Gerald Mannikarote ⋅ Houston, TX dMann Training Technologies ⋅ 20 years experience

Hi Karen,
I think you have a great idea. Medical billing is a very lucrative business and helps many medical facilities keep their doors open. You've received some great info from the others regarding setting up a business. Having been in healthcare for around 20 years, I think I can give you some info regarding medical billing.
I would suggest you try to get a job as a billing assistant or medical biller at a physician's office. This will allow you to see what really going on in the street. Healthcare is changing daily and real life experience will help you better understand what day to day needs are in medical billing.
You will also need to understand electronic medical/ healthcare records (EMR/ EHR) and other such software. This can be attained again by working at a physician's office. If you can score a gig at a hospital even better.
You also need to learn the latest ICD codes and where to find them. Different specialties use different codes. So when billing you need to understand which codes to use.
You will also need to learn the appeals process. Many claims are immediately rejected. Learn to appeal the rejection. Also learn the process and what evidences you need to provide to get a claim through.
I hope this helps.
Good luck.
Warm regards,
Jerry

Mike Cottell ⋅ Glen Head, NY Michael T Cottell Consulting ⋅ 42 years experience

Hi Karen, I know nothing about the field of medical billing, but will offer some advice. As you reflect on John's good guidance to craft and vet a business plan, do a few things:
1) Talk to any doctors offices that you, friends or family member use today to find out what systems and processes that they use today. Introduce yourself as a veteran looking to start a business and I'm sure some people will help.
2) Find out a few things :
a) what systems do they use?
b) what is working?
c) what do they dislike?
d) what would they like to have that they don't today?
3) Ask yourself how your company will compete and differentiate itself from the major players in the market today. The small business will get crushed unless you have a point of differentiation that provides a benefit that does not exist today--either cost or service.
4) Assume, best case, your business will take a year to turn a profit and make sure that you have working capital to hold you over.
5) Have a good financial person to guide you on a realistic business plan of expenses, as well a bigger picture issues like the type of entity you will set up--LLC, Corporation etc.
5) Work with a lawyer(s) to make sure you understand any liability issues and be protected with both insurance and the right entity.
6) No matter how small your business might start out to be, be very careful who you trust with your ideas and get all agreements in writing. You might, depending on the business and your idea, need multiple legal points of view. There is employment law, intellectual property law etc. No, you don't want to choke on legal fees and complexity, but you do need to be crystal clear about limiting risk and protecting your ideas and business.
I'm sure you will get some good advice from other advisors specific to your chosen field, but please don't lose sight of point # 3, above when you do your business plan. The market place is very cold and unemotional--the old concept of supply and demand makes and breaks businesses every day.
GOOD LUCK Karen and thank you for your service to our great country.
Best Regards, Mike

Carol Lindberg ⋅ San Diego, CA ⋅ 10 years experience

A home-based medical billing business is one of the most lucrative operations you can perform from the comfort of your home as it can provide work. The industry has continued to grow for more than 30 years as the U.S. Federal Government has encouraged health care providers to submit insurance claims electronically. Research shows that only 70% of insurance claims submitted on paper are eventually paid by insurance carriers.

Although most pharmaceutical and hospital claims are filed electronically, physician's offices continue to lag behind this trend and file on paper, providing a prime opportunity for home-based medical billers to market themselves. Here are three tips to help you start your business.

Educate Yourself About What Doctors Need
Understanding your options and the needs of doctors and medical facilities is the first key to success. Those who still do their own billing are your best bet to become potential clients. Learn about their daily patient volume and ascertain how many individual practices you can handle. For those practices that already use the services of an electronic medical biller, ask whether the service only handles insurance claims or other aspects of their accounting.

Medicare--Medicaid Eligibility Requirement Resource: http://healthlaw.hofstra.edu/resources/infographics/medicare-medicaid-eligibility-requirements/

Be wary of too-good-to-be-true offers from companies who will provide you with an easy means of starting your own operation. To ensure that you don't become a victim of a scam, contact your state attorney general's office, the Consumer Protection Agency or the Better Business Bureau to find out if the medical billing provider is legitimate.

Select the Right Billing Software and Basic Equipment
As you probably already have a computer, printer and fax machine, you won't need much else in the way of equipment to start your business. Ask medical professionals about specific programs that they use or recommend. Determine whether you want basic software or a package that includes extras like lead generators. Discover what kind of references are available and if they're easy to use. Having hard copies of reference materials such as ICD-10, CPT, and HCPCS Expert 2000 coding books is a good idea.

Develop a Specialty
Just as there are many medical specialties, you can specialize in serving a certain group of providers such as cardiologists, opthamologists, dentists, etc. Focusing on a certain practice area will require knowledge of fewer billing codes and will allow you to work more quickly and take on more clients.

Baby Boomers Impact on Healthcare Spending: http://online.adu.edu/resources/infographics/how-aging-baby-boomers-will-challenge-healthcare-in-the-near-future/

Full Medical Billing Business Plan Resource: http://www.bplans.com/medical_billing_business_plan/executive_summary_fc.php

Raj Sa ⋅ Houston, TX IBM ⋅ 17 years experience

Hi! Karen,

I have been looking to establish medical billing practice for myself. I had done some investigation and learned it is a very competitive business. As this services are commoditized customer has very low tolerance level and practices have to be always top notch with lowest billing rates.

If you wish you can reach out to me directly and I share my research with you. My email is realytexas@gmail.com

Thanks

Rajiv

Karen Bovell ⋅ Patrick Afb, FL U.S. Air Force, Staff Sergeant ⋅ 5 years served

Wow!
Thank you all so much for this information. I see where I can incorporate your suggestions into my checklist.

I really appreciate this feedback.
Karen

John Green ⋅ Cary, NC Information Technology ⋅ 40 years experience

Have you written the business plan ? Has the plan been vetted ?