Many nurse practitioners that consider opening a business believe they have to accept insurance to create a successful practice. Providers and patients are led to believe that insurance is a requirement to receive quality health care in this country. However, it is feasible to create and maintain a thriving medical practice on cash payment alone.
Cash payment vs. insurance payment
Insurance premiums and deductibles continue to rise year after year. Many people have annual deductibles ranging from $2,500 up to $10,000. Most are healthy individuals who will likely never pay their deductible fully to have their insurance kick in. Insurance companies can and will take advantage of their members, and institute dangerous roadblocks to necessary care. Out of fear or lack of education, the vast majority of the American population continues to enroll and pay into predatory insurance plans.
Cash practices are a way to avoid dealing with insurance companies, including Medicare, Medicaid, and private institutions. When you take insurance, you invite a third party into your business and must navigate intricate federal regulations associated with insurance reimbursement. With cash payment, you can take the middle man out of the equation and streamline both your operations and finances.
Are cash practices lucrative?
Cash payment affords you freedom. You can practice as you want. You provide a service, and the patient pays you. Therefore, you should strive to open a cash practice. Many people are afraid that a cash-only practice will not generate enough revenue to keep the doors open. This is largely inaccurate, as most regions have a plethora of people willing to pay out of pocket for medical care.
To run a successful cash practice, you must provide significant value to patients. A generic health coaching business or basic primary care visit does not provide much value to a person. You must open a practice that has a niched service that people find valuable and difficult to obtain. Think outside the box, and you can float your business on cash payment alone.
A niche practice that provides services that are not typically covered by insurance will operate best as a cash-only business. Services like cosmetic injectables, hormone replacement, medical cannabis assessment, or holistic wellness coaching attract clients that are willing to pay out of pocket. Distinguishing yourself from competitors and developing an effective marketing strategy are paramount to a practice’s long term success.
33 Responses
Justin
Can you please, go deeper into the various niches.
Example, what is mens health, what does it take to start it. How is it marketed.
Then, another niche, to the next, to the next.
Also,
Will you be willing to coach for a fee?
Daniel,
Please see this post on niches. It is not totally inclusive but goes over common niches. I discuss how to find your niche in my book that I will be releasing in the next month. Here is a tip though: Figure out a need that a certain group of people need fulfilled. It can be difficult to find a niche some times. I plan on releasing an article about niches soon.
In terms of men’s health, essentially you are treating male specific issues such as low testosterone, erectile dysfunction, and performance enhancement.
I do consulting. I can assist you with building a practice from the ground up or with any other need you might have. Shoot me a message.
Good morning,
Please message me back.
I need your help please. I don’t where to start.
Thank you very much,
Gerthy
Check out the start here section: https://elitenp.com/start-here/
The courses: https://elitenp.com/products
Or email me: [email protected]
Great tips. Thanks for sharing. There are different ways to market. What have you found to work for marketing your practice?
Social media, billboards, and small niche advertisements such as in local publications. My men’s health clinic is advertised over bathroom urinals in bars and restaurants throughout town. It costs me $250 a month and I make thousands from them. The best ad I have! Experiment with a few different marketing channels and see what works.
Excellent!! My practice is cash right now but I recently applied to take UHC, Aetna and CIGNA. Like you said I feel like I need to add insurances to make a profit. I’ve been open since September and right now my practice is paying the bills but that’s it. Right now my practice is all niche, I do weight loss, IV hydration and hormone replacement therapy. I really like men’s health, I need to delve more into that. I’d love an article on just had to open a men’s health clinic.
Candi,
Your practice has been open for 3 months. You have achieved autopilot status. You are on track to make a profit. Your business is still a baby. I say avoid insurance for now and give your business another 3-4 months. I promise, the money will come. Read this article about how long it takes to generate a profit. I will be releasing a course on how to start a men’s health clinic in the upcoming 2-3 months after I release my book. It is just way to much information to release in an article.
I’m in process of starting a practice just like Candi’s. However, I’ve had conflicting information about offering services to Medicare Patients. Some have said if your office visit would normally be covered under Medicare, then you have to exclude these patients or bill medicare. Secondly, if I DO decide to bill medicare, do I need a practice NPI for my LLC OR use my individual NPI??
Greetings Suzanne,
Be sure to check out the Medicare article HERE.
