Starting a Medical Billing Business > Starting Your Own Medical Billing Business
Do I need to file for a Third Party Administrator license?
Cmporter82:
Yes, my contract must be included in my application as well. I have emailed a few lawyers regarding this, anxiously awaiting their responses! I am waiting for my city license to be approved (which they told me could be a month) before I can send it in as well.
galley:
I was just certified by the NJ Department of Insurance and Banking a couple of month ago. Third Party Administrator are companies that receive monies directly from the insurance companies as payment for services. They will explain that to you. Third party billing services is what I believe you are speaking of. Billing on behalf of a healthcare provider. Yes, you must submit application, business plan and contract. You do not have to have a contract with a provider at the time of filing, but they want to see what type of contract you will be using. The business plan must be submitted in a binder by their specifications. I am doing business from my home and my county doesn't require me to have a license unless I have traffic in and out of my home. NJ department of Insurance and Banking require you to have documentation from Department of Treasury, division of Revenue for the formation of company which specifies your entity name. I have also checked with several other states about doing business and their only requirement is license for TPA (third party administrator license).
PMRNC:
Gallery is correct about NJ, The term licensing and registration are two different things. But from what Cmporter82 it looks like her state too does require the same things, more states are adding this which I think in the long run is GREAT for us as it gives our industry yet some more professionalism! How many of those home study or biz opportunity packages teach you that you need a compliance plan? Soon that will be required and every Third party billing company should have one in place! Requiring licenses and/or registrations is the first step in a great process I hope continues. It's going to force training and educational companies to step up their training or go out of business and it's going to weed out the billers with a false sense of what this business is about. On the average I speak to hundreds of new billers a month but sadly only 5-10% will make it.
Cmporter82:
Even though it seems like a hassle right now, I am glad that they do enforce such things.
I cannot believe the number of people that do not even know what a compliance plan is (sad, but true).
It kind of makes me laugh a little when I hear people talk about wanting to start an at home business and they think that Medical Billing will be "easy". Especially those people who don't even have any experience. I LOVE medical billing, and I wouldn't call it easy. That's part of the reason I love it! It keeps me on my toes and busy. It's very detailed oriented. You HAVE to be on top of things, you HAVE to be organized. You HAVE to keep up to date with your education. You have HAVE to know the laws. You HAVE to be compliant. You HAVE to know what you're doing. I think people who just try to walk into medical billing completely ignorant are going to find themselves in quite a bind.
DMK:
I LOVE that you realize the HAVE TO items! That indicates that you are moral, ethical, and legally compliant! When you include the HAVE TO items in your sales presentation it will make the Doctors more confident in you!
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