Start Your Own Medical Claims Billing Service

225 Pages·2012·3.619 MB·English

by  Entrepreneur Press, Charlene Davis

Additional titles in Entrepreneur’s Startup Series
Start Your Own
Arts and Crafts Business Hair Salon and Day Spa
Automobile Detailing Business Home Inspection Service
Bar and Club Import/Export Business
Bed and Breakfast Information Marketing Business
Blogging Business Kid-Focused Business
Business on eBay Lawn Care or Landscaping Business
Car Wash Mail Order Business
Child-Care Service Medical Claims Billing Service
Cleaning Service Net Services Business
Clothing Store and More Online Education Business
Coaching Business Personal Concierge Service
Coin-Operated Laundry Personal Training Business
Construction and Contracting Business Pet Business and More
Consulting Business Pet-Sitting Business and More
Day Spa and More Photography Business
e-Business Public Relations Business
Event Planning Business Restaurant and More
Executive Recruiting Business Retail Business and More
Fashion Accessories Business Self-Publishing Business
Florist Shop and Other Floral Businesses Seminar Production Business
Food Truck Business Senior Services Business
Freelance Writing Business and More Travel Business and More
Freight Brokerage Business Tutoring and Test Prep Business
Gift Basket Service Vending Business
Grant-Writing Business Wedding Consultant Business
Graphic Design Business Wholesale Distribution Business
Green Business

