The business involves sending insurance claims electronically (via phone line) to the commercial carriers and governmental agencies via a clearinghouse. Use of a clearinghouse is mandatory. There are perhaps a half-dozen widely-respected clearinghouses in the country. Location is irrelevant. Size is important here, since reliability (which usually results in size) is mandatory in the clearinghouse function. Choice of clearinghouse is determined by the software company. Often, they are both owned by the same entity. This may not be the best resource. The most popular clearinghouses are independent of a software company. Their setup packages are available in advance of client development and contain necessary physician setup documents-ask for them.

Special software is required. This is not available from typical retail outlets. It must be purchased directly from one of hundreds of companies or their resellers. Price range from $100 to $12,000. Software "packages" selling below $500 are usually very limited in application. This low-price "kit" of items appeals to would-be entrepreneurs with limited funds and the need to be underway quickly. This rarely happens. Software selling above $1,000 is usually part of a "business opportunity" which will typically include $500 software, "business/educational" items, and a "training" session. Some items in the package may be unneeded and some of the "training" may be questionable in usefulness and value. These "opportunities" appeal to those with access to greater funds who believe that cost equals value. This is rarely true here. Greater cost will usually buy more items but the value of the items should be challenged. Most successful homebased billing centers nationwide own software costing $500-1,000. The other business elements are rarely packaged together with the software. The most critical understanding regarding software is this: owning software does not create a business-clients are required for any business. The greatest challenge to this business is developing a client base, not learning the fundamentals of the business operation and software use.

This is a business of cashflow management. Marketing for this business does not involve persuading clients to change from one cashflow method to another (yours, electronic billing). If their existing cashflow method is successful, even if it is less efficient than may be possible, the providers will keep the existing method and refuse to consider a change. The only prospects for your services will be providers whose cashflow is below norm as a result of current inefficiencies. All others will turn you away and ignore your selling strategies.

This is a business of accounting and bookkeeping. It involves data entry. This is not a business of medicine. There is no need to learn medical terminology or coding. The information is sent to you from the provider's office already coded (in numbers). You just enter the numbers in the appropriate fields in your software.

You are usually prohibited from doing collections by law. Most states require collection services to be licensed and bonded. The doctor's staff, as direct employees of the creditor, may make collection calls. You are an independent contractor. You may refer an associate who is licensed (a service you can recommend) to provide any necessary collection actions for your clients.

This is a business in constant flux. It is critical that you maintain an understanding of the changing laws and requirements of the business. The Network newsletter (the Electronic Biller) provides the only source for this information.

Quick access to timely information is often required. The Network phone support is available during business hours (EST) to answer questions relating to all aspects of the business.

Trade publications and supplies are required. They are usually available at discount through the Network.

Membership in the Association brings additional benefits that can help make the process starting and managing an electronic medical business easier and less time-consuming. Join today!

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