Establishing cash only practice

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time to eat
15+ Year Member
May 16, 2007
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I would like to establish a cash only practice, and understand the best way to do this is to not be on insurance panels. (Apparently if you are on a patient's insurance panel, you can't take cash only without regard to the insurance guidelines.) In order to attempt to start such a practice, is it feasible to work part time for another practice (that does take insured patients) as an employee or contractor, without having to be on that practice's insurance company panels? This practice would be located approximately 45 minutes away from my cash only practice.

The goal is to ultimately offer podiatry services to patients who have high deductible plans, who are under their deductible, at a lower price than traditional practices would charge. My operation would be simplified with less overhead because I would not have to deal with billing and coding.

Not sure if this is the forum for this, if anyone has any ideas or resources with info, would be much appreciated.

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that doesn't seem feasible, as so many podiatry patients are medicare or medicaid. but good luck.
Thanks for the reply,what about getting on medicare and Medicaid but no other plans, then charging cash for all non medicare/medicaid patients?
Thanks for the reply,what about getting on medicare and Medicaid but no other plans, then charging cash for all non medicare/medicaid patients?

Child psychiatrist here. I'm in my last year of fellowship and have been researching starting a cash practice for a while.

So, you can absolutely take some insurances (medicare/caid included), and charge patients without those insurances cash. This might be recommended if you live in an area with one major insurer, you take that one, and charge everyone else cash.

Cash Medicare/Medicaid presents some special problems however. If you are signed up as a Medicare/Medicaid accepting doctor, and then you accidentally accept cash from a medicare/medicaid patient, you can go to jail. Seriously. So, don't do that. Most people have patients sign something saying that they don't have medicare or medicaid. Also, if you're currently (or ever were) signed up to take medicare/medicaid, and you no longer accept it, then you need to MAKE SURE that you are removed from their system and off their list. I would send a certified letter and keep the documentation of that letter being sent, and also verify that you are removed from their list. You can still go to jail even if you're just on their list.

For me, I would not take Medicare/Caid and no other insurance. If you accept Medicare, then I'd just take everything. There are also a ton of other headaches with taking Medicare (meaningful use, extra documentation, ugh), that you really don't want to deal with.

Now if you accept Aetna or some private insurance, and accidentally charge their patients cash, you've just violated your contract with Aetna, not the law. So, I'd be ok mixing and matching private insurances and cash all day long.

Hope that helps!
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