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  • Start Cash Only Patient Side Gig

    Hi,

    Currently I am employed, paid via W2. Mostly see patients that are Medicare, Medicaid and private insurance. My question is, if I start a side gig, LLC, and accept cash only patients, is there anything legally stopping me from doing this on the side since I accept Medicare, Medicaid :-(, and private insurance at my normal job?

    thanks for your help. Also I practice in Minnesota
    Last edited by Peds; 03-07-2020, 09:46 AM.

  • #2
    what does your current contract say about outside work?

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    • #3
      Malpractice insurance and risk.

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      • #4
        This is a healthcare attorney question. I think it goes beyond just your employer allowing outside work.

        I personally don't think you can do this. Even though you're employed, YOU have a Medicare number, Medicaid number, NPI, private insurance numbers that I believe follows you across business entities.

        You may be able to do it with cash patients that don't have Medicare, Medicaid, or private insurance - but you can already do this under your current employed status if your employer allows cash patients and if they do I suspect they would perceive your outside services as a competing conflict of interest.. I don't believe you will be able to charge anyone who is insured as a cash patient for any covered healthcare services simply because you have a separate TIN. I'm by no means an expert that's why I prefaced this with guidance from an attorney.

        A lot of healthcare providers own side business just not healthcare. I've seen things like restaurants, spa/nail/hair salons, car washes, etc. That's a way around but requires extra capital since you're not just offering your own personal services but require employees. The trade off is it's more passive than having to be there and do it yourself. For me, I chose commercial real estate under a separate holding corporation, also more passive. Personally when I think side gig, my first thought is how passive it? Your family will appreciate that.

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        • #5
          There are issues with MCR patients in particular. It depends on what you are doing for cash exactly. I don't do this myself but understand many end up opting out of MCR. Also as mentioned check your current contract..

          First google result
          https://www.dpcfrontier.com/opting-out-of-medicare

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          • #6
            I'm surprised there aren't more folks here doing concierge practices.For private insurance patients you give the patient a super bill and they submit to their insurance if they so choose. Most will reimburse something generally not the entire price paid. Many of mine don't even submit. It is my understanding that since you work in the hospital you can't opt out of Medicare which means you can't accept patients with Medicare at your private practice even if they would like to pay cash. Don't take my word for it but I believe you could be liable to return all fees paid if the Medicare patient submitted your super bill for reimbursement. Medicaid is state dependent and in my state the person I spoke with said it was ok although no guarantee to patient of any reimbursement.

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            • #7
              I am not a lawyer and I don’t have a side gig. But this is extremely common for psychiatrists to do. They work 1099 at a hospital, and have a cash only private practice on the side. So I’m going to guess as long as it is a different business entity it is kosher.

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              • #8
                I am not a lawyer.

                If the side gig patients are not under any insurances you are contracted with...

                AND

                Your w2 job allows for outside work...

                then you're clear to proceed.

                Both statements must be true. Contracting with any insurance typically states you will not side step a patient's insurance.

                I am not a lawyer.
                "Oh look another bajillion point declin-Ooooh!!! A coupon for pizza!!!!" <--- This is what everyone's IPS should be. ✓✓✓

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                • #9
                  Originally posted by Cubicle View Post
                  I am not a lawyer.
                  If the side gig patients are not under any insurances you are contracted with...
                  I'm not a lawyer either and am not 100% but I haven't heard this with the exception of Medicare which has sticky tendrils in virtually every aspect of health care. It is my understanding insurance credentialing is location dependent and if not why are we tortured with the extensive onboarding insurance paperwork every time we add a new job?

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                  • #10
                    Originally posted by StateOfMyHead View Post
                    why are we tortured with the extensive onboarding insurance paperwork every time we add a new job
                    I'm not on any credentialing committee, but I'd guess... Adding a location or employer is for payment "routing". But when you originally contracted, part of that was "permission" to see their (insurance company's) patients. Vetting you. When I have had to add a new location since being credentialed, it was relatively quick & easy compared to the initial application.

                    I am not an insurance "credentialer".
                    "Oh look another bajillion point declin-Ooooh!!! A coupon for pizza!!!!" <--- This is what everyone's IPS should be. ✓✓✓

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                    • #11
                      Originally posted by Cubicle View Post

                      I'm not on any credentialing committee, but I'd guess... Adding a location or employer is for payment "routing". But when you originally contracted, part of that was "permission" to see their (insurance company's) patients. Vetting you. When I have had to add a new location since being credentialed, it was relatively quick & easy compared to the initial application.

                      I am not an insurance "credentialer".
                      Yeah and I shouldn't complain because the heavy lifting is done by admin. Out of Network services are quite common in the concierge practice world. OP should do their own investigation of course but I haven't had an issue collecting cash from my private practice patients who have insurance even if I am paneled with that insurance at other locations.

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