Podcast
Jan 29, 2026
Roetzel HealthLaw HotSpot: Concierge Practices: Getting Started and Staying Compliant
In this episode of Roetzel's HealthLaw HotSpot, host Ericka Adler is joined by Roetzel shareholder Christina Kuta to discuss the growing trend of concierge practices and the initial steps to start a concierge practice. Ericka and Christina explain why choosing the right professional entity matters, how state laws and corporate practice of medicine rules may apply, and the key differences between hybrid concierge practices and cash-only practices. They also cover important compliance considerations for insurance contracts and Medicare, along with essential concierge documents like intake paperwork, patient agreements, HIPAA documents, good faith estimates and informed consents.
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Transcript
Ericka Adler:
Hi, everyone. Welcome to the Health Law Hotspot. I'm Erica Adler, shareholder, leader of the healthcare practice at Roetzel and Andress. I'm joined by my partner, Christina Kuta, who's also a member of our Health Law practice. Welcome.
Christina Kuta:
Thanks for having me.
Ericka Adler:
And today, we're at the beginning of 2026, and one of the biggest and growing trends that Christina and I are dealing with right now is the explosive increase in the number of concierge practices across the country. We've been setting up a lot of these, and one of the most common questions we get is what are the most basic steps to be able to start your own concierge practice?
We're going to run through those basic steps today, and of course, there's always a lot more information than we can cover today, but feel free to email us with any questions you may have.
Let’s start at the very beginning. What is the first step for someone who wants to start a concierge practice?
Christina Kuta:
One of the first things we tell someone is to make sure they have an appropriate professional entity. So, either form a new entity, or, if you have an existing practice that you want to convert to a professional concierge practice, you can use that as well. But make sure you have an entity. It's not beneficial from legal perspectives to operate as a sole proprietor. And make sure you follow your state laws on the type of entity you need to practice medicine.
There are a lot of states that we call corporate practice of medicine states, where entities are required to be owned by licensed professionals only, and have to be a certain type of professional entity. For example, a PLLC versus an LLC. So, make sure you're aware of what your state allows, and get an entity set up.
Ericka Adler:
Right? And I think that's really important, because a lot of the doctors that are doing concierge now, in my experience, seem to be exiting large healthcare systems and going out on their own, so they may or may not ever have owned a practice before, and don't necessarily know the right type of entity to use. This is something to pay attention to.
Now, there are a couple different kinds of concierge, right? And we want to kind of talk about both of these. There is a type of practice where you're going to be pure concierge, you're just taking cash, you're not taking commercial insurance or Medicare, and we're going to talk about that. And then there's what Christina and I call a hybrid concierge practice, which is that you're taking insurance and you're taking some type of cash for services not covered by insurance.
Let's start first with the more complicated type, which is the hybrid. Talk me through this. How do we create or convert to that kind of practice?
Christina Kuta:
If you want to have a hybrid practice, and if you currently have an entity that's already practicing medicine and taking insurance, then you probably don't have to make any changes. If you're forming a new entity, you would need to go ahead and be credentialed and enrolled in whatever insurance plans you intend to take.
As you indicated, the hybrid practice really is a practice that will take insurance for covered services but will charge cash for services that are not generally covered by insurance. Now, these are more complex, certainly, than cash-only practices for a number of reasons, but some of the highlights are you have to be very careful of what your insurance contracts say. There are a lot of things you may think are not covered by insurance, but they really are covered by insurance. And you can't charge cash for them if you are a provider participating with an insurance plan and have a contract with that insurance plan.
Additionally, you need to make sure there are no prohibitions in that payor contract on concierge practice. We have seen recently contracts with insurance companies that specifically say if you are running a concierge-type practice or a hybrid-type practice, you cannot participate as a credentialed provider with that particular insurer. You have to really pay attention to what your insurance contracts say, and make sure you get good advice that what you intend to do as a hybrid practice works with your contract because you don't want to run into a breach of contract issue.
The other thing is, if you're going to take Medicare as part of your hybrid practice, Medicare does not allow a provider to charge cash to a Medicare patient for any service that is covered by Medicare, even if the patient wants to pay cash.
So, if you choose to take Medicare, you have two options. Every service that's covered by Medicare has to be billed to Medicare. You only can charge patients out of pocket for things that are clearly not Medicare covered.
Or two, you can go into what is called a Medicare opt-out. And a Medicare opt-out is a formal process where you opt out of Medicare, and you are allowed, then, to bill patients with a specific written contract that you have with the patient, cash for services that Medicare otherwise would cover.
