We've compiled answers to the most common questions healthcare professionals ask about implementing Medicare-compliant direct care practices. If you don't see your question answered here, please contact us for personalized guidance.
The Social Security Act specifically excludes “routine physical checkups” from Medicare coverage (42 U.S.C. § 1395y(a)(7)). This statutory exclusion, reinforced in 1996 and 2006, creates the legal foundation for direct care services focused on routine exams, check-ups, and physicals, without requiring Medicare opt-out.
When a healthcare practice offers pre-sold routine exam services rather than services triggered by medical necessity, these services are not covered by Medicare and can legitimately be provided for direct payment.
You stay in Medicare and in network, and can keep locum work. Carefully implemented, our model has never been prosecuted for cash healthcare in US history.
A service is “routine” when:
Importantly, none of the three federal statutes excluding routine exams, check-ups, and physicals from Medicare coverage ever defined “routine.” This flexibility is both a strength and a source of opportunity for compliant cash healthcare.
If during a routine exam you identify a medical issue requiring intervention, you have three options:
The choice is entirely yours as the healthcare professional. Coverage is not determined by the patient’s condition; it is solely determined by what the healthcare professional does or doesn’t document and bill to insurance.
Based on Office of Inspector General guidance, these are the key practices to avoid:
Our routine exam model is specifically designed to avoid these compliance pitfalls.
Yes. Program patient fees are designed to be qualified medical expenses to enable employer/self-employed/HSA/HRA/FSA/MSA funding. Routine exams, check-ups, and physicals qualify as eligible medical expenses under IRC Section 213(d) and IRS Publication 502. The key is that services must be properly structured and marketed as specific medical services (routine exams, diagnostics, comprehensive care) rather than “access” or “extra time.” This qualification for tax-advantaged funding is a significant advantage over typical concierge models, and over DPC, whose HSA eligibility is capped at $150 per month ($300 for a family), making your services accessible to a broader range of patients.
These are three distinct tax-advantaged funding options:
HSA (Health Savings Account)
Approximately $170 billion in total U.S. HSA assets in 2025
FSA (Flexible Spending Account)
HRA (Health Reimbursement Arrangement)
Program patient fees are designed to be qualified medical expenses to enable employer/self-employed/HSA/HRA/FSA/MSA funding.
Yes. Employer funding of routine exams can be structured through various legal mechanisms:
These mechanisms create a pathway for employer funding, potentially making your cash healthcare model accessible to a much broader patient population.
While cash healthcare models can’t solve all equity challenges, our approach addresses accessibility in several ways:
While these solutions don’t completely solve healthcare’s equity challenges, they represent meaningful progress toward a more accessible system.
As an independent practice owner, you have complete freedom to implement whatever financial assistance or sliding scale policies align with your values. Many healthcare professionals using our model:
The financial stability of the routine exam model often provides the flexibility to serve patients across the economic spectrum.
Yes. The routine exam model allows you to remain in-network with insurance plans and bill for covered services as you choose. Opting out of Medicare and leaving plan networks costs you options. It removes plan revenue you may still want, it does not resolve compliance questions, and it gives patients a worse answer when they ask whether you are in network. Our model keeps you in Medicare and in network, and you bill plans never, some, or more, as you choose.
Yes. The routine exam model allows you to integrate health coaching services into a wide range of medical practices, including concierge, executive health, preventive, integrative, and functional medicine models. This approach supports longitudinal care, behavior change, and improved patient outcomes beyond traditional visit-based care.
Pricing depends on specialty, market, patient base, and the program we design, which we work through with each client directly.
The optimal legal structure depends on your specific circumstances, goals, and state regulations. Common options include:
Our practice formation process includes legal structure recommendations tailored to your specific situation, including considerations for:
Eischen DPSC, LLC provides business consulting, not legal services, and this is general information rather than legal advice. We do not form an attorney-client relationship with consulting clients, and we will coordinate with counsel where legal services are needed.
Yes. Unlike many cash healthcare models that focus primarily on primary care, the routine exam model can be implemented by virtually any healthcare specialty:
The key is proper structure and implementation based on the specific statutory exclusions for routine exams, check-ups, and physicals, adapted to your specialty’s unique aspects.
Projects normally require one (1) to three (3) months to complete.
We can adjust this timeline based on your specific needs and circumstances, whether you prefer a rapid transformation or a more gradual transition.
The subscription program is the practice, not an addition to it. The patient panel is built by being available to patients who subscribe. For an established practice, we plan the transition with you. For a new practice, we implement the full model from the start.
Patient response varies based on communication approach, value proposition, and patient demographics. Typically:
The key to positive patient response is clear, transparent communication focused on the enhanced value and experience they’ll receive, not just the change in payment model.
The routine exam model can be implemented with various technology solutions depending on your preferences and existing systems. Essential technology components include:
Many practices can leverage their existing technology infrastructure with modifications rather than requiring completely new systems.
Clear communication is essential for successful implementation. We provide templates and guidance for patient communications that emphasize:
Most successful transitions focus on communicating the enhanced value and experience rather than just the change in payment model.
While similar in some ways, our routine exam model differs from other direct care models:
These distinctions create significant advantages in regulatory compliance, patient accessibility, and practice flexibility.
Our routine exam model shares some similarities with DPC but offers several important advantages:
These advantages make our approach more flexible and accessible than traditional DPC models.
Our routine exam model uses the same fundamental approach as executive health programs but is adaptable to any healthcare specialty and patient population. We leverage the same statutory exclusions that have protected executive health programs for decades while making this approach accessible to a broader range of healthcare professionals and patients.
The key similarity is the focus on pre-sold routine exams rather than reactive, necessity-based care, but our approach can be implemented at various price points and service levels.
Our consulting approach differs from others in several key aspects:
These distinctions create significant advantages in practice ownership, sustainability, and compliance confidence.
No ongoing percentage. Formation is a one-time flat fee. Communications support is a one-time fee based on a small percentage of program revenue for the first year only, then it ends. Unlike enterprise platforms, we do not take a continuing share of your revenue.
Yes, we provide marketing guidance as part of our practice formation package, including:
For those desiring more intensive marketing support, we offer an additional HIPAA Implementation & Compliant Marketing Guidance (a full-day consultation) that provides more comprehensive marketing development.
The routine exam model works best for healthcare professionals who:
Our complimentary consultation helps determine if this approach aligns with your specific goals and practice vision. During this conversation, we explore your current challenges, desired outcomes, and optimal implementation approach.
Yes. For 18 years, we have completed projects throughout the United States, so you do not need to hire an attorney in your state. Our services are provided remotely via video conference and phone, with all necessary documentation handled electronically.
For clients desiring in-person consultation, we offer on-site services with travel expenses covered by the client.
The process begins with a complimentary consultation to discuss your practice goals and determine if our services are a good fit. During this 30-minute session, we’ll:
To schedule your consultation, simply click here or call 619-919-5395.
Contact Information:
Jim Eischen
Eischen DPSC LLC
2323 Locust Street
San Diego, CA 92106
619-919-5395
jim@eischendpsc.com
