How to Start a Medical Claims Processing Business

Startup Costs

One of the many nifty things about a medical billing service is that its startup costs are comparatively low. You have the advantage of homebased-ability, which cuts office lease expenses down to nothing. You have almost no inventory, which means no outlay of funds for pretty doodads to grace display spaces (you have no display spaces!). Your major financial outlay will go toward office equipment and your software and/or business opportunity--and if you're like many moderns, you already have a computer.

But let's take it from the top. The following is a breakdown of everything--from heavy investment pieces to flyweight items--you'll need to get up and running:

  • Computer system with modem and printer
  • Fax machine
  • Software and/or business opportunity fee
  • Clearinghouse
  • Reference materials
  • HCFA 1500 forms
  • Phone
  • Voice mail or answering machine
  • Stationery and office supplies
  • Postage

Software Solutions

Your medical billing software is going to be your closest partner after your significant other, so choose carefully. The list of suitors is lengthy, with medical billing/patient accounting programs and packages ranging from $500 to $10,000. Different packages have different capabilities, but more expensive is not necessarily better or worse. You can buy the bare-bones software or purchase a complete business opportunity package, which can include lead generation, seminars, marketing help and hold-your-hand technical support along with the software.

"You can hire a [local] marketing guru for lots less than [you can buy] a business opportunity," advises Gary Knox of Resource Books, which publishes The Directory of Medical Management Software. Don't ignore the business opportunities, he says, but look carefully to make sure you're getting your money's worth. Whichever option you choose, you'll want to make sure the software is the suitor of your dreams.

Once you identify the software of your dreams and pocketbook, make sure it has a good reputation. Find out how long the vendor or developer has been in business and how many people (preferably thousands) are using the product. Get references, and don't be shy about calling them. Most medical claims processors are only too happy to share their experiences and will be glad to give you tips other than just a software reference. It can be one of your first forays into networking. Ask lots of questions, such as, Is the program user-friendly? How good is the technical support? How available is the technical support? How long has the person you're talking to been using the program? Are they happy with it? Have they heard any rumbles about possible problems in the future, such as the vendor leaving for a permanent Tahitian vacation?

Clearinghouse Costs

Hiring a clearinghouse--the companies that receive and transmit claims electronically--requires research on your part. If the software is like a marriage partner or significant other, then the clearinghouse is the brother or sister-in-law that comes to visit for what seems like the rest of your life. You'd better be sure you're happy living under the same roof with it.

Also like software, clearinghouse costs vary radically. You should allocate from zero to $300 for "membership" fees and from zero to $50 per doctor for sign-up.

Reference Books

Although your reference library can comfortably contain a wealth of texts, we'll consider here only the very few that are real must-haves, the ICD-10, CPT and HCPCS Expert 2000 coding books. If you're billing for dentists, you'll also want the CDT-3, which is the dental version of CPT codes. You can sketch in about $200 total for the first three on the list, plus another $60 for the CDT book.

How to Start a Medical Claims Processing Business

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