Never Bill for Services. Obtain Payment at the Time of Service


If you are operating a cash practice like The Elite Nurse Practitioner Model suggests or even have an insurance accepting practice that takes co-pays, you must ensure you are taking payments at the time of service. Never, and I mean NEVER, bill a patient. That is the number one way not to be paid for the services you provide.

That is the beautiful thing about accepting cash in your practice, you are paid at the time of service. When you accept insurance, you are paid weeks or even months from the date of service and sometimes, you aren’t even paid at all! Or you do get paid and the insurance company decides they want their money back because they did not agree with what you did… this happens. Its a pain in the ass to the small practice owner.

Plumbers, landscapers, accountants, electricians, etc. are cash transactional professions. Nurse practitioner ran businesses should be no different. The issue these other professions have, is that they typically will bill the client after the job is performed. Usually the client will have 30 days to pay or the bill will be delinquent and possibly sent to collections.

You need to avoid this type of set up at all costs.

A cash accepting nurse practitioner operated side practice should accept payment at the time of service. If the patient can’t pay, they can’t play. It is as simple as that. I turn away medical cannabis patients all the time because they thought it was free. Hah, yea… I love spending my days working for free instead of going on a hike with my dogs. The entitlement developing in this country astonishes me…

Do not bill patients for work that has already been done. Don’t even think about it! It will result in unpaid bills and you wasting time chasing it. Do you really want to spend your time calling and sending letters to a patient? Do you want to spend your time sending off the bill to collections? This is unproductive busy work, not income generating work.  

You can either bill the patient before the visit or afterward. I personally bill patients after the visit because I feel like I provide significant value to their life. This translates into them being more than happy to hand over their money to you. They feel like they were helped and are happy after the visit. This results in positive reviews.

If you bill the patient before, they might feel like they are being pushed to pay before they have even gained value. They go into the appointment with negative emotions before it even started! I do not like this model. The main advantage though, is that you have guaranteed payment.

The issue with accepting payment after the visit is that some patients will not pay. This has happened multiple times throughout my business life. I will perform a medical cannabis evaluation on a patient and then at checkout they say “Oh, this cost money? I thought it was free. I can’t pay.” I will then shred the evaluation in front of them. They wasted my time. This happens more often with lower end services like medical cannabis evaluations because the demographic is dispersed among all income levels. This has never happened at my men’s health and testosterone clinic or stem cell practice. This demographic is wealthier, and they have a disposable income. It’s great.

This is another reason why its critical to identify your target market and demographic. If they have more money, billing the patient after the visit is safe. If they are in a lower income bracket, then you might want to consider billing the patient before the service. I have made sure that my medical cannabis patients are aware of the price before the visit now. I was burned too many times.

So, make sure you bill the patient at the time of service! Do not send bills. You will lose money and become very frustrated if you do so. Learn from my mistakes.

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