Some Tips for Starting Your Own Medical Claims Processing Business

Medical claims processing is the profession that deals with the submission of medical bills and records (in coded form) to insurance companies in order to expedite payment. Often people who want to get into medical claims billing think in terms of getting educated, putting together a resume, and looking for a job. However did you know that it’s possible to begin your own home business as a medical claims processor? That’s right, you can do it all by yourself – set up your own home office, work your own hours, and be your own boss. You’ll still have deadlines and so on – doctors, hospitals, and even patients will need medical records processed and bills submitted to insurance companies in a timely fashion. But at least you’ll be in charge of your own affairs and will be able to plan your time as you see fit.

There is a demand for medical claims processing

With the increasing complexity and fairly troubled state of health care in this country, doctors are more and more challenged to receive payment for their services. They need experienced professionals who can help them navigate the complex array of health care insurance organizations such as HMOs, PPOs and so on.

In addition, many doctors and hospitals are still stuck in the age of paper. They do not know how to file electronically. They need professionals who can help them with the ins and outs of electronic processing of claims.

For these reasons there is definitely a demand for Medical claims processors. It is an area which is not expected to slow down in demand any time in the foreseeable future. So it makes sense not only from a short term but also from a long term perspective.

Begin by Educating yourself

The traditional route is to go to a career college or a 4 year college and taking a course in medical billing and coding. Alternatively there are many online courses you can take. While these more tried and true educational routes certainly aren’t a bad idea, it is also possible to educate yourself. There are no legal certifications for billing and coding, though many educational programs offer their own certification exams. You can simply find your own manuals and documentation and learn the field on your own.

To educate yourself search on and similar sites for book length courses in the subject.  A good one to consider, though there are many others you’ll find as you look around, is the Guide to Medical Billing and Coding, A basic textbook by the educational publisher ICDC publishing. This book allows you to work through the material that comprises most curricula at traditional medical education institutions. But again, in keeping with the do-it-yourself theme, you can complete the course on your own time. This company even offers 2 levels of certification, which take the form of tests which the company administers. If you get a passing grade they certify you.

In fact this brings up an important point – though there is no federal or state mandated certification for medical billing and coding professions, certifications are highly regarded in the profession by potential employers – and in you case as a do-it-yourselfer – clients. So try to find some way to take a certification exam whether or not you go the classroom route. Mostly these exams are part of an entire curriculum at a specific college or online program, and there may be requirements that you attend classes in order to get a certification. But you may be able to do this with a minimum of class time if you plan it right. Either that or use the guide mentioned above or a similar guide. Look around and see what you can find.

Along with books that give a general overview you need a basic reference library that includes medical coding data such as CPT, ICD-10, and so on. HPCS Expert 2010 by Contexo Media, for instance, is a widely used and comprehensive guide to procedural codes. You will need to know medical coding, which is sometimes undertaken as a whole separate profession in itself, unless you hire your own coder or have it done remotely by a coding service. Chances are the latter would take a serious bite out of you profits, so becoming familiar with coding on your own is probably your best bet until you get a large enough to outsource.

Get on the books

Go through all the ordinary steps that new business owners go through, namely getting a business license, a DBA (Doing Business As) if you’re going to use any name for your start up besides your own name, and business insurance (if you can afford it). A separate business bank account and some tax software such as QuickBooks wouldn’t be a bad idea either.

Once you’ve gotten educated, licensed, and so on.

You may not need very much, but you will need some start up money. About $3000 to $5000 should provide you with reasonable leeway to start with. If you don’t have this much you’ll have to try to do it with less, but business costs (overhead) of various sorts can mount up quickly, so budget wisely.

Put together a business plan for expenditures, expected, profits and so on. If you don’t already know how to put together a business plan, there are many programs and web sites that can help you.

You’ll need medical billing software. This is software that prints bills, does coding, handles medical records in an efficient manner and so on. There are many programs to choose from, so look around and read reviews before purchasing one or several.

You’ll also need HCFA 1500 forms, which are standard insurance claim forms, as well as a few other forms. These can be printed out at this website:

You’ll need office equipment – computer and fax machine. You can purchase used office furniture to cut down on those kinds of expenses.

Market to Local doctors, hospitals and so on

Once you’re all set up its time to start marketing your services. Make a weekly marketing plan. You can and should set up a website showcasing who you are and what you do. Then market to doctors, hospitals, long term care facilities, nursing homes, chiropractors and any other health professionals you think may need insurance claim services.  You can use sales letters, phone calls, emails, and on or offline classified ads.

A note on specialization: It often pays to specialize in one or another type of billing for one or another medical practice, so don’t go to far with marketing to anybody and everybody. Medical professionals may see you as a better service provider if you market yourself as an expert in a certain part of the field. 

Investigate Online Medical Billing Websites and Outsourcing Sites

There are online medical billing sites that may hire you as part of their team. They will consider you an independent contractor or perhaps an employee that “telecommutes.” However beware scams. Often sites that make the whole process seem too easy are scams. They will say you don’t need any education to begin working for their company or don’t need to be certified. Usually legitimate sites will ask for certification or at least proof of your educational background and experience, so you can use that as a test of a company’s legitimacy.

Another type of scam to watch out for are medical billing “support” sites. These are companies that promise to help you set up, organize, and manage your own home medical billing business for a few hundred dollars, often only to provide some minimal service or no real value or disappear completely with your sign up fee. Be aware that in the medical billing/claims processing industry, as in many other fields, there are companies that cater to uninformed would- be entrepreneurs with a desire to work from home and so on. If it seems too easy it almost always is. The way to avoid all of these sorts of rip off schemes is to try to do everything yourself and see what’s actually involved before hiring any other parties to assist in the actual operations of your business.

With a little independence, determination, and good sense there’s no reason why you can’t start your own medical claims processing business. The key is to get as educated and well set up as a business, and to have a firm plan and marketing strategy in place. In a thriving market, as medical administration currently is, your chances of success are maximized. But it’s up to you to make your business one that medical practices see as professional, capable, and up to date.

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