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Getting Started   Welcome future medical billers, practice managers and consultants! Beware of classified ads promoting medical billing business opportunities!  Never pay for a JOB!  If you are looking to start this business the right way, be prepared to invest more than just a few hundred dollars! The big question:  How do I get started in Medical Billing? Before reading this page, you should first read:   Understanding the Industry! Download the Home Office Tax Benefit Calculator to see how you can benefit from a home office!  (requires MS Excel)   This is the most frequently asked question that we encounter:  "How do I get started?" The answer to that question is extensive.  It is what prompted us to develop this site.  We will share with you some insight on this industry and the best way to start.  We will provide you with the steps here, but many of the resources contained in these steps can also be found among our resources in the Subscriber's area!  You will NOT find such comprehensive resources ANYWHERE on the internet that are all in one place! Initially, understanding what this business entails is your starting point.       Read More     $69.99 for the year.  Renew before expiration for just $49.99! Group subscriptions are available.

√  Medical Billing as a home-based business     √  Getting Started

√   Understanding the Industry     √   Start-Up Check List

 

 

What does a Medical Billing Professional do? 
Many companies and dealers will lead you to believe that a medical biller just enters claims and sends them to the insurance company.  This is partly true, but this is actually the easy part.  Medical billing is the simple term for our jobs.  PRACTICE MANAGEMENT is the real term to describe what we do. 

What is Practice Management?
Practice Management includes the following services:

• Verifying patient insurance eligibility and benefits.

• Gathering and entering patient demographics into your practice management software.

• Making sure the appropriate CPT and ICD-9 diagnosis codes correspond and are the current AMA approved codes.

• Being certain that the procedure codes that are supplied by your client are not part of a CCI edit.

• Making sure applicable managed care authorizations and/or referrals are on file for the services performed.

• Batching and transmitting your claims to a clearinghouse is the most efficient means of transmission.

• Providing follow-up on unpaid or incorrectly paid claims and outstanding patient balances.

• Filing claim appeals when necessary.

• Making Secondary and Tertiary claim submissions when applicable.

• Posting patient and insurance payments to claims/accounts.

• Sending patient statements and, when necessary, letters for soft collections.

• Providing your client(s) with accurate monthly reporting on all of the above.

• Staying educated and on top of industry standards, such as with HIPAA and OIG compliance, as well as Medicare and state & local regulations.

Ok, NOW what do I do to get started? 

We are going to assume that, after step one, you have chosen the appropriate means of training/education OR you have previous billing/medical office experience.  This ultimately should be the first step.

1.   Research, Research, Research!  
Accept the following statement for fact from here on out ... You CANNOT start a medical billing company for a few hundred dollars.  It cannot be done ... no way, no how!  We do not sell business opportunities or software, so we have no ulterior motive for telling you the truth!  Average start-up costs run between $3,000 to $5,000.  Thoroughly research each company you deal with through the BBB, FTC and their local State Attorney General!  NEVER purchase software from a company without first evaluating it!  On the Subscriber section of this site, there is an evaluation process that you can follow if you do not understand what it is that you should be looking for in a practice management software.

2.   Decide how you want to set up your business (i.e., sole proprietor, corporation, LLC, partnership, etc.).  Consult with an accountant or business advisor.  Prepare a Business Plan (sample plans are located in our Subscriber area).

3.   Choose a name for your business.  Be sure to choose a professional name.  The name of your business is important!  Be creative, but professional.

4.   Visit your local municipality and state tax office to register your business.

5.   Research trademark for your business name.

 6.   Open a business checking and savings account (consult with your accountant for various types of accounts).  It is a good idea to set aside a percentage for taxes into an interest-bearing savings account.

7.   Research and purchase your medical billing / practice management software.  Remember:  Do NOT purchase without an adequate evaluation of the software and research of the COMPANY selling it.  Make sure you purchase a support contract!  Support contracts are vital in our industry, due to the many changes that take place.  Your software has to be from a company that is committed to staying on top of industry changes!  Don't think you will learn a program overnight!  We have an area with an extensive list of what you should look for in your Practice Management software and how to do a thorough evaluation (demo).

