Can Nurse Practitioners Accept Cash Payments with Insurance Credentials?

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Regulations regarding cash payments vary based on the nature of the business an NP practices under. Cash-only practices offer a number of perks, but it may be difficult to determine whether you are eligible to accept cash as a nurse practitioner. In many cases, providers must make a choice between accepting insurance or cash. However, there are some ways to operate a hybrid cash-insurance practice. Use this guide to learn more about protocols specific to private insurance carriers.

Understanding the specifics of your insurance credentials

Insurance-credentialed NPs who are employed through a private business are strictly credentialed through the practice that employs them. In these cases, individual providers are credentialed under their employer’s group NPI number. Because an NP’s insurance credentials are associated with the practice they work for, their credentials cannot be carried with them elsewhere. If a credentialed staff NP were to get hired by a different practice, their new employer would need to re-credential them under their group NPI. If the same NP were to establish their own practice, they would also need to become re-credentialed through the business they own.

How can I accept cash payments as a nurse practitioner?

If you are starting a side practice as a nurse practitioner, you can choose to accept insurance, cash, or both. Many NPs choose to strictly accept cash payments, and do not become insurance-credentialed under their LLC. This decision is mainly motivated by an unwillingness to navigate insurance-related red tape, and to get paid immediately upon date of service. If you do decide to become insurance-credentialed through your own LLC, the types of services you can accept cash payment for will be limited.

The key to running an insurance/cash hybrid practice is strategic billing. Here’s how:

  1. Bill insurance for covered services, like medically-necessary procedures
  2. Accept cash payment for noncovered services, like IV infusion, testosterone replacement, aesthetic procedures, and in certain circumstances, ketamine infusion
  3. Operate the “cash only” portion of your business under a separate legal entity (LLC)

Note: This protocol does not apply to medicare/medicaid plans. This guide can help NPs learn how to navigate these specific plans.

Some NPs operate an insurance-accepting general medicine practice and run a separate cash-only business in the same clinic with a different set of specialized services. (For example: an NP may operate a women’s health clinic that accepts insurance for basic gynecological services, while simultaneously offering cash-only aesthetic dermatology/injectable services in the same office.) When accepting cash payments for certain types of services, be absolutely sure that each service is indeed uncovered by a patient’s insurance plan. A simple call to an insurance carrier can verify coverage details.

50 Responses

  1. Good info. Instead of doing a separate LLC could you do a DBA? For instance you have a primary care practice and want to open a weight lose clinic.

    1. No, it needs to be a SEPARATE LEGAL ENTITY. A DBA is not that. It is just an extension of your already established legal entity that is accepting insurance. That would not work.

      1. Just looking for clarification… Here you say if you have a practice taking insurance, you cannot have a cash based clinic using a DBA, but below you answered another individual saying you could do that?

        1. Only if the cash based clinic is under a different LLC. You could do it as a DBA only if the service you are offering is a non-covered service.

  2. Does being credentialed through insurance companies interfere with clients getting reimbursed when they submit for OON benefits?

  3. Does it matter if you are credentialed by your personal NPI or group NPI for your primary care practice and open a cash only practice? if each practice has separate LLC.

    1. For a cash practice, you would just function under your personal NPI. No need to worry about group NPI.

  4. Considering having my psych practice with a side of weight loss offerings. I’m not able to dispense meds in my office. I’m primarily telehealth.
    I’d like to be cash based only (not accepting Medicare but not opted out due to primary w2 employment).
    If I’m cash based only, do I have to have separate legal entities for psych and weight loss?
    If I’m taking 1-2 insurances, will they cover weight loss visits (99213, 99214)
    Is it better to try just focus on psych patients and offer them some additional weight loss support as part of their overall treatment plan, or have a separate line of WL services?

    1. 1. You do not need separate entities for separate services unless you want to.
      2. Insurance should cover the standard E&M codes. But if you are wanting to build the cash based arm of this pracitce, you would need a separate entity for that for covered services.
      3. I think you should do both.

  5. Can you create two separate legal entities( owned by the same person) and be credientialed under insurance for one and not credentialed under insurance for the other? I am thinking of opening a Medicare risk assestment (thus would need credentialing by insurance) main practice but wanted to be able to have a small cash side practice(would not take medicare patients). Now it seems I would have to have two separate legal entities to do this? What things could cover both to reduce costs? (EHR, insurance,)

    1. Yes, that is exactly what you do as explained in the article.

      You can have a lot of the back end operational stuff (EMR, insurance, payment processors) be for both. That isn’t going to make difference.

