How to Start a Medical Claims Processing Business

Target Market

Your target market--the clients you're aiming for--can be as diverse as the field of modern medicine. Any healthcare provider is fair game. You can go after family practitioners, providers of every specialty from geriatrics to pediatrics, chiropractors and osteopaths, obstetricians and oncologists, proctologists and podiatrists. You can target mental health professionals, psychiatrists and psychologists. And don't forget the groups of providers not normally associated with doctoring, such as dentists, social workers, nursing homes, ambulance services, pharmacists, home-health practitioners, providers of durable medical equipment and providers of bionic body parts.

If you've had previous experience working in a particular medical specialty, you might want to target that market first. You'll feel comfortable with the jargon and procedures so your sales pitch--and your initial billings--will go more smoothly. As an added bonus, you may already have contacts in the field who can either become your first clients or steer you to colleagues in the field.

If you're a newbie in the world of medicine, you might want to start off targeting doctors in a single specialty, such as psychiatrists, chiropractors, cardiologists or dentists. These providers' practices involve a narrower range of diagnoses and procedures than a family practitioner, general surgeon or internist, so you'll have fewer new codes tossed in your lap at the get-go. This is a good, starting-from-scratch strategy, but don't let it dictate or limit your contacts. Most MIBs (medical insurance billers) find that the first client they land, through whatever means, is the specialty they end up going with.

Does Size Really Matter?

OK, you've decided--or are thinking about planning on deciding--which areas to specialize in. Good! But you're far from laying your decision-making skills to rest. Next you have to think about what size practices you'll want to focus on. Any size is fine, of course, but you might consider starting off with small to midsized practices. This way, you won't be overwhelmed by your workload while you're on the upside of your learning curve.

You should also consider the size to which you ultimately want your practice to grow. "If you don't want to be big, you don't want to grow a whole lot," medical billing service owner Mary V. counsels. "[Then] you want three or four doctors. That's going to give you a very good income, depending on the type of doctor you have."

"We love our chiropractor," Mary adds as an example, "but I will never take on another one."

Why? "Sheer volume," Mary says. "A chiropractor can see a hundred patients a day in one fell swoop, and then you've got all this paper, whereas a neurologist sees 20 to 26 [patients per day]."

Even though both doctors bring in the same amount of money for a day's work, Mary explains, the chiropractor, billing at $30 per visit, must generate far more claims--and more work for the medical claims processor--than the neurologist, who's billing $70 and up.

Practice Particulars

What, specifically, you will be doing during your peak hours and beyond will depend on how you've structured your services. Some MIBs perform full practice management for their clients--they handle all aspects of the doctor's accounting from submitting electronic claims to billing patients to tracking accounts payable and receivable. Other MIBs prefer to deal only with insurance claims submissions. Most medical billing specialists, being savvy businesspeople, take on whatever is required to land the client and therefore find themselves working in different ranges of practice management for different clients.

"I'm kind of an a la carte," Vicki D. says of the services she offers. "[The doctors] just tell me what kind of services they need. That's what I try to provide and then I charge them accordingly."

Mary V. and her partner discovered that smaller practices, those with one or two doctors at the helm, have no business background and desperately need assistance. "We don't like to say full-practice management," Mary says of the accounting services they offer these small practices, "because we're not in that office. We call it accounts receivable management."

How to Start a Medical Claims Processing Business

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