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A cash-pay practice takes no insurance: patients pay directly, at time of service or by membership. You trade payer revenue (and payer bureaucracy) for pricing freedom and radically simpler operations.

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What you skip, and what you don’t

You skip payer contracting, credentialing files, EFT/ERA enrollment, claims, denials, and most of the claim lifecycle. You do not skip: entity formation and CPOM rules, licensure, malpractice coverage, HIPAA (you’re still a covered entity if you transmit any covered transactions, and even if not, state privacy law applies), and OSHA.

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The Medicare decision

Seeing Medicare-eligible patients cash-pay is the one place this model gets legally sharp. You have three positions: enrolled (you bill Medicare, not this model), non-participating (you can charge patients but limits apply), or opted out with private contracts (you may charge freely, but the opt-out is a formal filing, renews automatically, and bars you from billing Medicare for two years). Dentists mostly avoid this; physicians in direct primary care live and die by it. Get the opt-out filing right before seeing your first Medicare-age patient.

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Superbills

Many cash-pay practices hand patients a superbill, a coded receipt the patient submits to their own insurer for out-of-network reimbursement. It costs you little and softens the “you don’t take my insurance?” objection, but it means you still need accurate CPT/ICD coding even without claims.

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The payment stack

Your revenue engine is card processing, memberships, and packages, covered in detail in Choose your POS system. Banking stays simple: an operating account your processor settles to, a tax reserve, and clean separation from personal funds (account structure).