cash practice
Money & Credit

A Cash Practice … Better Pay without the Hassle?

Practice overhead continues to rise. Third-party reporting requirements have become more cumbersome. Wages are going up. How can you work for reimbursement that doesn't even cover your practice's operating expenses?


With the rising costs of running a practice, many doctors are moving to cash practices. Does this make sense or is it even feasible for you?

Becoming a cash practice is ultimately a business decision. Cash-only practices may lower overhead by eliminating or greatly reducing costs for claim processing, clearinghouse fees and other expenses related to insurance and managed care.

In today’s market, with higher deductibles and copays, you may find that your practice is already shifting to more of a cash basis. However, it is important to keep the following in mind if you’re considering a cash practice:

  • Issues with time of service discounts. The Office of Inspector General stated that a time of service discount is customarily 5 to 15 percent and more than that may be considered to be an inducement. Check with your state board and/or a healthcare attorney before establishing a discount policy.

  • Preferred Provider Organization (PPO) agreements. Doctors often forget that as the provider, you agreed to accept a lower reimbursement in return for a PPO sending you more patients. Part of any contract negotiation is to look at what you are getting into. Read the policies and see what the reimbursement rate is before considering getting in (or out) of a PPO.

  • Current and potential patient demographics.
    • Are most of your patients in a PPO that covers chiropractic? If so, these individuals may be less interested in paying cash for their care.
    • How much can your patients afford to pay for care? In a recent survey, more than 25 percent of individuals said they could not could come up with $2,000 within 30 days for an unanticipated expense. An additional 19 percent of individuals could do so only if they pawned possessions or took out a payday loan.*

  • Regulatory requirements. Are you considering opting out of Medicare? This is not an option for Doctors of Chiropractic. Find out why. 

Is a cash practice a reality for you? The answer is—it depends. Look at your community, your patient base and federal and state regulations. Typically, the answer is a hybrid practice with some cash and some insurance received for care provided. Whatever you decide, make sure to do what’s right for you, your practice and your patients.


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.