Starting a Medical Billing Business > Starting Your Own Medical Billing Business
starting a medical billing business
PURPLELADY:
Hi all...
I am in the process of starting a medical billing business from home and it will also include a/r collections.There are so many questions I have and dont know where to begin. I am trying to get the "set-up" together. I do have a business partner and we are registered w the state and have a tax id#. I have the business license, llc, and npi apllications ready to be filled out (I may need help with these) We plan to do manual and electronic billing. Trying to be cost efficient(in case things dont work out). We are seeking a way to bill ins co directly without a clearinghouse (if possible). Is there a software that will give us this capability? I am currently reviewing the software from ezclaim for 30days (so far it seems okay for manual billing and reports and patient statements). I would also like to know what are the current fees to charge per claim the primary care Doctors and the percentage fee to charge the specialty Doctors?
I would greatly appreciate any help I can get. After reading some things on this site it looks like this is the "one stop shopping for me".
THANKS
Pay_My_Claims:
PurpleLady,
There really isn't a "set" fee to go by. You may want to research your area and find out what is UCR in your area. Also fees differ on what you are offering the client. Some are doing just billing only while others are doing full service Patient Management. There are various software that you can use. No you don't have to have a clearing house, although I prefer to utilize one. If you are concerned about cost, look at Practice Mate and OfficeAlly, both are free (to a degree). There can be a charge if I believe 50% of your claims are Medicare, then its 19.99 a month fee. I am not endorsing them, just giving you some leads. Google Medical Billing Software and you will come up with a lot. Some have clearinghouses that don't charge a per claim fee, if cost is what is keeping you from using one.
Good Blessings
Michele:
Congratulations on your decision to start your business. We wish you the best.
First, I noticed you indicated you were prepared to apply for an NPI number. Billing services do not need NPI numbers, only anyone who is providing a medical service and billing insurance companies for that service. All of the providers you bill for will need NPI numbers, but not your business.
Pay_My_Claims had some good suggestions for you on software. I have heard of both of them but never used either personally.
You can submit claims electronically directly to insurance carriers (as opposed to going thru a clearing house) but it usually requires a separate software that works with your practice management system. So it will depend on which software you go with. For example, we use Lytec and we purchased a separate software, ClaimManager, which allows us to submit claims directly. The ClaimManager software is quite costly (almost as much as the Lytec) but for us it is worth it due to the volume we have. However, we are currently working with a software company that is developing a webbased software that is going to be very cost efficient yet the features are very nice. It will be available in March.
As far as fees, Pay_My_Claims was right. There are no 'set fees'. You have to go by your area, the services you are providing, etc. We have found that nationwide the percentage can be from 5% - 13%. We have also seen per claim fees from $1.50 - $5.00 per claim.
Hope the information is helpful.
Michele
PURPLELADY:
Thanks to Pay My Claims and Michelle for your input. Your points are well taken. I am so excited that I stumbled on this site I just dont know what to do!!! (smile). Now, I need to know about the process of payments. We are having pymts sent to the Docs directly. Are the eobs sent to the Docs or billing service? Or both? Should the Docs be billed bi-weekly or monthly? We also will be accepting credit card payments over the phone. We have the quickbooks simple start software that also includes accepting credit card payment thru them. I feel that there fees are much to high so we decided on using pay pal since it is well known and a trusted site by clients. Is this a good idea or can I do better in this area? Oh, I almost forgot....We would like to create a "packet" for the Docs to review about our business or should I keep it simple with just a brochure? It was suggested to me that my first Doc should be charged half price or free since we will be trying to iron out any kinks there may be. What do you think? Forgive me for jumping from one thing to another. Maybe I just need a definite process to follow
as to how the business should be set up. I have been in this business for almost 29 years with different positions and I love it. I think I need a mentor.
Michele:
EOB's are usually attached to or in the same envelope with the checks so if the checks are going to the docs then the eobs will too. They will not send out more than one copy, you will have to get yours from the docs. We bill our providers monthly. I have used paypal and never had any problems. Currently we are set up with a merchant account. I don't have anything to do with that part (partner handles it) so I can't really comment on fees.
As far as packet or brochure, 6 of one, 1/2 dozen of the other. There is no right or wrong, but you should consider cost. Honestly I don't think providers make up their minds on how good your brochure is, they usually ask for one when they are trying to get rid of you.
I don't know if I would recommend offering a discount (or free) to your first client. Even though they are first you are providing them with the same service. Also, what if you don't have any kinks to work out, what if it all goes smoothly. And I hate to break it to you but you're going to have kinks 10 years from now. They seem to keep popping up here and there! :D
You can always discount their monthly bill if you have something big happen, but if you start at a discount it would be hard to change.
Good luck
Michele
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