We Are Not Paying You

  1. Dear Nurse Practitioners,

    I have been forming an interest in establishing a private practice clinic in my future.
    I know insurance/ billing is a major issue for all healthcare providers; I have even heard of insurance companies not reimbursing nurse practitioners, or even medical doctors.
    Some providers have started clinics/ offices that only accept cash.

    My questions for you all:

    1. Do any of you have a private practice that does not accept insurance, only cash?

    2. Have any of you heard of such a thing in your area?

    3. *Kind of an off topic question* Can an AG-ACNP open their own practice?

    Kindly,
    MrCleanScrubs
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  2. 17 Comments

  3. by   caliotter3
    The owner of an Urgent Care Clinic I have been to only accepts cash. He is willing to sign paperwork for patients to claim reimbursement from their insurance companies but he won't initiate insurance paperwork in lieu of his fees.
  4. by   Oldmahubbard
    I had a private psychiatric practice with a physician about 10 years ago. We attempted "cash only" for more than a year and got nowhere.
  5. by   lhflanurseNP
    There are quite a few "concierge" practices that take cash only. Many solo practices are going this route as dealing with insurance is costing them more money than they are collecting. You almost need 1 staff person to deal with insurance only in your clinic. These practices will lose patients who cannot afford this type of practice, but from what I am being told, "I may not be making as much, but I am a lot happier and less stressed". As to your third question...depends on your state's laws I would think. If in an independent state...sure. If not, is the collaborating MD willing to allow you "independence"?
  6. by   Jules A
    A cash practice can take a while to build and the success can depend on the economy in your area and your contacts. The NPs and MDs I know doing this business model bill far more than those of us who accept insurance. They are making more money if their practice grows to full time but also have more responsibility on many levels when dealing with the boutique crowd.
  7. by   Oldmahubbard
    I know an MD who does this, but he also has a M-F job. This has been going on for quite a few years, so it doesn't look too hopeful as a main income.

    Your odds are much better in a high socioeconomic zip code, but I am sure you know that.
  8. by   Oldmahubbard
    Also, even in independent states, many insurances do not reimburse NP's without a physician collaborator. Which would be a major expense.
  9. by   NHGN
    At the suggestion of my past Attending/mentor, I'm going to do a cash-only private practice on the side (starting with one day a week). He does the same in my town and charges $500 for intakes (granted he's a physician). He does p/t as well and says he consistently gets calls for new patients, whom he cannot take on (he's full). So I will see what comes my way. My expenses so far have been setting up my LLC ($500, to round up), listing myself in Psychology Today ($30/m), I have a pending email to change my malpractice insurance (this will not go up by much, I think), I checked out a nice office I can rent for $15/hr, and I was recommended an EHR for $60/m. That all adds up to... not a lot. My skeptical brain cannot fathom that I could make a profit in my first month (if I even had just two-three patients), but that's what it seems like.
    I'm not doing any outreach for now; I'm going to see if anyone contacts me this first week, and go from there.
  10. by   mrcleanscrubs
    Quote from caliotter3
    The owner of an Urgent Care Clinic I have been to only accepts cash. He is willing to sign paperwork for patients to claim reimbursement from their insurance companies but he won't initiate insurance paperwork in lieu of his fees.
    Oh wow, that's really nice of the provider to sign the insurance reimbursement claims; great idea actually.
  11. by   mrcleanscrubs
    Quote from Oldmahubbard
    I had a private psychiatric practice with a physician about 10 years ago. We attempted "cash only" for more than a year and got nowhere.
    Wow, that is great! Psychiatry is an awesome specialty - but it is unfortunate to hear that your cash only goals did not work out. Sorry about that; thank you for sharing your experience!
  12. by   mrcleanscrubs
    Quote from lhflanurseNP
    There are quite a few "concierge" practices that take cash only. Many solo practices are going this route as dealing with insurance is costing them more money than they are collecting. You almost need 1 staff person to deal with insurance only in your clinic. These practices will lose patients who cannot afford this type of practice, but from what I am being told, "I may not be making as much, but I am a lot happier and less stressed". As to your third question...depends on your state's laws I would think. If in an independent state...sure. If not, is the collaborating MD willing to allow you "independence"?
    That is exactly what I have been hearing, insurance is too stressful and costly due to the fact that as you said, a billing employee would need to be hired. I definitely agree with the quality of life over income statement - it's better to be happy and less stressed. I'm in New York, and a new law has been in process that allows nurse practitioners to have their own practice without a collaborative physician after the NP has had over 3,600 hours of practice under their belt. I know that nurse practitioners can open their own practice, however many that choose to are Primary Care Nurse Practitioners, or FNPs; I on the other hand would be an Adult-Gerontology Acute Care Nurse Practitioner - would opening my own practice be achievable given my specialty? As most ACNPs are utilized in hospitals.
    Thank you for your reply :-)
  13. by   mrcleanscrubs
    Quote from Jules A
    A cash practice can take a while to build and the success can depend on the economy in your area and your contacts. The NPs and MDs I know doing this business model bill far more than those of us who accept insurance. They are making more money if their practice grows to full time but also have more responsibility on many levels when dealing with the boutique crowd.
    You are absolutely right. As you said, I think it would be a great idea to get involved in the community first, and become well known - and then open a practice after you have a list of clientele ready for your services. Thank you!
  14. by   mrcleanscrubs
    Quote from Oldmahubbard
    I know an MD who does this, but he also has a M-F job. This has been going on for quite a few years, so it doesn't look too hopeful as a main income.

    Your odds are much better in a high socioeconomic zip code, but I am sure you know that.
    Oh wow, as you said though, your odds are much better in an area of higher income.Thank you for that suggestion.

    And yes, even in independent states, insurance companies will not reimburse NP's without a physician collaborator - in which cash only might be the case. But then again, who is to say cash only will be a success.

    Thank you for your awesome input!

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