You cannot see Medicare patients for COVERED services if you are credentialed personally with Medicare. Are IV vitamin infusions covered? No, they are enhancement. So, you can see them but they need to sign an ABN. Just check out the article.
In terms of NPI, you only need a group NPI (your LLC NPI) if it is going to be accepting insurance. If you are not, then you just function under your personal NPI. Check out the NPI article HERE.
Hi! Any advice on how to approach these businesses to get them to agree with marketing your business in their establishment?
Simply just ask to talk to the manager and see if there are any opportunities to advertise with them.
I would like to talk more about niche practices. This hospitalist night gig is getting old. Lol.
Shoot me a message through the consulting tab if you would like to brainstorm ideas. Night shift + hospitalist work = misery. That shit gets old really fast. I have been there…
What do you use for an EMR and how do you get around the Patient info gap between your practice and the conglomerates?
Paper charting during the start up phase. EMRs are regulatory requirements for insurance accepting practices. They are unnecessary. I only see an EMR being necessary until you have reached a patient census of 200. Then I would use a cheap one like simple practice or unicharts.
If a large corporate practice needs info, they can call and we will be more than happy to fax it to them and vice versa.
“My men’s health clinic is in one of the poorest counties in the country and it is flourishing. We only accept cash.”
#❤️OfaNurse
Thank You for this info! I’ve just launched my practice and have actually been stressed about the cash only aspect. I applied for Medicare provider but as you remind that’s a lot of oversight and regulations. I would love to speak with you more.
Ya, once you begin accepting medicare and medicaid into your practice, it really complicates things… Stick to cash if you want to start a side practice. Email me at [email protected]!
Hi Justin! We are following your elite np model after taking your courses. We have decided to start a medical weight loss practice- cash only. We are having some trouble figuring out prices, and payment models. I found a few blogs: Payment models, and Automatic payment plans. Do you have more articles that would help us with this issue?
Greetings C.,
In terms of pricing, I assume you are referring to this post. Also with automatic payment plants, I assume this one. Be sure to check out this article about subscription vs time of service pricing.
Follow the pricing recommendations in the courses. I personally like subscription models as it develops a solid stream of passive income. Essentially, call around other weight loss clinics in your area and determine the going rate of services, match or undercut them by 10%. This is an overall solid strategy!
Hi there,
I’m a FNP and interested in opening up a similar practice. Thinking cash pay as well. Have you started and how is it going?
Thanks!
Mich
If you take insurance, can you still have a cash practice for services not covered? How do you bill/charge for this?
Yes you can. You just charge them cash if it is a non covered service.
Read this: Accepting Cash Payments While Being Credentialed With Insurance
How do you transition from insurance to cash in psychiatry? How long will it take to build revenue? I do have a lot of cash paying clients. Best simplistic affordable emr that supervising physician can send out controls from? Hoping that Texas will become independent to cut out the supervising fee cost. Going cash will help eliminate biller and insurance verification person!!
It will take time Candra… Cash only psych works, it can just take some time to build up a solid clientelle, therefore it is best to treat it as more of a part-time practice for the first year.
Everything discussed in our “How to Start a Psych Practice” course here: https://courses.elitenp.com/p/the-how-to-start-a-psychiatric-clinic-course?affcode=521959_c6nscsmr
What would be considered “saturated”? I live in a rural town of 10,000 pop. and there are 3 medical practices that offer IV hydration. Would this be considered saturated?
In my opinion, yes that is saturated for IV infusion. So instead, offer something no one else is! Anyone doing HRT or weight loss?
I am interested in offering mobile services with injections and IV infusions. My question is how to obtain supplies. For example neurotoxins say they cannot be delivered to a residential address. If my business LLC is also my residential address will it work to have supplies sent to my home address? I also don’t know how to name my business. If you use aesthetics or med spa in the name do you have to have state inspections?
Yes, you can just ship it to your home if that is your business address.
In terms of naming your practice, follow the advice in the courses that covers this. Basically use a noun of your chosing and state the services you do. So something like “Flower Vitamin Infusions and Injections”
great infor-thanks
I’m trying to determine if I want to do a subscription payment system (monthly fee to be a patient), or to bill per visit. Do you know if subscription services can give patients a “superbill” for their insurance to reimburse?
Yes you can still give a superbill