      1. Justin – I think someone mentioned that the back end stuff like EMR etc should also be separate… But you think this isn’t necessary?

  6. JustinAllan, thanks so much for the excellent information. I have a question that takes the discussion one step further… I am a private practice physician (practice owner with one other partner; under an LLC utilizing a group NPI number) that currently accepts a wide variety of insurances including Medicare. Would I be able to accept cash for select in-office procedures (that would normally be covered by insurance) by forming a new, separate LLC wherein all transactions (revenue and expenses) pertaining to the elective procedures would pass?

    1. To my understanding: for Medicare no, because YOU are credentialed which is global for Medicare. For private insurance: Yes, you could do that.

  7. Hello, I am an autonomous NP in Virginia. I work full time for a company seeing their employees and family members for acute issues and there is no dealing with insurance, it is just a service provided by the company to have me there. I worked for a corporate family practice clinic for the past 6 years which I was credentialed with all insurances, Medicare and Medicaid. I quit the corporate job by the way. Now I want to start my own practice and have just filed my LLC. I would like to offer some routine medical services, telehealth, weight loss program and aesthetics. I am stumped at how I should go about setting up payment for services. I know aesthetics would not be covered by insurances so can I just set up pricing and do cash for that service while accepting private insurances? Or should I start out as a cash based practice and then potentially be credentialed later for insurances?
    I feel that my business will take off and grow substantially in my area once I open because of my reputation as a good provider and there is a great need for providers in the area.
    Thank you for any advice you may give me!

    1. Yes, if it is not covered you can charge cash for it. It is up to you…. credentialing will take 3-6 months, so if you want to start now just go ahead and do cash only.

  8. I own & am credentialed with all commercial insurance, Medicaid & Medicare for psych. I’m dual certified FNP/PMHNP
    I have an S Corp… if I want to add cash pay weight loss can I do this as a DBA?

  9. Thank you Justin for always providing insight. I’m a Psych NP. I am getting credentialed at a clinic I’m a 1099 at and I’m opening a cash pay practice LLC (just me). Based on your article, I should be able to accept insurance patients, even if I’m credentialed with them through my 1099, with the exception of Medicare and Medicaid. I was planning to have my 1099 pay me through my LLC which I was planning to use for both my 1099 AND LLC. Is that ok to do or should the 1099 pay me directly to avoid any insurance issue?

  10. Thank you Justin for the wonderful insight. I was wondering if I have a primary care clinic that accepts medicare it sounds like I could also have a cash based Telehealth practice if I build a separate entity for it. I was planning to make a virtual urgent care Telehealth. My question is will I be able to offer my primary care patients this service or would that be considered self referral since I own both businesses?

    1. If it is a totally separate entity then you should be fine. But yes, I would think this would be considered a self referral and a BIG no with Medicare

  11. It’s me again.
    After a while of trying to be cash based only (cash rate was 300/ 150, now higher that I’m taking ins)…. I am now seeing psych patients with commercial insurance via third party companies (Grow Therapy and Alma) and am directly credentialed with two smaller insurances.
    I’ve been doing some medical weight reduction with my psych patients, both in the same visit. Many are paying cash for the prescription products. PAs were a headache, and rarely approved. Now, supply issues have made it difficult for most. I’m finally brave enough to start offering compounded meds as an option. I have a pharmacy I feel comfortable enough to start with compounded. I have the option of the patient paying the pharmacy direct, or I pay the pharmacy (discount which I can mark up).

    1. Should I create a cash pay “package” for weight loss services (within my current LLC that also sees MH pts) where I purchase the meds and the pharmacy ships to the patient, and the patient pays me for the package (visit, meds, follow up)

    2. Should I create a separate LLC for cash only medical weight reduction and maybe eventually TRT?

    3. Right now I rent out a small office for my LLC. I don’t have a separate entrance, or separate exam room.

    1. 1. Yes, that is the best way for profit. 2. Yes, separate LLC for cash services 3. I wouldn’t worry about it… I doubt anyone would come look.

  12. I suppose a slip and fall insurance policy for a second cash pay entity would be needed as well.

    We are a private pediatric office starting to offer semaglutide to our over 35 BMI patients with comorbidities. We are concerned that prescribing semaglutide and having them pay cash for the medication would cause our insurance companies to drop us. We are contemplating staying one entity or making weight loss a second entity. We are currently one MD and myself, a PNP. If just I did the weight loss portion under my NPI, would a second entity be needed?