Now, one of the things we find with physicians wanting to start their concierge practices, they tend to maybe keep another job around for a while until the business ramps up and gets a good patient base.
If you opt out of Medicare, you opt out of Medicare not just for your concierge practice, you opt out of Medicare entirely. You cannot pick and choose. Almost universally, if you have another job, or you want to work or maybe moonlight in a hospital system or something while you're building up your concierge practice, they're going to require you to take Medicare, and you can't opt out if you have another job that requires you to be in Medicare. You have to be very, very careful when taking Medicare patients and actually accepting Medicare as part of your practice.
Ericka Adler:
One of the most complicated things for a concierge practice or a hybrid concierge, is trying to figure out what are those extras you could charge for. As you mentioned, you need to make sure it's not something covered by the insurance contracts, and we spend a lot of time talking with our clients about what can they charge for, and it's got to be things that aren't covered, and the answer to that can change annually.
Years ago, when we used to do these, the annual physical wasn't covered, and doctors used to charge extra and do an annual physical. Now it is covered by Medicare and most insurance policies, and so there's an annual review of your contracts that's needed, and you're going to have to be creative about testing. A lot of the concierge practices we see are offering items and services that are clearly not covered by insurance. Whether they ever will be, I don't know, it's possible. But they work very hard to try and figure out what these are.
The ones that are taking a little bit more risk are doing kind of iffy type things, where some insurers might carry it, some insurers might consider it to be part of what they're paying for, and there's a little bit more risk. So, it's really important to work with your counsel to try and figure out what are these extra services, and to come up with a process to continuously confirm them.
Christina Kuta:
Yeah, and a really good example of that is we have a lot of clients that want to say, okay, well, I'm going to charge a monthly fee, and that monthly fee is going to allow anyone who enrolls in that is going to get better, quicker office visits, or better appointment times, or we'll see them on weekends, but we won't see anybody else on weekends.
Many of your insurance contracts, if you read through them, will say if you offer certain times, and you're open certain times for any patient, you have to allow our patients to be able to go into those times, and you can't charge them extra for that. So, you have to be very mindful of what your insurance contracts say, and they often get amended from time to time. And almost always they say they can be amended by just giving you notice of the amendment, not having your approval for the amendment, so you've got to be on top of it.
Ericka Adler:
Right, I think that's probably one of the biggest challenges because that extra fast service and additional availability, etc., is one of the most popular things that are offered in concierge practices.
One other item I want to talk about here is if you are converting to a hybrid concierge practice, can you require everybody to participate in it? And what happens if some patients are not interested?
Christina Kuta:
That, again, depends a lot on your insurance contract. I've read contracts that specifically say you can't charge an access fee for someone if you accept our insurance, you have to accept our insurance patient, and you can't charge an access fee. So in that instance, you couldn't tell, let's say, a Blue Cross patient, just as an example, you can see me here, but you have to pay $500 a year to be part of my practice because that would be considered an access fee, and if the contract said you can't do that, you can't do it. So, you really have to pay attention to your contracts.
If your contract doesn't say that, and there's no contractual restrictions, generally you're okay saying my practice is open to patients that are paying an annual fee or that are willing to pay our monthly fee, that's generally acceptable. There's no overarching law prohibiting that, but there certainly may be contractual provisions, if you are a hybrid practice, that are going to prohibit that or limit it in some way.
Ericka Adler:
Let’s talk about the other kind of practice, which is a pure concierge. This would be a practice that takes cash only, there's no insurance at all. Obviously, it's a lot simpler. You can charge what you want, and you can say it's any amount for any type of services that you're offering, okay?
What happens if you're running a cash practice, though, and patients still have insurance? What happens then?
Christina Kuta:
It you're running a cash practice and the patients still have insurance, but you are not yourself enrolled as a credentialed provider in insurance, you're not required to accept insurance or bill insurance for the patient.
Patients sometimes may say to you, look, I want to see if my insurance will reimburse me for this. You'd be considered an out-of-network provider, so we have practices we work with that may provide a super bill or provide a copy of the record that a patient can take to their insurance and see if their insurance will reimburse the patient directly for the service for which they paid out-of-pocket cash, but that's not generally something the practice would be involved in. They're not billing insurance, and they're not collecting from insurance.
They can just assist the patient with documents and records as may be needed if they want to try to get some sort of reimbursement from their insurance.
