Once you have your medical clams billing service up and running, you get down to the business of filing and submitting claims for a client. The main point of your service is to increase the client’s revenue. You need to make sure this happens, within a realistic timeframe, by diligent follow-up and tracking. You also need to charge your client reasonable rates to make your hard work pay off.

Outsourced Medical billing, whether home or office based, demand commitment and an economic savviness. Medical billing professionals must have good marketing and networking skills. It takes time to build relationships and gain expertise. Setting up the business takes time and client revenues do not increase overnight. You need to set realistic expectations to keep yourself motivated and the customer satisfied.

Medical Claims billing process

Here is a stepwise description of the work involved in medical billing:

1. Receive bills from the client.

2. Enter the information – patient details, insurance company, referring doctor or physician, and any other information the client wants to track.

3. Enter the CPT and ICD-9 codes from the super bills and day sheets. Super bills are forms that contain:

      a. patient information – name, date of visit

      b. common CPT/ICD-9 and HCPCS codes used in the practice

      c. an update section – follow-up appointments, co-pays, payments, etc.

4. Each charge is entered in a separate line. Charges are calculated by the software automatically.

5. Submit the electronic claims to the clearinghouse or insurance carrier directly.

6. Review the audit report, correct errors, and move clean claims forward.

7. Call the insurance carrier and find out why a claim has been rejected. Get the claim corrected and resubmit it.

8. Print two copies of any paper claims – for the insurer and yourself. Post the claims to the insurer.

9. Post bills to each patient. The software allows you to track payments made and that are pending.

10. Print reports that show aging patient accounts. These are the patients that have not settled payments on time.

11. Follow up delinquent claims (mostly paper claims).

Pricing your medical billing services

Medical billing companies charge on one of three bases – percentage of collection, per claim and per hour. Medical billing services that work on claim submissions and patient billing or offer complete practice management services usually charge a percentage of the amount they collect in a month. The bill is sent out monthly or fortnightly. The percentage charged varies with the location of the service, the client’s patient volume and type of practice.

Medical billing services that work on claim submissions only charge an amount per claim. The least preferred method of charging is hourly – for both clients and medical billers. However, this option is useful to charge clients with very low billing rates or who prefer this arrangement over others.

Medical claims billing is a high revenue generating business service. Gross annual revenue of small to mid-sized medical billing services ranges from $350,000 to $650,000. Even part-time medical billers who work from home earn $25000 to $50000 annually. Obviously, starting a medical billing service is an excellent business idea. Take steps to get your career on the right path today.

Tags: medical billing

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