If you are starting your own business it is imperative you have start up funds. You will need more than just your software. The costs you can then incur later with clients will be clearinghouse fees, forms, etc. Depending on what software you purchase you might also consider training and I highly recommend a support plan as well. You are also going to need many other items to start. It's like any other business. For example, you wouldn't purchase a restaurant and not the ovens while you wait for people to enter the restaurant. There are some of us who will connect with offices and use their PM software but I would suggest you have a vast amount of experience first because you do not want to charge your client to learn their software, one of the advantages to outsourcing for providers is cost, so you have to keep that in mind.
I have had formal training in billing and coding and am certified in both, my understanding is that soon billing and coding certification will be mandatory, but I am from New Jersey or some say Joisey, I cannot find a job and I see most billers and coders are uncertified, I am presently targeting small practices with a number of options. Frustrated yes, I am the only surviving member of my class, everyone else gave up long ago.Oh yes, I graduated last June!