Entrepreneur Press, Publisher
Cover Design: Beth Hansen-Winter
Production and Composition: Eliot House Productions
© 2012 by Entrepreneur Media Corporation
All rights reserved.
Reproduction or translation of any part of this work beyond that permitted by Section 107 or
108 of the 1976 United States Copyright Act without permission of the copyright owner is
unlawful. Requests for permission or further information should be addressed to the
Business Products Division, Entrepreneur Media Inc.
This publication is designed to provide accurate and authoritative information in regard to
the subject matter covered. It is sold with the understanding that the publisher is not engaged
in rendering legal, accounting, or other professional services. If legal advice or other expert
assistance is required, the services of a competent professional person should be sought.
Library of Congress Cataloging-in-Publication Data
Start your own medical claims billing service/by Entrepreneur Press and Charlene
Davis.—3rd ed.
p. cm.
Includes index.
ISBN–10: 1-59918-444-3 (alk. paper)
ISBN-13: 978-1-59918-444-9
1. Medical fees—Data processing—Handbooks, manuals, etc. 2. Health insurance
claims—Data processing—Handbooks, manuals, etc. 3. New business enterprises—
Handbooks, manuals, etc. 4. Medical offices—Management—Handbooks, manuals, etc. 5.
Medicine—Practice—Finance—Handbooks, manuals, etc. I. Davis, Charlene, 1957–
II. Entrepreneur Press.
R728.5.A297 2012
362.10681—dc23 2012010194
Printed in the United States of America
16 15 14 13 12 10 9 8 7 6 5 4 3 2 1
Contents
Preface ....................................... xi
Chapter 1
Prescription for Success ......................... 1
The Doctor’s Key ........................... 2
Not a Small World .......................... 2
Preventive Maintenance ...................... 4
The Problem ............................... 4
Electronic Filing Beats Paper .................. 5
Software Magic ............................. 5
Skimming Along with Superbills ............... 6
Counting Your Coconuts ..................... 7
Crank-Up Costs ........................... 10
The Rock of Gibraltar ...................... 10
The Right Stuff ............................ 11
Move Over, Miss Moneypenny ................ 12
People Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
The Great Debate .......................... 13
Starting Over .............................. 16
My Friends, the Doctors ..................... 17
(cid:31)
e Summing Up ....................................... 18
c
vi The Prognosis ...................................... 18
r
e
S
g
n
Billi Chapter 2
s Health Insurance 101 .................................... 19
m
ai Who’s Who in Insurance ............................. 20
Cl
al Commercial Carriers ................................. 23
dic Those Dang Deductibles ............................. 23
Me The Big Three ...................................... 25
n The Blues .......................................... 25
w
O Alphabet Soup ...................................... 26
r
u Muddling through Medicare .......................... 28
o
Y
t Part B Particulars ................................... 30
r
a
t Accepting Assignment ................................ 30
S
Oh, That Medigap! .................................. 32
Medicaid .......................................... 32
TRICARE ......................................... 33
Workers’ Compensation .............................. 33
The End, Finito ..................................... 35
Chapter 3
Day to Day Operations .................................. 37
Good Morning, Medical Biller! ........................ 38
Practice Particulars .................................. 39
The Nitty-Gritty .................................... 40
Secret Decoder Ring ................................. 41
Verify and Clarify ................................... 47
In the Groove ...................................... 48
The Diagnosis Code Dirt ............................. 50
The Denied ICD-10 Code ............................ 51
Just the Fax, Ma’am ................................. 52
Organically Organized ............................... 54
The Instant “A” ..................................... 55
The Old-Fashioned Way ............................. 57
Submission Time .................................... 57
Playing the Insurance Game ........................... 58
Winning the Game .................................. 60
Time Juggling ...................................... 62
vi
(cid:31)
Chapter 4 C
o
n
Diagnosing Your Market ................................63 t
e
Tripping Doctors .................................... 64 n
t
s
Does Size Really Matter? ............................. 66
What’s My Niche? ................................... 67
Starting from Retiring ................................ 68
Go the Extra Mile ................................... 69
Up Close and Personal ............................... 70
Ready, Willing, and Able ............................. 70
The Economic Pulse ................................. 71
Have Modem, Will Cybertravel ........................ 72
The Competition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Nosy—Not! ........................................ 73
Shopping the Competition ............................ 75
Chapter 5
X-Ray of a Medical Billing Business ...................... 81
Name That Business ................................. 82
Buffalo Bill(ing) ..................................... 84
The Fictitious Business Name ......................... 84
Your Skeletal Structure ............................... 85
Home Zoned Home ................................. 86
Strange Fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Loose Lips Sink Ships ................................ 87
HIPAA, HIPAA. . . Oh No! ........................... 87
Your Business Gurus ................................. 89
Chapter 6
Pain Management: Figuring Your Finances ............... 91
Startup Costs ....................................... 92
Computing Computer Costs .......................... 92
Fax Facts .......................................... 93
The Skinny on Software .............................. 93
Clearinghouse Costs ................................. 93
By Way of Reference ................................. 94
Phone Fun ......................................... 94
Please Leave a Message ............................... 94
Office Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Postage ............................................ 95
vii
(cid:31)
e Postage Meters and Internet Postage .................... 96
c
vi Adding It All Up .................................... 96
r
e
S Talking Money ...................................... 97
g
n
Billi PCeoru-nCtlianigm t hJuem Hpoinugrs . .................................................................. 9998
s
m Operating Expenses ................................. 100
ai
Cl Cuckoo for Clearinghouses ........................... 101
al Paying the Piper ................................... 103
c
di Olé for Online Service .............................. 103
e
M
Putting It All Together .............................. 104
n
w Help from Your Friends ............................. 104
O
r Romancing the Bank ................................ 105
u
o
Y
t Chapter 7
r
a
St Medical Center or House Calls: Locating Your Business ...109
The Home Office .................................. 110
The Tax Man Speaketh .............................. 110
Growing Pains ..................................... 111
Let’s Make a Deal .................................. 111
Alternative Officing ................................. 111
The Medical Complex .............................. 112
Portrait of a Home Office ............................ 112
The Outside Office ................................. 115
Chapter 8
Employees, Insurance, and Other Facts of Life ............117
Hired Hands ...................................... 118
Slave Labor ....................................... 119
The Temp ........................................ 120
Insuring Your Gems ................................ 120
The Error of Omitting .............................. 121
Forward to the Basics ............................... 122
Chapter 9
Your Operating Theater: Equipping Your Business ....... 123
Computer Glitterati ................................ 124
Monitoring the Monitor ............................ 125
Flashy Drives ...................................... 125
Purring Printers .................................... 125
viii
(cid:31)
The Fax for You. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 C
o
Soft on Software ................................... 126 n
t
e
The Business Opportunity ........................... 128 n
t
s
Clearinghouse Check-Up ............................ 129
More Software ..................................... 130
Hello, Central ..................................... 132
Automated Answering Service ........................ 132
Vociferous Voice Mail ............................... 133
Rah-Rah Reference Manuals ......................... 133
Form-Fitting ...................................... 134
Laugh at Lightning ................................. 134
Lightning Strikes Again ............................. 135
Cool and Calculating ............................... 135
Paper Cloning ..................................... 135
Chapter 10
Blowing Your Own Horn ............................... 139
People Will Talk ................................... 140
The MIB Letter ................................... 141
At ’Em Advertising ................................. 142
(Cold) Calling All Clients ............................ 144
The Doctor’s World ................................ 144
Handle with Care .................................. 146
Capture That Client ................................ 147
Percentage Pow! ................................... 148
The Per-Claim Pitch ................................ 148
You Must Remember This ........................... 149
People Who Need People ........................... 150
One Singular Sensation .............................. 151
Public Relations Patter .............................. 151
Are You Being Served? .............................. 157
Kill Them with Kindness ............................ 157
Chapter 11
More Pain Management: Controlling Your Finances ..... 159
Making a Statement ................................ 160
Dud Doctors ...................................... 161
The Tax Man Cometh. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
ix