Last week I had a meeting with a potential client to discuss social media issues. When she learned I had a medical billing background, she asked me if medical billing programs that teach you how to bill from home are a scam. My response was yes and no.

Medical billing courses that teach people how to do billing from home are popular. Yet, most are incomplete and give people a false sense of security as to their prospects for actually getting into the business. Not only is it not easy, but from what I understand, training is limited because the idea for the people doing these courses is to get your money, then get you out of their hair quickly so they can go after the next group.

The truth of the matter is that if you have a background in medical billing already, you have a major step up on people who have never done it before, but even then it’s going to be hard to break into the business. The main issue for someone with experience is in trying to convince a physician to leave what he or she already has to go with you. Physicians are money conscious; not enough that they won’t stop hiring their wives to do it for them, but enough otherwise. They don’t want to pay a lot of money to someone to do their billing for them, but they also don’t want to entrust their livelihood on someone untested in working on their own.

What are other issues to overcome for everyone? Let’s take a look:

1. What you need to start medical billing can be expensive. You need medical billing software. You need software that helps you encrypt your files. You need to buy medical coding books such as CPT-4 and HCPCS manuals. You’re also probably going to need to buy a HFCA-1500 form book. You need to buy HCFA-1500 forms because not all insurance will accept electronic billing just yet. And with paper, you need to buy storage for it.

2. You need to realize that you’re going to be doing a lot of data entry. Very few physicians will give you an electronic file to take back with you, and even if you get somewhat lucky, you’re going to probably have to enter all the charges on your own. And of course you have to store all that stuff because each state requires you keep it for a certain length of time. Also, you’re going to have to log every payment and every denial and keep all those records as well.

3. While we’re talking about it, did the training course teach you anything on how to follow up on unpaid claims? This is one of the biggest issues home medical billing companies face. If you’re good enough to send out what we call “clean claims”, you have the chance to get 95% of all the claims you send out paid in a reasonable time. But there’s always something that goes wrong, and you have to know how to fix it and turn it back around in a timely manner to get it paid. Sometimes it’s your fault; sometimes it’s the fault of the insurance company. You have to be able to figure it out and know what to do next.

4. All medical billing isn’t created equal. Billing for surgeons is much different than billing for podiatry. Maybe you have a nurse practitioner you’re billing for; once again, some different codes. Different insurance companies might require different information to pay claims as well. Did anyone talk to you about authorizations? Did you get a copy of the contract to know which services are considered inclusive if your physician does another service at the same time? And are you familiar with all the medical coding terms?

5. The final piece; what will you charge? This is predicated often on two things; one, the specialty of the physician and two, how busy they are. If you’re dealing with a physician who only sees four patients a day but the reimbursement is high, that’s a great thing for you. If you’re dealing with a physician who only sees four patients a day because he’s lazy, you’re going to be in trouble. In some states you can only charge per the number of claims you send out, while in others you can charge a percentage of what you collect. However, if you don’t know how to ask the right questions up front, you could end up with a lot of consternation.

I’ll stop there, because there’s a lot more. Medical billing isn’t easy when you’re doing it in a hospital or any other medical entity. At least there you get constant training and reinforcement. On your own, if you’re lucky to get a physician in the first place, you could get overwhelmed and cause yourself more problems than it’s worth. Proceed wisely if you decide you just have to take up this endeavor.

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