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How to Start a Home-Based Medical Billing Service


It is quite obvious that the health care business is one of the most beneficial professions regarding income and respect both. Although, you are not a medical specialist, still there are so many benefits that a health care industry provides to you. With appropriate planning, resources and relative solution to health care problems arising in the market, you can change the landscape of your income.

With proper private insurance and following the standard regulations laid out by Medicaid, any person can start his/her medical billing and coding service at home with complete feasibility. As, claiming the receivables from health insurance companies will make you the part of 10th largest economic business of the United States of America. 

What Is a Medical Billing Service?

Medical coding is the procedure of translating physician’s services into standard medical codes, and medical billing is the process of submitting a claim against that code to receive payables from patients, secondary payers or third-party payers (health insurance companies).

Yes, it is certain that health care providers don’t just forward invoices on their own, they require medical billing and coding specialist to perform health care administrative tasks. They may perform these tasks manually or by using smart software. Although, it is difficult to keep and monitor this bulk data manually, therefore, special medical billing and coding software are used to perform these tasks. The smart devices and software used for medical billing and coding tasks also comply with the government standards, so they stringently abide by the rules. 

Education Requirements:

Health care billing contrasts from the billing process in most other businesses in the two following ways. 

  1. Medical bills are submitted to health care insurance companies instead of patients.
  2. When medical bills are submitted to health care insurance companies for payment, then they require highly specialized descriptions and codes. If the code doesn’t comply with the description exactly, the results would be claim denials. Many factors can cause ambiguity in the claim submission process like; similar names of patients, misunderstanding of billing anatomy, physiology, pharmacology and other health care and insurance terms.

There are several ways to obtain medical billing and coding certification. Many schools, colleges and universities provide certification for medical billing. Also, there are online courses available for medical billing and coding certification. These online certifications require the completion of 18 credits that can be conveniently fulfilled in 9 to 18 months. It is vital to make sure that the online certification, must provide the following essential coding manuals;  

  • CPT: 

It stands for Current Procedural Terminology, which is laid out by the American Medical Association

  • HCPCS: 

It stands for Healthcare Common Procedure Coding System. It is a collection of medical codes that represent procedures, supplies, products and services that are offered to Medicare legatees and to those individuals who are registered in private health insurance programs.

  • ICD-9-CM: 

International Statistical Classification of Diseases and Related Health Problems, which is sustained by the World Health Organization. This system will be replaced by ICD-10-CM in October 2015.

These training programs must also prepare yourself for the national certification examination offered by each of the following medical billing and coding associations:

  • American Medical Billing Association (AMBA): 

Certified Medical Reimbursement Specialist exam

  • American Academy of Professional Coder’s (AAPC): 

Certified Professional Coder’s board exam

  • American Health Information Management Association (AHIMA)

Certified Coding Associate

After proper certification, you can initiate your own startup;

Initial Setup:

You should set up a complete plan for your business before buying hardware, software and other products for your business. It will enable you to make decisions; what name is suitable for your services, how to pitch clients, how to monitor profit and loss. It will make you perform wise investments regarding money and time. The best way to avoid unpleasant tax and accounting problems, you must contact good accounting professionals for a better understanding of this business. 

Equipment Costs:

It is a significant advantage of a home-based business like a medical billing service as the relative investment cost is much lesser than any other technological business. 

Following are the requirements of hardware equipment:

  1. Printer
  2. Fax Machine
  3. Computer System
  4. Stationary (business cards)

Following are the requirements of a software system:

  1. Minimalist specific software for automated medical billing and coding.
  2. Business enterprise software including; marketing and lead generating software.

These are the essential assets required for medical billing.

Clearinghouse Costs:

It is mandatory for every size of medical billing and coding firm, to involve the services of clearinghouse to submit claims. Clearinghouse is the third-party assistance that forward claim information from healthcare providers to insurance payers that is called “Claim Scrubbing”. There is a membership cost of each clearinghouse that cost also depends upon their number of featuring capabilities and services. 

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