    Thank you sooo much for this great information!!

  13. Hello Justin, thanks for this valuable information. I’m slow- sorry about that.
    QUESTION: I am starting a psychiatric nursing corporation (PC) and will work with Alma/Headway for billing. To see psychiatric cash patients (no insurance), do I need an NP2? Or with my NP1 is fine? Or how can I do that if these patients won’t be run by Alma/Headway? What would be the easiest way? Thanks in advance.

  14. Hi, I am starting with Grow therapy (accepting insurances) for my Psychiatric patients. I will be credentialed under their NPI and is not credentialed individually. I want to also have an integrated medicine in which I am only accepting cash clients. I have 1 LLC that I use now since I am 1099 that I switch to an S-Corp. Will I need to get another NPI and LLC for my integrative psychiatry medicine cash pay or can I just use my own NPI and LLC? Thanks

      1. Thank you so much for that info. Also, I am licensed in 3 states and wish to prescribed controlled substances in all 3 states. However, the DEA states that I need physical practice addresses in order to get a DEA number. Do you know how that is possible?

  15. This article has been so helpful! Could you clarify if it is possible to work in an out of network practice part-time that submits superbills on behalf of clients while also working part-time at another practice that is credentialed with insurance? I understand that both companies will have different NPI numbers. The difference here from the examples you have provided is that the out of network practice isn’t cash only.

  16. Hi Justin,
    Thank you as always for your great information. I started a telehealth weight loss business as a FNP, Sept 2022, very slow growing but now I have about 50 patients. I started doing cash only for compounds, added prior auths and insurance patients for 100.00 a month, and then became credentialed for 3 insurances. I’ve been doing my own billing since I don’t have a lot of insurance patients. I didn’t mind the slowness since I was finishing my Psych NP as well as working full time teaching.
    Now I want to add psych and here are my questions on how to go about this:
    1. I’m interested in doing integrative psych practice so I can utilize everything with hormones, psych, weight loss, etc. I would operate cash only and then keep the same LLC. My DBA is Scale Down for the weight loss. Should I add another DBA with psych name or just can add wellness services to my original DBA?
    2. If I just stick with cash only, I want to cancel my contracts for the insurances. Can you get recredentialed at any time, in case you want to accept insurance again?
    3. I could do both, but then I would have to make a new LLC, and would I do all 3 states, or just start out with one state and go from there? I also had to get 2 bank accounts linked to my LLC (long story) so I’ve been putting insurance payments in one account and cash business in the other account to keep them separated. If I get another LLC, do I have to open a third bank account?
    Sorry for all the questions, I just want to choose the easiest solution 🙂 Thanks so much!

    1. 1. I would do the DBA with the psych name
      2. Yes
      3. Just start with one state. And you need a separate bank account for each LLC

  17. Thank you for all this information. I am a PMHNP, and I have a Psych LLC in-person and virtual company that is credentialed with all insurances. I desire to have an integrative psychiatry business where I only pay cash. What do I do?

  18. I own a RHC and want to start a cash based weight loss clinic. I’m having issues with a name for the WL clinic to register as a separate entity. Is it feasible to use my regular clinic name in the name of my cash clinic? or does that make things messy so to speak? For ex: New clinic name @ RHC name or dose it need to be something completely separate and not connected?

  19. If I work at an out of network clinic that submits claims on the patient’s behalf, does that mean I am credentialed with insurance? I have worked at other clinics that did take insurance, not sure if that matters? But my current clinic is out of network only. I am want to see clients my own on the side and I want to provide them with a superbill, but I am unsure if i can use my individual NPI number or not. I don’t have an LLC, I was going to start just as sole P until I build a case load.

    1. You are crednetialed as a single provider but if you open a cash based practice, your entity isnt so you are fine

  20. Hello. We are a new mental health clinic cash pay only for ‘packages’ that include the mental health evaluation and prescriptions sent to their home. We will provide a super bill for the clinical appointments. If we decide to get credentialed through insurance, can patients opt to pay cash? We often run specials for new patients, etc. If we take insurance, how does that change what you are able to advertise as the cost of your services?

    1. They can pay you cash if they want. You can advertise whatever you want… insurance doesn’t dictate that. But you are “supposed” to bill insurance for covered services

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