this for you.
16. Revenue Draws
You are allowed to request draws on funds already collected on your behalf prior to the normal distribution
at the end of the month. These requests are directed to the Clinic Manager. While every effort will be
made to fulfill these requests, the Clinic Manager maintains discretion in providing draws based on
available funds and the clinic's overall needs. Things to keep in mind when taking a draw:
A. Please be mindful of the fact that NWPR requires adequate cash reserves to pay for the services
and amenities required for your business. Excessive or frequent draws deplete NWPR’s ability to
honor clinic financial obligations during the month. We ask that you avoid taking large or repeated draws.
B. You cannot request more money than is already recorded on your behalf as of the date of your request.
C. It is prudent to leave sufficient funds in your account to honor your overhead obligation to NWPR at
the end of the month. Unless you have ready access to funds outside of your NWPR revenue stream,
do not leave your account with less money by the end of the month than will be necessary to fulfill your anticipated overhead fees.
D. Persons who demonstrate a pattern of inability to meet their month-end overhead obligation in a
timely fashion due to excessive draws and/or insufficient productivity may be restricted from taking
more funds than is required to honor their anticipated overhead fees. These decisions are made at
the discretion of the Clinic Manager in private consultation with the clinician and Executive Team.
E. During the last 30 days of your tenancy at NWPR, you will be allowed to take draws only on funds
over and above the calculated average of your two prior months’ overhead fees. This ensures there
are sufficient funds on hand to honor your overhead obligation as of your departure date. The difference between your actual overhead and the reserved amount will be promptly refunded to you or assessed
against you upon termination.
17. Deportment, Professionalism, and Respect for Diversity
A. Attendance at monthly staff meetings and case conferences is expected. While acknowledging the
potential loss of revenue-generating time, we expect all clinicians to engage freely and frequently
with other clinicians contracting with NWPR to foster familiarity, collegiality, and mutual
Page 15 – v13
investment in decision-making. Consistent with research on this issue, we observe that clinicians
who routinely isolate and avoid clinic activities are less professionally satisfied, receive fewer inter-
office referrals, are subject to policies and expenses voted on by other clinicians without
representation, and are at higher risk of burnout and ethical missteps. Take advantage of the
opportunities for interaction within NWPR to anchor yourself, combat loneliness, and seek consultation.
B. We highly value independence, personal, theoretical, and religious diversity, good humor, and
amicable partnerships with each other. A culture of professionalism and respect is important to NWPR.
This culture fosters client trust and confidence, enhances the clinic’s reputation in the community, creates
a positive work environment for all, and promotes high ethical standards. Below are some guidelines we expect each clinician to follow:
a. Except for particular and very brief occasions, do not leave clients unattended in your office.
b. Avoid routinely taking clients into the kitchen or administrative areas of the building, and do
not invite or allow clients to enter these areas unescorted. You are responsible for educating your
own clients who may inadvertently enter restricted areas.
c. Maintain sufficient privacy of your desk space and computer so that clients cannot readily
view confidential material on your desk or device screen. Similarly, do not leave PHI exposed within
client view or stored in easily accessible locations, such as on bookshelves or under furniture.
d. Do not discuss your cases outside of the office with partners, family, or friends.
e. Extra-office encounters with clients are inevitable in a small community. This requires special
awareness paid to respecting boundaries and avoiding dual-role interactions, including both social
and business relationships with your clients. Seek consultation if such issues arise and you are
unsure how to handle them.
f. Make phone calls and listen to voicemail messages using your handset or with your door closed.
g. Adjust audio volumes during telephone or telehealth/video interactions so that communications
cannot be deciphered outside of your office through walls or doors. Using a headset with a
microphone can be a good solution.
h. Maintain quiet in hallways and doorways, especially within earshot of the waiting areas.
i. Avoid discussion of client or treatment issues with other clinicians in common areas, hallways,
or doorways.
j. Maintain quiet while in the administrative area, especially when the window is open or when staff
are on the phone using their earpieces. Keep in mind that conversations at normal or greater
volume in this area can likely be overheard in the waiting room.
k. Whenever possible, e-mail or leave a voicemail for the administrative staff with non-urgent
questions.
l. Remain politely respectful of privacy and do not engage clients waiting for other clinicians unless
they clearly need assistance, are disruptive, or are venturing into restricted areas.
m. Do not have clinically-oriented discussions with clients or families in waiting rooms, hallways,
or with your office door open.
n. Maintain supportive and complimentary behavior and verbal comments toward your colleagues,
both within and outside the clinic.
Page 16 – v13
C. Clients are not permitted to bring pets into the office. What is comforting to some may be anxiety-
provoking or offensive to others. Registered, trained, and clearly identified service animals are an
exception. You are responsible for enforcing this policy and can cite the official clinic policy to your
clients as the reason.
