|
A medical billing
service helps physicians obtain payment from insurance carriers and patients
by handling insurance claims, and provide information to help physicians to
more effectively manage their practice.
(article continued below ...)
Medical billing is a business that can easily be done at home, even on a
part-time basis. However, running it as a business takes more than just the
technical know-how: you need to know how to manage and run a business,
market and promote to get clients, and possess financial savvy to turn it
into a success.
It is a business that has grown by leaps and bounds in the past decades.
While demand is great, competition in the medical billing market is fierce.
While there are a number of large and well-established firms dominating the
market, the medical billing business has a lot of room for a small and
home-based business entrepreneur.
Knowledge and Skills Needed to Start the Business
As a medical billing professional, you will provide the following
services:
- Preparing either electronic or paper claims to insurance companies,
such as Medicare, Medicaid, and third party insurance's, such as Blue Cross
Blue Shield, Humana, Great West, etc.
- Entering patient information into
the software
- Mailing patients’ statements
- Posting payments
-
Following-up on all unpaid insurance claims, as well as appeals and denials
- Conducting "soft" collection on non-paying patients (e.g.
making phone calls and sending out past due statements)
- Submitting
reports to the doctor (e.g. number of patients per month, etc.)
- Handling
all patient billing inquiries
Medical billing is a business that requires specialized skills and
knowledge that can only be gained through education and training. The first
step when planning to enter this business is to enroll in coding and billing
courses at your local college or a reputable home study program. For
example, Purdue University’s Professional Development Studies offer an
Administrative Medical Specialist course that covers medical billing for
$1,395. Professional Career Development Institute http://www.pcdi-homestudy.com
offers a medical billing course for $789.
When choosing your educational institution, make sure that the course
offered will cover the following aspects of medical billing:
- Learn basic medical terminology (e.g. key systems of the body;
building medical words with prefixes, suffixes, and combining forms) ·
Understand an insurance claim’s lifecycle (e.g. developing the claim;
procedures for patient interviews)
- Basic claims process for medical
insurance and third party reimbursements (e.g. how to manually file claims;
general billing and optical scanning guidelines; reporting diagnoses:
ICD-9-CM codes; tracing delinquent claims)
- Using common insurance forms
·
- Introduction to the national diagnostic and procedural coding systems. ·
-
Become acquainted with medical office computer software · Procedures and
steps to appeal denied claims ·
- CPT (Introduction, Guidelines, Evaluation
and Management Specialty Fields such as Surgery, Radiology and Laboratory) -
understanding Medicare
The key to longevity and success in this business is to gain the trust
and confidence of your clients the doctors. Billing is the lifeline of
doctors; hence they will only give their account to you if they are
confident that you know how to bill their claims. They will not outsource
their billing to someone coming in to this business with no experience or
skills, as you may jeopardize the doctor’s chance to collect their income.
Be prepared to provide references to potential new clients.
Starting a Medical Billing Business
Starting this business is just like any other business: you need to plan
for it, set it up, know how to market your venture and sell to potential
clients, manage the business and provide the best customer service that you
can. The steps to starting a business entail the following:
Prepare a business plan.
This is your roadmap to success. It will help
you think through what you need to make the business a success, the
resources you need to have, and the constraints you are faced. It will help
you understand your market and determine your competition.
Decide on a form of business.
You can choose to have a sole
proprietorship, partnership, a limited liability company (allowed in the
some states in the U.S.), or a corporation. Learn the advantages and
disadvantages of each business form, and find which one is suited for you.
Complete your business registration requirements, and other permits and
licenses.
This includes choosing a name for your business. Even if you will
work from home, it is best to operate with all the legalities covered.
Check out zoning requirements, particularly if you are operating a
business from home.
This is particularly crucial if you will be seeing
clients in your home office, setting up an outside sign to announce your
business, and will require constant parcel deliveries. Find out from your
county or area if a home business is permitted, and what kind of businesses
is allowed to be operated from home. If you don’t cover your ground, a
complaint from your neighbor about too much traffic coming into your home
can jeopardize your entire operation.
Set up your home office.
Decide what part of your house you can use. A
room would be best to help you keep all your files and records in one place.
Get all the equipment you need, from computers to an additional phone line
installed.
Prepare your family.
Get your family to support your decision to work at
home. If you have children, plan on how their care could be provided when
you are busy with your business.
Start-Up Costs
Including education costs, you may need about $3,000 to $5,000 to start
the business. The cost of your new business will depend on the kind of
start-up expenses that you will incur e.g. whether you go first class
with brand new equipment and supplies, or you go slowly and simply use
everything that you currently own.
Start-up expenses include your:
- Basic office equipment (e.g. computers, fax, modem and internet
connection, back-up systems)
- furniture (chair and table, filing cabinets)
- office supplies (e.g. staplers, paper, bookends, diskettes, envelopes) ·
forms that you will need (e.g. HCFA, Medicare, and other insurance forms)
-
coding and other reference books · medical billing software
The medical billing software will be one of your biggest expense. Usually
starting at $500, it is important that you research various medical software
before you make a purchase. Ask for a demo before purchasing the product.
Steer clear of companies that do not provide demo products that you can
evaluate. Also make sure that you buy software with ample technical
documentation to help you figure it out.
Buy a software that can grow with your business. Avoid those that only
allow you to handle only one physician or tax I.D. numbers (there are many
unscrupulous vendors out there).
Another important factor in selecting the software vendor is the quality
of their after-sales support. Check to see the kind of technical support
available, and how much do they charge.
Marketing the Business
When starting a business, you have to be prepared to market it. You
cannot simply start a business and expect people to find you and flock to
you. In fact, majority of your time will be spent looking for clients during
your start-up phase.
There are various ways to market a medical billing business. The most
important thing is networking. You must know potential doctors who may need
your help and services. Check out the doctors that you and your family use.
Introduce your business to them. Ask for referrals to other doctors they
know who may need your services. Note, however, that networking takes time
to bear fruit and you must be patient and continue to working on getting the
word out about your business.
You can also send out mailings to doctors in your area. Send a letter
with a brochure detailing the services that you offer. Immediately follow up
your mailings with calls. If you can, set up a meeting with potential
clients so you can personally present to them your business.
Another strategy is to try “cold calling” on the doctors, although
you may not be able to talk with the doctor given their usual tight
schedules. Instead, you can simply leave your business card and marketing
materials to the receptionists. If the clinic or doctor’s office does not
allow for soliciting, it would be best if you could just send out that
particular office with a direct mailing piece.
Word of Advice: Avoid Scams
Those looking to start this business need to watch out for scams. The
rise in demand for the medical billing business also increased the number of
scams preying on hapless individuals, eager to go into a business the easier
way. Many of these promoters offer software, training and technical support,
even a list of potential clients, for the price of $2,000 to $8,000, and
promise that they are able to find clients, start a business and generate
revenues. They get the intended victim to believe that they will earn a
substantial income and recover their investment in a short time. But
instead, victims find that they are unable to find clients, have a hard time
starting the business and the revenues promised to them are non-existent, it
there is, it is not even enough to recover their investment.
If you believe the claims of business opportunity ads that you can start
this business even with zero knowledge, then you are in for a great
frustration. The unscrupulous advertisers often give assurance that no
experience is required, that they will provide clients eager to buy your
service, or that their qualified salespeople will find clients for you. This
is the biggest fallacy of all.
======
|