> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Practice model: cash-pay only

> What running a cash-pay / direct-pay practice actually changes, pricing, compliance, Medicare opt-out, and the payment stack.

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.

## 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](/concepts/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.

## 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.

## 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.

## The payment stack

Your revenue engine is card processing, memberships, and packages, covered in
detail in [Choose your POS system](/guides/choose-your-pos). Banking
stays simple: an operating account your processor settles to, a tax reserve,
and clean separation from personal funds
([account structure](/concepts/practice-banking-structure)).

## Related

* [Choose your POS system](/guides/choose-your-pos)
* [Choose your legal entity](/guides/choose-your-entity)
* [Practice model: insurance-based](/concepts/practice-models-insurance)
* [Practice model: telehealth](/concepts/practice-models-telehealth)
* [Practice model: hybrid and membership](/concepts/practice-models-hybrid)