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Medical Billing Software: Starting A Medical Business
As demand for health services increases, the medical billing business has grown by leaps and bounds the past decade. Learn how to start this business.
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.
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.
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