Chapter 5
The Fatal Blow – Let’s All Go “Cash”
So let’s give them the fatal blow—let’s all go “cash.” Not so fast! Do you really think they haven’t thought of that?
But here’s their fatal blow: Make it so difficult for you to compete that you want to give up, only to realize that you cannot.
Just when you think you are out, they pull you back in!—The Godfather
You can get more in depth on this topic by visiting www.pricipledcash.com.
There are several reasons why there is really no such thing as a fully “cash” practice.
The “Cash” Myths
- A lot of doctors believe that “going cash” means that if they collect payments from their patient (and give them a super bill), they can avoid all liability, billing hassles, and documentation and coding compliance.
- Doctors believe they are more principled when they go cash.
The “Cash” Truth
- State boards are now requiring Medicare level (or higher) medical necessity and coding. So you’re never really off the hook with documentation or coding. It is now a standard of care requirement, not just an insurance company requirement.
- You must submit claims to Medicare for patients in active care. It is the law. You cannot collect fees from Medicare patients up front for active care.
- Even if a patient pays you in cash and submits a super bill to their insurance company, insurance companies and state boards can still audit you (see the Principled Cash website).
- Patients want to use their insurance. A lot of cash practices give their patients super bills and have the patient submit the claim to their insurance company. We already know that insurance companies are a pain to deal with. Why would we think the customer experience is improved by asking them to do something that is a pain in the
- neck (no pun intended)? We’ll talk about how we can make this really simple for a practice later on, but for now, just keep this in mind. Patients want to use their insurance, and they do not want the hassles you are trying to avoid. One little denial from the insurance company, and they will just stop coming in, especially since the insurance company will likely blame you for the denial.
- Going cash means nothing in terms of principle. The way you measure principle and your ability to communicate it is by PVA (patient visit average). How long do patients stay in your office? More principled practices have patients convert to lifetime care regardless of who pays for that care at various points.
I have been in cash-only practice for five years and practicing for over 10.
We see a very high volume of patients. I have been using Dr. Brian’s systems
before and after going cash, and I can tell you from experience,
there is nothing like it. I would never practice without it again.
—Chris Zaino
Wrong Question
The question we should not be asking: How can we see patients and avoid coding and documentation and other compliance requirements? It is a reality we cannot escape.
Correct Questions
- How can we see patients, regardless of who is paying at any given point, and have systems in place that make it feel like a cash practice for the doctor and staff?
- How do we convert patients to lifetime care regardless of who is paying at any given point?
Fight Back
It’s a hard pill to swallow. They have you where they want you. So how can we band together and beat them at their own game? Here’s the short answer:
We must change the way we are thinking about this game
and the way we are currently fighting back.
After all, insurance companies are playing chess, and we are playing checkers.
I hope by now that you see I have been looking at this chess board for many, many years while others have no idea they are playing chess. Others are building services and technology, all based on a false premise or paradigm. This will all go away someday, or they can make it go away by “going cash.”
“Contradictions do not exist. Whenever you think that you are facing a contradiction, check your premises. You will find that one of them is wrong.”
—Ayn Rand
It is an inconvenient truth and a reality. I am a realist. I never wanted to get into this field, but when I found this information, when I realized there was something I could do to help other chiropractors, I simply had to take action. I closed a very successful (yes, principled) practice to take on this battle. I found a way to actually beat insurance companies at their own game.
I’ve spent 13 years and literally millions of dollars to make this a reality. I would have made much more money simply practicing and turning a blind eye. In that way, it has cost my family as well. I had no promise I would ever see a return on this investment.
Today, thousands of users are leveraging this new methodology I put together to build large, principled, lifetime care, massively profitable practices. They are collecting both cash and insurance, while maintaining compliance with relative ease. They do this in as little or less time as it would take them to be a cash practice.
We are in a time when chiropractors are struggling due to overwhelming demands. They’re not just insurance demands—they’re all the demands that go into managing a business, professionally and personally.
After all, insurance companies are playing chess, and we are playing checkers.
I hope by now that you see I have been looking at this chess board for many, many years while others have no idea they are playing chess. Others are building services and technology, all based on a false premise or paradigm. This will all go away someday, or they can make it go away by “going cash.”
“Contradictions do not exist. Whenever you think that you are facing a contradiction, check your premises. You will find that one of them is wrong.”
—Ayn Rand
It is an inconvenient truth and a reality. I am a realist. I never wanted to get into this field, but when I found this information, when I realized there was something I could do to help other chiropractors, I simply had to take action. I closed a very successful (yes, principled) practice to take on this battle. I found a way to actually beat insurance companies at their own game.
I’ve spent 13 years and literally millions of dollars to make this a reality. I would have made much more money simply practicing and turning a blind eye. In that way, it has cost my family as well. I had no promise I would ever see a return on this investment.
Today, thousands of users are leveraging this new methodology I put together to build large, principled, lifetime care, massively profitable practices. They are collecting both cash and insurance, while maintaining compliance with relative ease. They do this in as little or less time as it would take them to be a cash practice.
We are in a time when chiropractors are struggling due to overwhelming demands. They’re not just insurance demands—they’re all the demands that go into managing a business, professionally and personally.
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