Business Overview

Billing a patient for medical services can be complicated. Plus, not all patients can afford to pay the entire bill in full. And then there's the paperwork. With laws like the Health Insurance Portability and Accountability Act of 1996 (HIPAA), it can be confusing and difficult to know which documents need to go where. If a hospital or doctor messes things up, it's a huge legal liability.

This is where a medical billing businesses can help. They take care of billing clients on behalf of doctors, hospitals, and other healthcare providers. Medical billing companies try to simplify the process by coordinating multiple providers and billing systems, while incorporating processes to adhere to changing regulations, so healthcare providers stay compliant and can get paid for their services.

Who is this business right for?

This business is perfect for individuals who are passionate about running a business in the healthcare industry and want to help both patients and providers make the billing process easier and more streamlined. Business owners should be naturally detail-oriented and task-focused thinkers. Medical billing is all about systems, processes, and completing tasks in a specific order to comply with federal regulation as well as internal healthcare provider policies.

What happens during a typical day at a medical billing business?

A medical billing company stays busy. The owner of the business oversees day-to-day operations which include collecting delinquent accounts and establishing payment arrangements with patients, monitoring patients' payments, and following up with patients when payments do not arrive on time.

The business also subcontracts business out to collection companies when payments cannot be collected within a reasonable amount of time. It maintains a medicare bad-debt cost report, which tracks billings and collections. It also initiates claims against estates for backpayment of medical bills. Medical billing companies maintain an active list of contacts with various legal departments and law firms as well as local governments (e.g. clerk of the court), which they use to help with collection attempts.

Medical billing companies also do normal bill collections by sending out bills for payments on behalf of hospitals, doctors, and other healthcare providers.

What is the target market?

The target market is as wide as the healthcare industry. You can narrow your focus, of course, and target specific types of practitioners and providers. This is what most small to medium-sized medical billing companies do.

How does a medical billing business make money?

A medical billing business makes money in any of several ways: billing by the hour, billing by the claim, or taking a percentage of the money collected from claims.

What is the growth potential for a medical billing business?

Medical billing can be done on a small or large scale. Starting out of your home, you can get a medical billing company up and running with a laptop computer and basic accounting and billing software. Larger operations require a staff, ranging from 5 to 10 employees up to thousands.