8.   Set up your office.  Find space.  Organize that space to fit your needs for both now and in the future.  Picture the growth of the company you want to build and make sure your space can accommodate those goals.  Make sure your office meets HIPAA privacy standards.  Take every precaution to be sure your clients' Private Health Information is PROTECTED!  Even if you work from HOME!

9.   Purchase office equipment:

• Printer(s) - preferably ink jet for your marketing and a laser or dot matrix for your claims printing.

• Fax - you should have a separate fax line, so your clients can fax you the source documents you need to do your job without delay.  We recommend an onsite fax machine (or fax software through your computer) and NOT online services who cannot guarantee the privacy of your incoming and outgoing faxes!

• Phone - a multiple line phone works great so you can have a line for your home and at least one line for your office. You don't want to answer your phone "Hello" when it could be a potential client on the line.  Even if you plan to work from home, you should plan to run a professional business.

10.   Purchase your supplies.  Ink/toner, claim forms, envelopes, postage (marketing), paper, marketing supplies, filing cabinets, file folders, etc.  Remember that you need envelopes for both claims and patient statements.  You should choose the envelopes to match the format of your patient statements within your practice management software.   

11.   Prepare your marketing materials.  You will want to prepare business cards, flyers, postcards, newsletters and brochures.  Decide on a marketing strategy and track your efforts, so you can find the strategy that works for you.  Our marketing area is packed with many different samples for you to look at or use!  Website marketing is also an excellent tool.  Doctors use the internet for their research; they use it to find services as well.

12.   Begin preparing your company's compliance plan.  The OIG has put forth proposed regulations for third-party billing companies, as well as physicians.  Many professional associations (such as the AMA) are advising doctors to get a billing company's compliance plan to be sure they outsource to companies that are in compliance!  Our subscriber area has many resources regarding compliance, as well as HIPAA compliance (which should be a vital part of your compliance plan - see below). 

We don't guarantee these are all the steps every business or individual needs to take or that they are in the right order for you and your business.  Every person and business is different.  All of the above steps and MUCH more is covered throughout the Subscriber area of our site!

 

Additional TIPS:

Medical Billing Software
Our site has a listing of reputable vendors, as well as tips on how to choose a company and choose software!  We make sure to check our advertisers and sponsors with both the Better Business Bureau and Federal Trade Commission.  Software alone will run you between $500 to $5,000, so be sure to do a good evaluation!

Education
The career you are choosing is one that makes you responsible for your client's income.  It is imperative that you gain the knowledge to do this correctly and efficiently.  Your business will fail miserably, if you enter into this profession without educating yourself first and you will do a great disservice to your clients as well.  Not to mention, you will find it difficult to sell your services if you do not know what you are doing.  Remember that your client's financial status depends on YOU knowing your job! 

The cost of education can range from a few hundred to thousands of dollars, depending on experience, aptitude and material.  We have a wonderful learning center, as well as recommendations for reading material that we have rated excellent.  There are also reputable companies and associations that offer home study programs and seminars that are very thorough.  When purchasing an educational program or business opportunity, ask for references and check with the Better Business Bureau and Federal Trade Commission.

Methods for Staying Up to Date
Joining associations, subscribing to newsletters and attending seminars are great ways to stay up to date.  This industry changes rapidly and one of the things that attracts clients to outsource their billing is that we, as professional billers, make it our business to stay abreast of these changes.  Continued educational resources are a MUST!

You will need to set up with a clearinghouse.  Be sure to find out which are compatible with your software.  We have several listings of clearinghouses you can contact.  PMRNC subscribers also receive a discount for ET&T clearinghouse and LTC clearinghouse.  Additional information on these discounts are found within our Subscriber area, under "clearinghouses".

Marketing
You need to develop a marketing plan tailored to your specific market.  Marketing is a large part of a successful medical billing business.

Developing Marketing Material
We recommend that you set aside at least $500 for initial marketing.  That is a minimum cost.  A typical "mailing" will run you at least $100. 

Our Getting Started section walks you through the steps of getting started and provides you with resources for starting a business  -  all in one place!