How to Start a Medical Claims Processing Business

Here's the Radio City Rockettes chorus line of chores, a sort of rapid-fire revue of a medical claims specialist's daily bump and grind:

1. Enter your patient information, adding new insurance carriers to your database as you go along. Be sure you enter the referral source or referring physician as well as any other information you've agreed to track for your clients.
2. Enter CPT and ICD-9 codes from the superbills (a charge slip that lists the services and procedures commonly performed by the provider and gives the patient's name, date of visit and any charges) and day sheets. Your software will automatically fill in the amounts charged for each procedure. Enter each charge on a separate line.
3. Transmit electronic claims directly to insurance carriers or to the clearinghouse.
4. Receive the audit report, review and correct errors on it, forward clean claims and resubmit rejected claims.
5. Print any paper claims. Separate claims into your copy and the insurer's, fold and insert in envelopes. Weigh any envelopes containing more than five claims to make sure you have sufficient postage.
6. Post payments to each patient's account. Most software programs include features that show which charges have been paid, how much is left on each charge and which charges are still unpaid.
7. Print aging reports so you can review each patient's account to determine which ones haven't been paid in a timely manner. Most software packages will do this for you, too.
8. Call insurance carriers to check on the status of delinquent claims. Most of your follow-up calls will be for paper claims.
9. Put your feet up and relax. You've earned a breather.

Location

One of the great perks of running a medical billing service is that it lends itself ideally to the homebased entrepreneur. It's convenient--you couldn't get any closer to your office unless you slept with your computer. It's economical--you don't need to spend money on leased space, extra utilities, transportation costs or lunches down at the corner grill. It doesn't require a high-traffic or high-visibility location and doesn't need to be in the trendy part of town or in an industrial complex, although those are certainly options. You don't need a mahogany-paneled office with a lobby and conference room to impress or entertain clients. The only space requirement is an area large enough for your desk, your chair, a few filing cabinets and perhaps a bookshelf.

Working at home, however, is not mandatory. You may want to leave your laundry, your dog and/or your kids/spouse at home while you go off to an office space that's nice, quiet, clean and yours alone.

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