Cash Only Practices, Specialists, Concierge Medicine & Direct Primary Care

So many providers are fed up with the health insurance organizations tricks, games, and time wasters that they are often interested in alternative ways of doing business. Whether this means concierge medicine for a small select group of patients, membership plans, or cash only set ups.

Health insurance organizations are always messing with providers to try to make barriers to them being able to collect their full payment for seeing their patients. Whether this is about using their coding systems to require particular codes, making multiple different codes at the same rate when they are differing amounts of work, requiring providers to keep adding the same codes each year even though they know about them. Such as the known practice of needing patients with amputations to have that code entered each year to get that higher level of payment, even though they know it didnt magically grow back. Or if they paid for a procedure or lab test, still needing the practice to recode that it was done by them or elsewhere in order to get their QI scores. Finding ways to not pay such as denial of the claim, or saying they are waiting for more information from a patient and never even contacting the patient. Wasting providers time with tons of forms and audits etc. So it is no wonder providers are so interested in alternative setups.

However, providers need to remember that health insurance systems provide a number of services, and that the current healthcare system is often stuck in this model regardless of its problems. So negotiating alternative systems can make it super difficult, and require a number of potentially expensive or time consuming aspects. If you want to review those barriers anyway feel free to reach out to us to discuss it further. So we can figure out whether it is right for your organization. As well as whether you can outsource some of those issues to us to assist you with

Some issues you may encounter include how to get new patients. Needing marketing assistance is often a immediate issue of going this route. As the health insurance company often provides you with patients. By going the cash route you need to acquire those patients yourself. Need help with this? Reach out to us today. We have experience helping organizations acquire new patients and keep existing patients. Whether you need SEO assistance to get patients via their search engine listings, flyers, etc. we can help.

Health insurances are always seeking to reduce your reimbursements, so it is totally understandable for you to want to leave them and figure things out yourself. Protesting and making noise can only get you so far, so we totally get the idea of looking at alternative setups. However keep in mind that if you are out of network and everyone else is in network, they will be receiving the majority of the referrals, as although they often say patients can go anywhere, providers often refer in network. And health insurances are always looking for ways to make this easier to do. So you would have to really work to do your mareketing well in order to get the referrals you need to stay afloat. This can often be a little expensive, so you may not be able to afford being out of network.

Your main challenges may be marketing related. As you need to be able to get the volume of patients into your practice that you need to stay afloat on your own. Of course if you are able to attract and retain patients using your marketing systems and word of mouth that would definitely be amazing for you to save yourself from a lot of the headache of health insurance companies. But usually if you are not accepting insurances and people are being expected to pay out of pocket this can really be a lot more difficult to find and retain a good amount of demand for your healthcare practice. So the competitiveness of your specialty and local area is going to be a a key factor to your success.

Some people who go this route have been successful in cases where patients have been willing to pay out of pocket, such as concierge practices or urgent care walk in setups. In which cases being able to fully Bill and collect has really helped these organizations save money and time. Which is why they wanted to go that route. But they usually have fewer patients to see, but make more money per person (As they are not getting denials, wasting time on audits, and lots of paperwork and coding). These practices also therefore don't need as much administrative staff etc. so they save money on employees too. But remember this is a small minority of practices. Some people are saying that the demise of two large direct primary care providers Qliance and Turntable Health show that these alternative setups are not feasible. Particularly for larger organizations. As just a minority of these types of practices can survive. But it is really up to what your priorities and goals are. Of course we are here to help regardless of the setup that you choose. So feel free to reach out to us to continue this conversation and discuss your options. Just click hereGet Expert Business Help – Perfect Sweat