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by ronick

10 Things You Should Do Before You Start Your Medical Billing Business

September 30, 2011 in Medical Billing/Coding

One time, I saw a news­pa­per ad say­ing they are hir­ing work-at-home med­ical billers. I called the num­ber (just to find out what it is!), I found out that for you to be able to work as a Med­ical Biller, you have to pur­chase their soft­ware at a range of $800–1,500 (I thought, it is actu­ally a packaged-medical billing busi­ness). They will then train you how to use their soft­ware, after (I think) 10 days of train­ing, you will have an access to their so-called doc­tors’ data­base. They promised you can get your 1st client through their database.

Due to my curios­ity, I started read­ing and research­ing pack­aged home­based med­ical billing busi­ness. But take note: the train­ing you will get is NOT actu­ally a med­ical billing train­ing. The bot­tom line here? – you sim­ply pur­chase the busi­ness, pay for their soft­ware and start your busi­ness! But how real­is­tic is this? I know some peo­ple who ended up with no clients at all after pur­chas­ing the soft­ware! And then later on, I’ve read that the Fed­eral Trade Com­mis­sion warned us about these com­pa­nies offer­ing home­based med­ical billing busi­ness with their false claims on how you make a lot of money on this business.

Med­ical Billing is a legit­i­mate busi­ness (either home-based or office-based) and you can make good money as long as you know how to do it, the right way. But before that, con­sider the 10 Things You Need To Do:

1. Try to gain actual work expe­ri­ence. Work as a Med­ical Biller in a doctor’s office (or even as a vol­un­teer at your near­est hos­pi­tal). Do this for at least a year.

2. You should be highly knowl­edge­able on HIPAA (Health Insur­ance Porta­bil­ity and Account­abil­ity) and how does your cur­rent work/practice place complies/follows its rules and reg­u­la­tions. I always empha­size this because it is very impor­tant in any health provider businesses

3. Learn the actual “know-how” on claims sub­mis­sion (paper billing & elec­tronic billing)

4. Learn how you can deal with insur­ances, can you han­dle col­lec­tions? denied/rejected claims? Learn how to file appeals for denied claims

5. Learn how to ana­lyze and opti­mize proper cod­ing (pro­ce­dure and diag­no­sis codes) to avoid rejec­tion & denials

6. Learn how to review and ana­lyze the rea­sons for unbilled and or aged med­ical claims

7. Beside learn­ing the med­ical ter­mi­nolo­gies, you should also know many “med­ical billing” terms and its mean­ing: (PCP, copay, co-insurance, deductibles, allowed amounts, pre­de­ter­mi­na­tion, med­ical neces­sity, progress notes, prog­no­sis, treat­ment plan, preau­tho­riza­tion, appeals, refer­rals, scripts, ben­e­fits and eli­gi­bil­ity, cap­i­ta­tions, HMOs, PPOs, POS, EPOHIPAA)

8. Learn how to prop­erly post: – pay­ments, deductibles, co-insurance, adjust­ments and write-offs (it is dif­fer­ent when you are actu­ally at work doing the post­ings than what you learned dur­ing your training)

9. Feel the med­ical billing sce­nario (how is the cash flow? what about the turn-around time of payments?)

10. And the last but not the least, feel the work— do you like what you do? Do you have the abil­ity and the man­age­r­ial skill to run your business?

Writ­ten By: Pinky Mcbanon

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