- Is Medical Billing for You?
- Which Specialties Work
Best
- The Presentation
- Clearinghouses
- How To Charge
- Getting Started Checklist
- Getting the First Client
-
I would say first that you should thoroughly research this
business and find out what it truly entails. Unfortunately there are some vendors out
there who misrepresent the business and make it sound a whole lot easier than it is. Many
people who start looking into this business have a false impression of what the business
is all about due to the ads these vendors are putting out there. Do yourself a favor and
do some serious research.
Some general medical terminology would be helpful but not
absolutely necessary. Rather than medical terminology you need to know billing
terminology. What you will also want to have is a moderate understanding of the health
claims business especially coding, and also a high knowledge and skill level in marketing
and sales to get clients.
Start-up costs can vary greatly depending on if you're coming
into this with or without experience, the amount and type of training you need, the
software you choose, your equipment needs. After some research into the business you
should have a better idea of what you needs are and putting together a business plan would
be a good idea. I'd say at the very least it would cost a few thousand dollars and can run
up to $10,000 or more depending on various factors. There are the such costs as a business
licenses, phone lines, equipment, reference books, billing manuals, forms, stationery,
marketing materials, software, subscriptions, and continuing education to consider.
The way you typically get work if you are planning on doing
this from home is by marketing to get your own clients. Methods include direct mail,
telemarketing, personal visits, networking, and booths at medical conventions.
Do you have prior experience or training in medical billing?
This is probably the most important keys to success in this business. Billing is the
lifeblood of a doctor's practice and they will not out source their billing easily. They
must be convinced that you have the skills and expertise to handle the billing more
efficiently than they are already doing so in-house.
This business requires at least a moderate understanding of
the health claims business especially coding, Medicare/Medicaid, and commercial insurance
regulations. It requires a high knowledge and skill level in marketing and sales to get
clients. Unfortunately there are a few business opportunity vendors out there who
misrepresent the business and make it out to be a whole lot easier than it is so take your
time and research carefully before jumping in.
The book Making Money in
a Health Service Business on your Home-based PC by Rick Benzel has a good overview of
the business. You might want to take the time to read the this book for many tips.
Other titles worth looking at are:
Understanding
Health Insurance : A Guide to Professional Billing; Jo Ann C. Rowell
Insurance
Handbook for the Medical Office; Marilyn Takahashi Fordney
Selling Your Services : Proven Strategies for Getting Clients to Hire
You (Or Your Firm); Robert W. Bly
I wouldn't say any specific medical specialty is particularly
easier than another to bill for. They all have their own idiosyncrasies that you have to
learn. I would suggest though that you target the small solo-provider practices. These are
the ones that are more apt to out source their billing and tend to have little or no
staff. An example would be a Licensed Clinical Social Worker. They tend to really need a
helping hand and are very appreciative of the assistance. Also, providers who primarily
see patients in the hospital often have little on no staff as well. A Gastroenterologist
is a good example where the bulk of his practice is seeing patients and doing procedures
in the hospital. So, my recommendation would be to go after the Allied Health specialties
and the some of the specialists. Start out with something small to get your feet wet.
Don't let yourself be overwhelmed by taking on more than you can handle.
You really need to be prepared for anything and everything.
Some doctors don't ask many questions at all and some will grill you like crazy. One thing
they typically want to know is how the whole process works, what the flow of getting
information to you and how you handle everything is.
Everyone seems to handle presentations differently and it can
vary depending on the size of the client and the specialty as to how you approach it. You
need to establish your own style that works for you. Some presentations are very
unstructured. You don't need any sort of formal presentation or any props but they might
be helpful. It's more like an interview where there are a lot of questions you ask so you
can establish what their needs and preferences are.
Once you know that then you can explain how your services can
help them. Typically leave them with a brochure, a profile of your experience, and maybe
some copies of some marketing newsletters you may have sent out in the past.
To send claims electronically, for the most part you will
need a clearinghouse. You cannot transmit directly to ALL carriers. You typically can only
go direct to Medicare, Medicaid, and maybe Blue Cross/Blue Shield. What then do you do
with all your other claims? You would have to paper them (not the best idea) or use a
clearinghouse. Be aware too that going direct sometimes means double-entry and the edits
are not always as thorough as a clearinghouse.
I don't see a clearinghouse as being an unjustifiable
expense. A claim costs you money whether it's sent on paper or electronically. It's paying
for a claim form and postage versus paying for a clearinghouse fee. The per claim fee is
comparable depending on the clearinghouse you choose. However, with a clearinghouse you
benefit from their edits. You know ahead of time, before the insurance company even gets
the claim, that there is some sort of problem. It's certainly more desirable to know at
that point of a problem and to correct it than to wait several weeks for the insurance
company to send you out an EOB denying payment due to some error. Also, there are less
"lost claims" and your clients get paid faster. Your clearinghouse provides
claims status reports so you know how claims are progressing through the process of
getting paid.
