As physicians continue to operate with razor-thin margins, some are considering alternatives to relying entirely on traditional fee-for-service revenue from payers. These additional options include:
- Concierge medicine, a business model where all patients use traditional insurance for visits, labs, and procedures but pay membership fees — usually monthly or annually — in exchange for enhanced access and personalized service. Fees vary widely but are often $1,500–$5,000+ per year and sometimes even more for high-end practices.
- Direct pay primary care, a business model where all patients pay directly for primary care services and also pay a membership fee (usually lower than concierge) for non-primary care services. In this model, patients do not use traditional health insurance.
- Hybrid model, a business model where patients choose whether they use health insurance or pay a flat monthly fee (with no health insurance billing).
| Model | Bills insurance? | Revenue source | Billing complexity |
| Concierge medicine | Yes (for covered services); membership fee for non-covered services | Dual: Membership fees + insurance reimbursement | High — Must manage two revenue streams and ensure strict separation to avoid compliance issues |
| Direct primary care (DPC) | No (for primary care services) | Membership fees only (cash pay) | Low — No claims, denials, or payer rules; focused on recurring payments |
| Hybrid model | Yes (for some patients/services); others pay membership only | Mixed: Membership fees + insurance (varies by patient and service) | Very high — Multiple workflows depending on patient type; requires careful coordination and communication |
From 2018 to 2023, the number of concierge and direct pay practices grew by 83%, and the number of clinicians in those practices increased by 78%. Shifting to an alternative business concierge medicine model is monumental for practices, and it’s also a big change for the billing companies that support them.
What happens to billing when practices go concierge? It evolves. This means billing companies must be ready and willing to pivot.
What happens to billing when practices go concierge?
When transitioning to concierge model billing, direct primary care, or a hybrid model, billing workflows must change accordingly. Depending on the specific model, traditional fee-for-service billing may still apply for certain services. In this case, billing outsource partners must continue to submit claims using standard ICD-10-CM and CPT codes and follow payer rules for medical necessity and documentation.
However, billers may also need to collect monthly or annual fees for non-covered services such as enhanced 24/7 access, care coordination, longer visits, and communication. The practice must clearly separate what’s included in the membership vs. what’s billable to health insurance.
| Workflow area | Pre-concierge (FFS model) | Post-concierge model |
| Revenue intake | Insurance-driven (claims submitted after visits) | Membership fees upfront + selective insurance billing |
| Front-end processes | Eligibility checks, basic copay collection | Membership enrollment, recurring payments, clear patient financial communication |
| Claims processing | High-volume claims submission and coding | Lower volume, but still required for covered services |
| A/R & follow-up | Heavy focus on denials, appeals, A/R aging | Reduced A/R, more focus on payment at time of service |
| Patient billing | Statements, collections, payment plans | Fewer statements, more real-time payment and engagement |
| Key focus | Back-end revenue recovery | Front-end financial management + compliance oversight |
What billing companies should do immediately when a client goes concierge
What happens to billing when practices go concierge? When a client goes concierge or adopts a direct pay model, billing companies must immediately:
- Establish new key performance indicators (KPI). Billing companies must expand beyond claims to track membership churn and retention, monthly recurring revenue, and cash flow predictability versus fee-for-service variability.
- Evolve your value proposition. To stay relevant as fee-for-service revenue decreases, billing companies can offer additional services such as financial modeling, patient financial experience optimization, advisory services, for hybrid transitions, and more.
- Provide staff training on how to avoid ‘double dipping’ (i.e., charging patients a membership fee and billing health insurance for the same service), front-end financial workflows, and clear patient communication about the cost of concierge medicine.
- Revise client contracts to support clear service carve-outs and documentation policies, as well as billing compliance with state rules and subscription healthcare regulations.
How the concierge model changes revenue and billing workflows
The concierge model changes revenue and billing workflows by shifting how money flows into the practice. With a fee-for-service model, revenue depends on visit volume and payer reimbursement timelines, creating delayed and variable cash flow.
But with a membership model, practices enjoy a predictable base revenue stream and steadier cash flow, making it easier to forecast finances.
In addition, in fee-for-service models, billing workflows tend to focus on denials, appeals, and accounts receivable follow-up. In concierge models, they prioritize point-of-service collections, patient communication, and improving the patient financial experience.
When should billing companies adapt vs. disengage from concierge clients?
The decision to adapt vs. disengage from concierge clients very much depends on client expectations and internal capabilities. For example, it may make sense to disengage from concierge clients when:
- Cultural mismatches arise (e.g., you strive to provide analytics, reporting, and advisory services, but the client wants transactional services only)
- The concierge doctor anticipates minimal claims volume (and thus minimal need for revenue cycle management)
- The concierge doctor is not willing or able to invest in front-end financial workflows
- There’s no clean and defensible compliance model (i.e., no client delineation of what’s included in the membership)
Understanding what happens to billing when practices go concierge is the first step. Then, billing companies must decide whether they want to evolve commensurate with their clients. It makes sense to adapt when there are dual revenue streams, the client wants a strategic partner, and you can clearly define compliance boundaries.
Pros and cons of concierge medicine for billing companies
Billing companies benefit from concierge medicine in the following ways:
- Greater focus on optimization rather than rework
- Lower churn risk thanks to more predictable client revenue
- Opportunity to expand into advisory services
Some potential disadvantages of concierge medicine billing changes include:
- Harder to scale revenue without higher per-client pricing or new services
- Higher compliance risk associated with double-dipping
- Operational complexity
- Reduced revenue (when relying on a percentage of collections)
- Risk of becoming commoditized or unnecessary
Understanding the potential advantages and disadvantages helps billing companies make informed decisions about what happens to billing when practices go concierge — specifically, whether they will continue to support concierge clients.
Contract, compliance, and payer considerations
When it comes to contract, compliance, and payer considerations, billing companies working with concierge medicine practices should keep the following in mind:
- Ensure contracts clearly spell out what the billing company is and isn’t responsible for billing.
- Promote compliant documentation to avoid payer scrutiny.
- Clearly communicate patient financial responsibility.
Knowing what happens to billing when practices go concierge helps billing companies and their clients remain legally compliant during times of operational transition.
Key takeaways for billing companies
What happens to billing when practices go concierge? Here are five takeaways for how billing companies handle concierge medicine practices:
- Billing companies must clearly separate membership vs. billable services.
- Billing companies must strategically decide when to adapt vs. disengage.
- Billing company success requires expanding beyond traditional RCM into advisory and analytics.
- Compliance, contracts, and staff training become higher-stakes priorities.
- Concierge and direct pay models fundamentally change revenue and billing workflows.
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