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Thread: Staring a Billing Company

  1. #1
    Join Date
    Apr 2007

    Default Staring a Billing Company

    AAPC: Back to School
    I would be interested in talking with a CPC that has starting a billing service. The information I am looking for to compare is how you selected your software, marketing and calculating your fees to charge physicians.

  2. #2


    Choosing software is a personal choice -- meaning it's usually through personal experience of having used a program or knowing the features you need or like or think you will need in the future that one bases their software on. There's a lot to picking one that you can live with. Cost is usually a big factor, but I think you should be looking at the software benefits you can utilize that will give you an advantage over your competition. You may find that you will buy a program and use it for a few clients and then change. Or you may be required to use a client's program. It's not uncommon to own or use 2-3 programs. That's why it's important to make a good decision up front. Will you require a stand alone program or do you want to utilize a web based product? A web based product would permit your clients to log onto your system for reports or patient scheduling or even data entry. Will you use one that has EHR capabilities? Also, the clearinghouse you use will be tied to the software program you use. Report capabilities are also extremely important. Most programs are pretty similar in terms of the data required, its the way you manuver around them and the extras that you're looking for. Be sure to demo a LOT of products so you get a feel for what you like or don't like about a program.

    Calculating your fees is an area that is not set in stone. There is no "one price fits all" because each practice is going to be unique. You may want to charge an hourly rate, a flat per transaction rate, flat monthly rate, percentage of collections, etc. You have to consider how much work you're going to be doing -- will there be a lot of new patients or with they most be established patients because established patients cost you less in time and money to input. Once the patient's demographics are input, it only takes a few seconds to do a claim. Will you be required to verify benefits? Will you do appeals and follow up on unpaid claims? Will you credential? Some things are charged for separately. One provider may have 100 new patient claims each month that require a a certificate of medical necessity to be submitted with the claim and another provider may have 300 claims a month that are easy to process. No two providers will ever be the same and you can't charge both providers the same fee because you could be losing money on one or both. You have to know how much money you have to make to cover your expenses and your time plus a profit. The only way to know this is to put it to paper. Most people don't take the time to do this and eventually, the realize that it's costing them money to work for a client.

    You didn't ask about compliance. There is a whole host of things you need to consider before starting your business such as developing a compliance plan, complying with HIPAA requirements and doing a business continuity plan for risk mitigation. Any provider who is worth having should be asking you for a copy of your compliance plan and they should want to see your HIPAA Policy and Procedures book.

    You will want E&O insurance, too.

    Marketing will be one of the hardest things you will do. It requires constant attention and everything you do will be about marketing. That's why it is so important to make good decisions from the onset.

    You should consider networking with other billers and or joining an association that works with billers. That will give you access to information that would help you start your billing business.

    I don't want to discourage anyone -- God knows there are plenty of people out there doing a poor job of billing. You be different. If you do a good job, there will always be plenty of work. BUT, do your homework. Work hard at starting your business and then at marketing it and you'll do well.

    I'll be happy to answer additional questions you have.

    Best wishes!
    Last edited by cyndeew; 08-04-2010 at 12:07 PM. Reason: forgot something
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    AMBACode Coding Software
    2015 AMBA National Medical Billing Conference

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