I also believe in this day and age that providers expect that
their claims will be processed electronically when using a billing service. There has been
so much hype and publicity to the benefits and advantages of electronic claims that
doctors are surely going to expect for you to send their claims that way.
Electronic claims are certainly a time-saver as well. There
is time saved in folding them, putting them in envelopes, and adding postage. There is
less time spent on the phone following up since they are paid more promptly, have less
errors, and there is less chance they will not make it to the insurance company.
Using a clearinghouse enhances the services you provide and
in no way limits your ability to produce reports that you would be able to do if you
weren't using a clearinghouse.
I have never heard of anyone HAVING to use a clearinghouse,
but why wouldn't you want to? You can still file the claims directly to the carriers via
paper claims but you could be holding up payments. It seems as if they are reimbursed more
quickly with a clearinghouse as you have an automatic built in editing system. If you sent
them by paper you would have to wait for a couple of weeks (or more) to receive the denial
compared to a matter of minutes with a clearinghouse (which you can go in and fix right
away and resend). Plus the insurance carrier would have the claims more quickly via a
clearinghouse. To me a clearinghouse virtually eliminates the chances of them not
receiving the claim and the "black hole syndrome" that carriers seem to have. I
don't see any draw backs on using them. And as far are reports go I would think that a
clearinghouse would enhance your reports.
Ask yourself this, if you could get a more rapid return on
payments with less error rates for your clients don't you think that you look better to
them? They will appreciate having more money faster. A clearinghouse will also free up
some of your time. You will not have to prep claims (as much),you wont have to do as much
printing (saving on time and cartridge expense), less mail (envelope cost) and less
postage (self explanatory). With all the time you would save you could probably take on
another client or two. I don't see clearinghouses as an unneeded expense. I think you
would be better off using one.
Now as far as MedUnite goes, reports come back before the
modem hangs up the phone! Reports are written in plain easy to understand English. And
resending repaired claims happens immediately.
Plan on doing most of your work from home and visit the
offices at least once a week. Calculate charges based on a yearly fee - for example, on
the practice income for the prior year. You can charge 9% for the first $500,000 and 5%
thereafter. This can be derived from the day sheets and aging report for the previous
year. You may take a percentage (usually 40%) of what's on the aging report, and add that
to the day sheets and then I add 10% for cash payments that never appeared anywhere. This
works well if adjusted yearly.
Never discuss this formula with the doctor. They seem to
cringe when you mention percentage. In my opinion this is the best way to price your
service based on the prior year's activity. It eliminates the doctor's ability to question
you about how much you make off their claims.
You also need to consider the the value of your services.
Consider that the insurance only pays $25.00 on a claim and you charge $3.50 per claim,
then the practice is paying you 14%. If the insurance pays $350 on another claim, then the
practice is only paying 1%. Payment by a percentage would not benefit you if your claim
payments were small.
Mention your fee and what a great service you provide.
Mention your fees are reevaluated on an annual basis.
Getting
Started Checklist
- research the business idea and assess your skills and
interests
- write a business and marketing plan
- obtain necessary training if no prior experience
- choose a name for your business and register it
- check zoning laws and apply for a business license
- check into insurance needs
- consult a lawyer regarding legal issues
- consult an accountant regarding tax and bookkeeping issues
- set up an office in your home
- have a business phone or extra phone lines installed
- open a business bank account
- set up bookkeeping system
- have business cards and stationery printed up
- purchase necessary office equipment and supplies
- purchase file cabinets and other storage items
- create marketing materials
- purchase software and learn how to use it
- purchase HCFA forms, envelopes, and patient statement forms
- purchase coding and other reference books
- get on Medicare and Medicaid mailing lists
- subscribe to publications and join organizations
- get out there are start marketing your business
Regarding how long it takes people to sign their first
client, this can vary greatly. I've seen people who have gotten clients right away and
then there are people where it takes them a year or more. I think those with experience
and connections in the field tend to sign clients more easily than those without. The more
experience and education your have, the more credible you will be and the more likely you
will be to gain clients.
Regarding the marketing, if you are just mailing out the
letters and waiting for your phone to ring, then no, this isn't very effective. You need
to be proactive in your marketing efforts. Doctors typically won't pick up the phone and
call. You need to make follow up phone calls within a few days of your mailings. You need
to also use a combination of marketing methods and not just one method.
Yes, this can work as a home business but to be completely
honest, very few people who attempt it probably succeed. This is because there are vendors
out there misleading people into thinking that all you need to know is how to use a
computer and you can do medical billing. I'm sorry, but it's far from being that easy.
Those that make it are those that know what the business really entails and are completely
committed to doing whatever it takes to make it work. Persistence and perseverance are
very important.
Good luck!
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