Ericka Adler:
For both concierge and hybrid concierge, obviously, if you're starting a practice, you need to think about some of the traditional items that any practice would need, right? You've got to get your space, your equipment, your personnel, your new vendors, EMR, whatever it is. Those are general practice startup items, and certainly, you know, we assist many of our practices, whether concierge or not, to do that. But let's talk about the next step in a concierge practice, which would be the documentation. What kind of documents are these practices needing to have set up, and how might that differ depending on the type of practice?
Christina Kuta:
Sure. You definitely need intake documents, which you would have probably at any type of practice, even a traditional, medical practice, that sets forth patient information, information you may want to know as a clinician about medications, past, health history, etc.
The really important document for a concierge practice, whether hybrid or cash only, is a patient agreement that details what services they're getting, what the costs are, what the practice policies are, what's the expectation of the practice, and how you can get ahold of the provider. The most important of that being what services are being offered and what the cost is for those services. That's really a contract directly with you and the patient, where the patient understands, I'm getting X and for that, I'm paying Y. Very, very important.
And like I said, if you opt out of Medicare, you go through that process so you can charge cash to Medicare patients. There's a very specific contract that needs to be signed with a Medicare patient that's almost entirely set by regulation, so you want to work with, a legal counsel who understands that type of arrangement to make sure that you have an appropriate contract set up with Medicare patients if you're opting out.
HIPAA documents will generally be required, so again, that's something that would be similar to most practices. One of the things we also talk about is a good faith estimate. There is a law that came out a few years ago that said patients paying cash for services and not using insurance are entitled to a good faith estimate and a notice of a good faith estimate of costs. I don't personally think that when the law was created, regulators and legislators were thinking about these cash-only practices, but by definition of the law and the way it's written, I believe that good faith estimates are included and required, so that would be something you need to consider.
Also, depending on the type of practice, if you're going to do telehealth, you should have a telehealth consent that clearly explains how telehealth will work. and what the expectations are for that. Like, you won't be in a car when you have telehealth, you'll make sure you're in a private space, etc.
If you're a practice focusing on mental health services, we generally recommend a separate informed consent for mental health services, informed consents for specific treatments. If you're going to offer certain treatments that are more thought of like medical spa treatments or laser treatments, things like that, you would want to have specific consents that discuss the risks and the benefits and expected outcomes for those services.
And then also, if you intend to keep a credit card on file, which is allowed in most states, but does depend on your state's law. Many of our concierge practices, because there is an out-of-pocket fee, will keep a credit card on file and automatically charge that credit card. You want to make sure you have a document that specifically allows you to do that, and that also meets your state's legal considerations. There are some federal laws, as well that touch on the credit card on file use.
Ericka Adler:
Okay, well, that's a long list, and I'm sure there's more that come up in our discussions with clients as well. The one last thing I want to remind people of is that a cash or concierge practice is still a practice, and a lot of the doctors who start these practices still need to think about the business and legal issues that any practice would think of, right? Whether that is doing a website that's appropriate and not inappropriate. I find this is very common, just copying photos off Google or something and using them on their website because that opens you to getting sued for copyright infringement.
You want to make sure even if you have a small staff, that appropriate supervision is being provided. In these concierge practices, if you're using a nurse practitioner or an RN, depending on the services you're offering, supervision is still required. There are no carve-outs because of these types of practices that would allow you not to otherwise comply with the very same practice requirements of a larger practice, a private practice, a traditional practice, right? Sure. I know they're very new and popular, but you still need to understand that it's a practice in all the ways that matter, and the same requirements apply.
If there's any questions you have about setting up your new practice, these are the steps that you can look to follow. We're happy to help you every step of the way, and although it sounds like there's a lot to do, it's actually not too difficult or too time-consuming to help you achieve these goals. And as you start off in 2026, if this is something that you're hoping to do, we hope that you'll give us a call and let us know what questions you have. Anything you want to add?
Christina Kuta:
The only thing I would add is, I actually talked to a practice once that didn't think they had to keep patient records because no insurance company would ever review them. That is absolutely untrue. For your own liability, always keep patient records, but most often, your state medical board, your license, all require you to keep appropriate patient records. So, like Erica said, it still is a practice, and still is a business, and you have to follow all the rules that apply to the practice of medicine and being a medical professional.
Ericka Adler:
Right, that's a great point, I forgot about that. All right, well, this is our topic on concierge practices. I hope that you'll reach out with any questions that you have. This is the HealthLaw HotSpot, and you can catch more of our episodes at ralaw.com. Thanks for joining us, we'll see you next time.
