Medical Billing Services: Growth Is Spurred on by Changes in the Health Care Industry Ad the Data Revolution

Article excerpt

In 1993 about 6 billion medical claims were processed, burying physicians and health care providers under a deluge of paperwork This forced many medical professionals to outsource their billings and collections to companies capable of wading through numerous insurance codes and government regulations. Electronic medical billing services has proved to be a viable business opportunity for companies with experience in accounting, provider billing and computer systems.

Electronic medical billing services read patient claim forms, inputs the data according to complex coding systems and then submits the forms via computer to major clearinghouses. The clearinghouses then bill the patients or the insurance companies, who, in turn, pay the physicians.

Armed with 14 years, experience in hospital medical billings and a $5,000 investment, Vanessa Best began Precision Health Care Consultants in Jamaica Estates, New York, in 1995. A physician at the hospital where she was employed was leaving for private practice and Best persuaded him to retain her medical billing services - for $1,200 a month. Best's business now earns $38,000 annually. In addition, she was recently employed as a consultant to help launch the medical billing division of the Fidelity Group, a $8.5 million African American-owned insurance, benefits and medical management company in Great Neck, New York.

For new entrants to the industry, home-based medical billing businesses generally net $30,000-$100,000 a year. Most billing services receive $3 per claim processed; of this, a claims clearinghouse generally takes a fee. After a claim is processed, it takes about two to three weeks for a physician to receive his or her money, and depending on the payment terms, another 30 days before the client pays the billing service.

To get started in the business, you'll need a computer, fax machine and a medical-billing software package that meets claim requirements for Medicaid and Medicare. …