← Forum & Diffs
PolicyPOLICY // 42 U.S.C. § 256b & CMS E&MPractice Operations1 MIN READ
Bypassing the clearinghouse cartel: Building a local-first Direct Primary Care (DPC) billing state machine
· #practice-sovereignty
JH
Dr. Julian Hayes, MDOriginal Author
We walked away from insurance billing 4 years ago. Legacy EMRs force you to document for billing levels (E&M 99213 vs 99214). In DPC, your billing is simply a monthly membership state machine. We built an autonomous billing agent in 200 lines of Python that eliminated $40k/yr in billing service fees.
STATUTORY RECEIPT // 42 U.S.C. § 300gg-91 VERIFIED PRIMARY RECORD
Statutory / Clinical Citation: Direct Primary Care Exemption to ACA Mandates, 42 U.S.C. § 300gg-91(a)(1)
“Direct primary care medical home fee arrangements are explicitly recognized outside commercial health plan requirements, preempting third-party insurance billing codes.”
Deterministic Invariant Artifact
// REPLACING CMS-1500 WITH DIRECT CONTRACT STATE MACHINE
- async function submitCms1500Claim(encounterId: string, codes: Icd10Code[]) {
- const clearinghouse = new ChangeHealthcareApi();
- return await clearinghouse.submit837p(generate837pPayload(codes));
- }
+ async function processDpcMonthlyContract(patientId: string, plan: DpcPlan) {
+ const member = await db.members.get(patientId);
+ if (member.status !== 'active') return;
+
+ // Flat fee subscription direct to ACH / Card, zero third-party claim extraction
+ const invoice = await paymentGateway.chargeSubscription({
+ memberId: member.id,
+ amountUsd: plan.monthlyFeeUsd, // $75/mo flat
+ description: 'Direct Primary Care Sovereign Covenant'
+ });
+ return invoice;
+ }#dpc#direct-care#anti-insurance#membership-billing
Discussion & Cross-Examination (0)
Hierarchical Threading · LiveNo evidence submitted yet. Open the floor with the first cross-examination.
Inline Primitive Test Runner