Some Tips For Starting Your Own Medical Claims Processing Business

by Karen on October 13, 2011

Medical billing and claims processing is a crucial part of the medical industry. It is these professionals who are responsible for the submission of medical bills and records to insurance companies in order to expedite payment. These submissions must be in coded form in order for all involved to understand the procedures.

Many people think that in order to get into the field of medical billing that you must get an education, get a good resume and go out looking for a job in a medical office and while there are medical billing professionals who work directly in doctor’s offices, hospitals and large medical conglomerate billing offices, it is also possible for a medical billing and claims processing professional to start a home business. With a home business it is possible to set your own hours, be your own boss and do it on on your own. You will still have deadlines as the doctors, hospitals and patients all need to have their records processed and the bills submitted to the insurance companies in a timely fashion but if you are a self-motivated individual who can handle your own business, you can run your own business and plan your time as you see fit.

The health care industry is facing increased complexity and health care in this country is facing a fairly unpredictable and troubled course. Doctors are increasingly challenged to receive payment for their services and with patients to take care of they do not have the time or the expertise to worry about getting their payments. This is why medical billing and coding professionals are so important in the healthcare field because experienced professionals are needed to be able to navigate the complex array of health care insurance organizations such as PPO’s, HMO”s and more.

In addition to that most claims are now filed electronically and the doctors and hospitals have neither the time nor the energy to learn about the electronic processing of claims. It is a much more efficient business model for them to do what they do best, which is taking care of patients, and to delegate the billing and coding to a trained professional.

These are but a few of the reasons why the demand for medical claims processors continues to grow. With the constant changes and fluctuations in the healthcare industry and the insurance industry the demand for medical claims processors is not expected to slow down at any time in the near future.

If you are interested in a job or starting a business in the medical billing and coding profession the traditional route to success has been to attend a career college or a 4 year college degree program and to take courses in medical billing and coding. You can also take online courses in the field. Or it is possible to educate yourself. There are no legal certifications or licenses required for medical billing and coding so it is feasible to purchase your own manuals and documentations and educate yourself. However, if you choose to take a more traditional approach and take courses offered through an educational program the benefit is that many of these programs offer certification exams. While not necessary, these types of certifications can enhance your resume and may help you to get employment if you are looking for a job or clients if you are starting your own business.

To educate yourself you should start by finding the books that you need. You should be able to find some books offering full length study programs on such sites as or With a simple search you may also find some websites that are specifically geared toward the medical billing and coding profession and you should be able to get some good information from these sites.

One book that you may want to consider the Guide to Medical Billing and Coding. This is just a basic textbook that covers all of the valid and useful information for the medical billing and coding industry. It is offered by the educational publisher ICDC publishing. This book is complete in that it offers you all of the material typically presented in medical billing and coding courses at most traditional medical education institutions. You can complete the course in your own time frame. The ICDC publishing company also offers 2 levels of certification. You must pass a selection of tests that are administered by the company but if you can prove that you have learned the curriculum by getting a passing grade on their tests they will give you a certification.

There are no Federal or state mandated certifications or licenses required for medical billing and coding professionals anywhere in the United States, however, certification is usually very important for potential employers or potential clients. It is important that they hire someone who is knowledgeable enough in the field to collect the payments that they need to run their businesses smoothly. So if you are planning on getting into the medical billing and coding profession it is important that you find a way to take a certification exam. These are typically part of the curriculum if you are taking a course from a college or an online program but if you get a book and educate yourself you may need to make sure that the publishers offer certification testing. This is very important for your future career prospects.

You may want to add other helpful books for your library for basic references. Medical coding data such as CPT, ICD-10 and HPCS Expert 2010 by Contexo Media are widely used and comprehensive guides to procedural codes. If you start your own business you will need to know medical coding or hire your own coder or delegate it to a coding service. The last two options can take quite a chunk out of your potential profits so you might be better served to be familiar with coding yourself until your business grows to the point where you are making enough money that outsourcing makes more sense.

Once you have your training and certification and you have made the decision to start your own medical billing and coding business, you will need to get a DBA (doing business as) if you plan to use any other name for your business besides your own. Your state may also have some laws pertaining to home businesses that you will need to check out. It is wise to get a separate business bank account and some tax software such as Quickbooks because you will need to keep track of your expenses for tax purposes.

You’ll probably need a small amount of start-up money so that you can remain solvent until the checks start rolling in. Business costs can arise unexpectedly so it is important to budget and have some money in reserves. You’ll also need some medical billing software, which prints the bills, does the coding and handles all the medical records in an efficient manner. You will need to provide periodic reports to your clients so the software you select should be able to prepare professional reports. You will need to have a supply of HCFA 1500 forms, which are the standard insurance claims forms, as well as a few other forms. You can typically print these forms online from websites such as

Most importantly, and never to be overlooked is the fact that you will need clients. You can’t have a successful medical billing and coding business if you don’t have clients to work for. So brush up your best sales skills and go out and see some doctors so you can get some great clients to work for. After you have a few clients you may be able to grow your business by referrals but to get a good start you will need to hit the pavement and conduct interviews with doctors for whom you would like to work.

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