The emerging cash-based practice model, also called private pay, is an alternative to the traditional insurance-based system, and it’s changing how practitioners and patients navigate healthcare. It’s no surprise that this model is growing in popularity as practices seek to maintain the balance between providing quality care and maintaining financial sustainability.
In this article, we’ll help you understand the concept of running a cash-based health practice so that you can evaluate the advantages and disadvantages and decide whether the model is a good fit for your practice.
What is a Cash-Based Health Practice?
A cash-based health practice follows a payment model in which healthcare providers set their own out-of-network fees, bypassing the complexities and limitations of insurance-based billing.
In this model, patients directly pay the practitioner for their care rather than using health insurance as an intermediary. From there, patients with health insurance will submit claims to their insurance companies for reimbursement.
It’s a clear-cut exchange that many find appealing due to the simplicity and transparency of it. It’s important to note that ‘cash-based’ doesn’t just mean physical money – checks, credit cards and online payments are typically accepted as well.
How Do Cash-Based Health Practices Work?
Cash-based practices work by creating a direct financial relationship between the healthcare provider and the patient.
Instead of billing an insurance company, the practice bills the patient. This payment is usually made upfront or at the time of service, although some practitioners may offer payment plans for more expensive procedures.
The pricing structure is usually straightforward, with fees for services clearly listed. This transparency allows patients to claim from their insurers and better anticipate healthcare costs.
Keep in mind, that while some patients may pay for services entirely out-of-pocket, many will use their out-of-network insurance benefits to cover some of the expenses. As a cash-based practice, you can provide the necessary documentation for out-of-network insurance claims with Power Diary’s Superbill feature. Superbills contain a complete breakdown of the treatments and fees associated with a patient’s care.
Superbills are used primarily for out-of-network patients, for example, if your practice is not included on a patient’s insurance company panel.
The simplicity of the cash-based model doesn’t necessarily imply that it’s the right choice for every practitioner or patient, as there are some pros and cons. Understanding the implications will help you gauge if this model aligns with your professional goals, patient care philosophy, and any requirements that apply to your practice regarding billing and out-of-network reimbursement.
What are the Benefits of a Cash-Based Practice?
Running a cash-based health practice can offer several potential benefits that could enhance your professional experience and the service you offer to patients.
Here are some of the key advantages:
By sidestepping the insurance system, you gain more control over setting your rates and managing your income.
This can free you from the limitations and unpredictability of insurance panels and their reimbursement rates, allowing you to better steer the financial direction of your practice.
Reduced Administrative Burden
A significant portion of healthcare administrative work is dedicated to managing insurance claims, following up on reimbursements, and navigating the nuances of insurance policies.
Adopting a cash-based model can significantly reduce this workload, saving both time and resources and reducing therapist burnout.
This reduction in administrative tasks means you won’t need a dedicated staff member to handle claims, leading to further cost savings. This becomes even more achievable if you’re using good practice management software.
Greater Flexibility in Treatment
In insurance-based models, third-party payers often set restrictions on the types of treatments covered and the number of sessions allowed, or they may require prior approval for certain procedures.
With a cash-based practice, you have the freedom to design tailored treatment plans without session limits or the need for third-party approvals. This means you can focus solely on what’s in the best interest of your patients.
Improved Patient-Practitioner Relationship
A cash-based practice has the potential to foster a more direct relationship between patients and providers. With less bureaucratic interference, your interaction with patients becomes more personal and focused.
Potential for Improved Patient Commitment
Patients who invest directly in their healthcare may feel more committed to their treatment plans. This can enhance treatment adherence and overall patient outcomes.
Expanded Clinical Reach
With options such as memberships, payment plans, and concierge services, running a cash-based practice could expand your clinical reach.
Keep in mind, though, while these benefits are appealing, it’s important to weigh them against potential downsides and consider whether this model is the best fit for you and your patients.
Cons of Running Cash-Based Health Practice
Cash-based practices can offer benefits, but they also come with their own set of challenges.
Here are some potential hurdles to consider:
Potential Decrease in Client Pool
One of the primary concerns for healthcare providers contemplating a transition to a cash-based model is the potential decrease in their client base.
If you’ve previously accepted insurance, some existing patients who rely on in-network insurance coverage may choose to leave following a shift in payment requirements.
It’s essential to plan for a potential client drop-off and consider how this change might affect your patient numbers and your practice’s financial stability. But remember, existing patients with out-of-network insurance coverage can still submit their own reimbursement claims with Superbills.
Attracting Clients Without Accepting Insurance
While a significant portion of the population carries health insurance, the number of individuals willing or able to pay entirely out-of-pocket or go out-of-network for services is usually smaller.
The challenge lies in reaching and convincing this demographic to consider your practice. This may also limit the scope of services you can provide, as more expensive treatments may only be feasible for some patients with the help of in-network insurance coverage.
Need for Effective Marketing & Communication Strategies
Transitioning to a cash-based practice often requires practitioners to adopt a more entrepreneurial mindset.
To attract and retain clients, you’ll need effective marketing strategies that communicate the value your practice offers. This is particularly crucial in explaining to potential patients why they should choose your services over a provider who accepts their insurance.
Potential Loss of Referrals
In insurance-based models, new patients often come through in-network referrals.
This referral stream might diminish in a cash-based system as you’re no longer “in-network” for any health insurance companies.
Increased Patient Financial Responsibility
While a cash-based system can offer more transparency in cost, it also places more financial responsibility on the patient.
This can become a challenge if patients are unable or unwilling to meet these obligations, leading to potential payment issues.
Professional Body Compliance
Depending on your location, a ‘good faith estimate’ may be required for uninsured or self-pay patients. This is to protect patients from any nasty surprises when they receive their bills.
It’s crucial to carefully consider these factors and plan adequately before transitioning your practice.
The growing trend of cash-based health practices is reshaping the healthcare industry. Whether or not a cash-based health practice is right for you, staying informed about these trends will ensure you’re equipped to make the best decisions for your practice and your patients.
Before taking the plunge, consider the feasibility and potential pros and cons. The benefits can include financial independence, reduced administrative burdens, and greater treatment flexibility. But there are also challenges to be mindful of, such as potentially diminishing your client pool, the need for effective marketing and communication strategies, and increased patient financial responsibility.
Whether you’re currently operating a cash-based practice, considering the transition, or simply exploring options, practice management software like Power Diary can help you navigate the ins and outs of efficient patient billing and payment. And, with features such as the ability to generate Superbills for clients, you can mitigate some of the common concerns with switching to a cash-based model.
Ready to take the plunge?