Electronic medical billing is a
modern business, resulting from the
development of the personal computer. You must have access to a computer to operate this
business. There are no special hardware requirements beyond the computer (the faster the
better), a printer (any type), and a modem (the faster the better).
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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For more information please feel free to
contact us at:
Electronic Medical Billing Network of America, Inc.
51 Eton Court, Bedminster, New Jersey 07921
Phone 908-470-4100 FAX 908-470-4233
Email: merl@medicalbillingnetwork.com
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