D. Privately, quickly, cordially, and correctively confront any colleague who appears to be acting
unprofessionally, creating a negative or offensive work environment, or breaching ethical guidelines
such as confidentiality, questionable billing, dual-role relationships, inappropriate use of tests, etc. If
this approach is ineffective or you are not comfortable with it, enlist one or two additional colleagues
and/or Managers with whom to review the issue and, together, confront the offending clinician. If this
is not effective, bring it to the Executive Team's attention for action.
E. Seek consultation from your colleagues about any ethical dilemmas or questions you may have,
and document that you have done so.
F. Concerns about the performance of the administrative, IT, or cleaning staff should be brought to
the attention of the Office Manager.
G. Concerns about the performance of the Clinic or Office Manager should be brought to the attention
of clinicians serving on the Executive Team.
H. The use of obscenities and crude language contributes to an unprofessional, offensive, and potentially
hostile work environment and is prohibited within common areas or at NWPR group functions. Similarly,
religious, cultural, racial, gender, sexual orientation, and political viewpoints are respected and protected
at NWPR. Refrain from making any derisive or derogatory comments regarding these issues.
I. NWPR has a zero-tolerance policy for aggressive, hostile, threatening, or sexually harassing behaviors.
Clinicians or staff who experience, observe, or are concerned about such behavior are asked first to
confront the offending individual and seek reconciliation, and to report this immediately to a member of the
Executive Team.
J. There is no dress code for clinicians. Keep in mind that this is a respected professional office.
While appreciating individual styles and the desire to reduce barriers between you and your consumers,
we recommend that your appearance and attire remain consistent with this and generally conform to a business-casual dress code.6 Such issues reflect not only on you but also on your colleagues and on
the overall image of NWPR.
K. NWPR assumes that clinicians are intrinsically motivated to collect their usual and customary
rates. Collect all appropriate fees from your clients in a professional and timely manner. Although it may
seem counterintuitive, insurance companies consider it fraud to write off or use “sliding” fee schedules regularly, either directly or by failure to collect. There are important clinical reasons to ask clients to value
and pay for your services. This is also the basis of your livelihood. Fee collection can be a sticky issue
for people in helpful professions. Particularly in the case of Practice Builder or other percentage-based
plans, please be mindful that we are accommodating
6 If desired, see https://careers.usnews.com/advice/outside-voices-careers/articles/what-is-business-casual-attire for definitions and examples.
Page 17 – v13
your need to build your practice. NWPR maintains a stake in seeing that you are effectively
collecting revenue. Persistent failure to do so may result in NWPR insisting you move immediately
to a Standard Associate’s agreement. If you encounter difficulties collecting client fees, please seek
collegial consultation and assistance.
L. Timely submission of billings is critical to your financial well-being. This is the only way you get
paid. Day sheets submitted or revisions made after the 23rd of each month will not appear on that
month’s charges and revenue statement, as this is the cutoff for making sure your revenue is
distributed on or before the 1st of the next month. Charges and revenue after the 23rd will appear on
the following month’s statement. Furthermore, turning in delinquent (>1 week old) day sheets also
creates a backlog, adversely affecting staff workflow and efficiency. At the Office Manager's
discretion, day sheets more than 14 days past the date of service may be rejected or assigned a low
priority for entry and billing. Typically, and at the Office Manager’s discretion, adjustments made more
than 45 days after the date of service will be rejected, as they may fall outside the timely filing rules of
many insurance plans.
M. Monthly statements are mailed to your clients as prepared by our office staff. These statements
may be placed in your box for review before mailing. If this occurs, review each statement carefully
for anomalies and sort them into those that are correct and ready to mail, those that are ready to send
with a past-due sticker, and those that need correction, research, or editing before being mailed. You
must get them back to the staff for mailing as soon as possible, typically within 24 hours. Mailing delays
slow your revenue flow, and delayed statements quickly become obsolete and misleading. Statements
serve important purposes. They provide information to your clients about their accounts and balances
due, prevent large and unexpected balances from accruing, and establish a record of services and
payments they may need for their own personal and tax records. They also provide opportunities to
correct accounting or insurance errors.
N. NWPR has worked hard to garner contracts with various insurance companies and wishes to maintain
positive relationships with these companies. While NWPR staff checks and documents benefits and
requirements for a specific insurance plan, clinicians are solely responsible for understanding and
complying with these requirements, and for any denials or refunds resulting from failure to do so. You
may choose not to panel with an insurer based on what you believe to be their unreasonable
reimbursement rates and/or onerous policies and procedures. If you have a grievance with an insurance company, it is very important to avoid denigrating comments toward the company with your client(s), attempting to blame the insurer, holding clients liable for lost revenue due to your lack of adherence to
their insurance policies, or engaging in belligerent interchanges with contract representatives. These
behaviors place clients in challenging positions, put other clinicians' contracts at risk, and create a
negative, unprofessional impression of NWPR as a whole. NWPR will act to protect critical group-based contracts and may elect to terminate the contract of any clinician whose conduct places these in jeopardy
due to noncompliant or contentious behavior.
