How to Start a Medical Claims Processing Business


Editor's note: This article was excerpted from our Medical Claims Processing Business start-up guide, available from the Entrepreneur Bookstore.

A medical billing service is a doctor's key to getting paid. Despite the fact that the health-care industry is alive and well in America, most doctors and other health-care providers have no idea how to get themselves paid quickly and efficiently, if at all, by either insurers or patients who are also waiting for that check to arrive in the mail. Private and government-administered insurance companies, HMOs, PPOs and a host of other mysteriously initialed plans have conspired to make physician reimbursements as elusive as the pot of gold at the end of the rainbow. Doctors, once the lords of the health-care world, are fast becoming the underdogs.

Not to worry--the medical billing industry is on hand to save the day. A billing expert can dramatically increase a doctor's immediate revenue. Through the miracle of cyberspace, the biller electronically transmits insurance claims directly to the insurance company or, in other words, into the company's check-generating computers.

Medicare gives priority to any claims submitted electronically. Claims received online are paid in 10 to 14 days, as opposed to paper claims, which are set on the back burner for at least 27 days. Most other insurers now follow this same tenet--electronic claims before paper. The results can be dramatic.

Amazingly, however, while electronic claims processing is the method for getting providers paid, most providers are still stuck in the Snail Mail Age. This makes electronic billing a thriving field with room for growth.

Not a Small World

With legions of providers and an ever-expanding patient pool, the health-care industry is flourishing. According to a recent study by the government's Health Care Financing Administration (HCFA), national health-care expenditures totaled $1.3 trillion in 2000. Medicare spending accounted for $224 billion of that total. So let there be no doubt: Health care is big. And, like Jack's legendary beanstalk, its growth shows no signs of slowing. This makes it fertile ground for the medical billing entrepreneur.

How to Start a Medical Claims Processing Business

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