We are going to assume for the sake of this article, 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. Check out our medical billing courses and certifications!
1. Research, Research, Research!
PMRNC does not sell business opportunities or software. We have no ulterior motive for telling you the truth! When looking at software companies and/or business opportunities, Check with the BBB, FTC as well as your State’s Attorney General’s office. Speak with others who have purchased or thought about purchasing from that company. Know how long that company has been in business. Completely look at what they are offering and make an informed and educated decision. CERTIFICATIONS are only as good as the education behind them!! Our members only area has an area for those setting up a medical billing business that includes links to various associations, software, clearinghouses, and MORE. We offer various discounts as well.
You do not have to purchase a costly medical billing business opportunity package if you carefully plan your business!
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. Check with your local county and/or state for name searching to be sure you choose a name not already registered
4. Visit your local municipality and state tax office to register your business. If you are planning to work from your home, obtain the zoning laws/rules from your county/state.
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 choose a business model – Years ago, it was advisable to purchase your own medical billing software license or system. Today, medical billing business owners need to be more diversified in order to compete in a very tough market. While a medical billing business could purchase, maintain and support their practice management software, the option to utilize a clients existing system is much more practical and beneficial to your clients. In utilizing the practice’s existing medical billing system or software you can reduce the setup time, reduce your overhead and allow your client a more controlled solution. Another advantage of utilizing your clients system is that you will not become a slave to the medical billing software vendor. Over the course of 20 years, I have been through several medical billing systems and many times it was not by choice. Conversions are extremely costly and time consuming. Save your company time and money and allow your clients to also reap the same rewards!
Should you choose to purchase your own solution or software, you should definitely research all of your options. Our members only area has a lot more information about how to demo various software’s, we offer discounts as well as how to research each vendor. Make an informed decision that is right for your business.
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 full HIPAA Compliance. Take every precaution to be sure your clients’ Private Health Information is PROTECTED! Our members only area has an extensive area for HIPAA along with other regulatory issues pertinent to this industry!
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. PMRNC member discounts are available!
11. What services will you provide? Depending on your experience and knowledge you will want to prepare a list of services that you are capable and ready to deliver to potential clients. Obviously the more services you provide, the more marketable you and/or your business is! Our members only area contains a consultants corner where you can see articles, resources and download tools and forms to help you provide some great add-on consulting services!
12. 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 medical billing marketing area contains a variety of marketing 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. We also offer a great Medical Billing Marketing Guide which is free in HTML format within our members only area. You can purchase this in PDF format (printable) at a discounted price for $10.99. Non members can still purchase the guide only by clicking HERE
13. 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 members only area has many resources regarding regulatory and HIPAA compliance. This is an important step most medical billing business owners miss!
14. Decide what you want to charge for your services You want to decide HOW you will charge for the services you can provide. Some companies charge a percentage of collections, however in some states, it is illegal for providers to enter into such a fee splitting arrangement. Our subscriber area has a listing of these states as well as the legal notations for each one. There are other means of charging, such as; flat monthly fees, per claim, and per service fees. Some billing companies also choose to bill on an hourly basis. Our getting started area shows you how to formulate each method. Read our free article on setting your fees.
15. Create your contract You will absolutely need a contract, in addition to other important agreements such as your HIPAA Business Associate’s Agreement. Our getting started area has step-by-step information on how to create your contract to protect your company. You may want to seek the legal advice of a skilled contract attorney to help you.
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!
Our subscriber only area also has the option to purchase a contract review. I have extensive experience and education regarding contract law. I’m not an attorney but I can review your contract and tell you what its missing and help you get your contract up to par so that if you decide to have an attorney review it, it will cut down on your costs.
Medical Billing Software
Our site has a listing of reputable vendors, as well as tips on how to choose a good solid practice management software/solution! We make sure to check our advertisers and sponsors with both the Better Business Bureau and Federal Trade Commission. Software costs as well as various solutions are available. Today’s medical billing professional can even easily access a provider’s practice management system if a potential client doesn’t want or need to make a change.
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. You also want to remember that certification is not mandatory in this business and that some companies, associations and vendor’s will lead you to believe in a “National Medical Billing Certification” when one really does not exist. Certification is only as good as the education behind it.
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.
You need to develop a marketing plan tailored to your specific market. Marketing is a large part of a successful medical billing business. Our Medical Billing Marketing Guide is free in HTML format for members. You can also purchase the PDF printable format, without becoming a member for $24.99.
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!
Facts & Myths
Q: A company told me that as long as I can type 45 wpm, I qualify to start doing claims for them after I purchase their software for $399. Is this true?
A: Absolutely, positively NOT! Typing has nothing to do with medical billing! In fact, I am willing to bet that most of your successful billing companies can’t type at all! Data entry is just a very small part of this business. You should never have to pay for a “job”. These companies that sell software and promise to have you working after you buy are scams, PERIOD! Your success is up to you. You can have as many clients as you want and be as successful as you want.
Q. I was also told I can work from home from my Pajama’s, is this true?
A. That could be true, but there is a bit more to it than that. Most people who decide they want to work from home don’t fully understand there is a big difference between working “remotely” and starting your own billing company. We have written an article to explain the differences here.
Q. I was told I will need to be certified to do medical billing, is this true?
A. NO! Although it is recommended to be certified if you will be providing coding services, there is NO national medical billing certification. You will see that companies and associations OFFER a certification nationally, but it is NOT required. Some states do require you to be registered.
Q. I was told that I would learn both medial billing and coding and receive a full certification. Is that true?
A. Medical billing and medical coding are both important to a practices revenue cycle, however they are two separate jobs. Some medical billers do pursue coding certifications along the way which is very good for their marketability, however medical billers don’t code. Coders are usually certified by the one nationally and well known organization called the AAPC. The coding certification of CPC is widely recognized and often necessary to provide coding services to a physicians office. There are many medical billing certifications and certificates. The key is to understand the differences and make sure the education behind the certificate or certification is worth it. Most physicians won’t know of the various certifications ut there, so it’s your job to make sure you receive the best education possible to prove yourself.
We are here for you every step of the