What is Medical Billing?

What is Medical Billing?

Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider or medical billing company (interaction between a health care provider and the insurance company (payor). 

Medical centers, hospitals, and private care professionals bill patients for appointments and services. These services can include check-ups, procedures, testing, treatments, and so on.

Medical coding and billing businesses translate these patient services into a bill and then send and follow up on medical claims with insurance companies.

Why do doctors and healthcare providers use outsourced billing methods in their revenue cycle management procedures?

Health insurance companies, Medicare, and Medicaid, require billing departments to process medical bills through extensive software under strict rules and provisions.

These rules state that billers and coders submit claims with a series of particular codes specific to the health provider’s medical procedure. This makes the medical claims billing process far more streamlined and organized.

However, that isn’t all.

Revenue Cycle Management is the administration of medical financial transactions resulting from patient-provider encounters. These transactions include:

  • Billing
  • Collections
  • Payer contracting
  • Provider enrollment
  • Coding
  • Data analytics
  • Management
  • Compliance

Medical billers and coders play a vital role in carrying out these revenue cycle procedures. They follow the patient’s payment actions from the first appointment or interaction with a medical provider to the bill’s final payment.

Billers and coding specialists help doctors earn revenue immediately through their coding and billing abilities and extensive knowledge of insurance companies’ requirements.

Patient medical records and medical reports, billers, and coding specialists can create and process accurate bills far quicker than health professionals.

Faster processing means more cash flow and decreased accounts receivables for care providers.

Is there a Need For Your Service?

Before putting time and money into your home business, you must research first if there is a need for third-party billing in your area. 

Contact doctors and healthcare providers and ask them these questions:

  • Does an outside company handle your billing, or do you do it yourself?
  • What software programs do you use/recommend?
  • If you use an external provider, what processes do you outsource?
  • How many patients do you see and bill daily?

Tip – Nursing homes and hospitals also use medical billing services and can be a lucrative area of specialization.

The questions listed above will:

  • Present a clear idea of the need for your services in the area
  • Give you advice on which software is the best
  • Indicate what volume of claims you can expect from your prospective clients.

Here are the essential items you will need to run a medical billing business smoothly:

1. A Clearinghouse

A clearinghouse is a financial institution that processes and facilitates the exchange of payments, securities, or derivatives transactions. In your case, it is a company that electronically receives and transmits medical claims billing.

How much does this service cost?

A clearinghouse’s cost can range from below $100 to several hundred dollars depending on the bells and whistles. Some clearinghouses also demand additional fees for each new medical care provider or account you add.

2. A Medical Billing Software

As mentioned earlier, the most expensive part of setting up your in-house company is medical billing software.

Billing software can range anywhere from a couple of hundred dollars to $10,000. While some are basic, others include features like marketing plans and lead generation.

3. Other Equipment & Forms

There are a few other necessities you will need to have:

  • A reliable computer with an internet connection
  • A phone, printer, and fax machine
  • Medical insurance forms
  • Reference books (ICD-10, CPT, and HCPCS Expert 2000 coding books)
  • A productive work environment

If you gain a plethora of clients, you can also use invoicing software to remain organized. If you run a high-volume business, electronic billing may be of use to you.

Your business, like all businesses, won’t grow itself.

Medical billing is a heavily saturated industry. You must create a rigorous marketing plan if you want to hit the ground running.

Getting your first client can be the biggest challenge. You have a head start if you have experience in the medical care industry and have maintained positive relations with healthcare providers in the past.

One of the best ways to market yourself in the medical billing industry is through in-person visits, where you drop off marketing material and create relationships with providers.

Moreover, creating a website and business cards for your service and offering incentives will stimulate growth and leadership opportunities.

While generating leads, consider providing these free incentives to lure in prospects:

  • An analysis of the benefits of outsourcing billing services for their specific medical practice.
  • A code review. Analyze which codes are out-of-date or incorrect, and estimate the amount of lost revenue that has resulted from these codes.
  • A free claim process and an estimate of the time your services saved them.
  • An analysis of their Superbill and accounts receivable, and an estimate of why some of their medical claims are rejected.
  • A consultation to evaluate if they comply with HIPAA and OIG.

If you struggle to bag your first client, you can also offer discounts and other incentives for some time. For instance, you could offer twenty percent off for the first month of your services.

Whatever route of marketing you choose to pursue, create a strategic plan ahead of time so that you are ready to go when it’s time to grow your business.

Knowing the right people can always help you achieve your goals. That’s why Networking is always important. What’s more? Word of mouth referrals and positive personal testimonies are fantastic for your business.

Embed yourself in the network of medical professionals and make a name for your business. Involving yourself can be done through joining professional organizations, getting in touch with your own family’s medical providers, and working in a medical office that allows you to come in contact with a variety of providers.

Expanding your network will increase your chances of obtaining new clients and growing your business. Taking good care of your clients will lead to more clients, simple as that.