Every entrepreneur dreams of launching a successful business, but many are at a loss once the goal has been achieved. Medical insurance billers (MIBs) may be tempted to rest on their laurels once they’ve made it to the “big leagues”. In this revealing article, Nitin Chhoda provides medical insurance billers with helpful advice when they’ve outgrown their home-based business.

It’s easy to let day-to-day operations slide a little in the excitement and chaos of moving to an outside office.

Joining the ranks of highly visible businesses means medical insurance billers will need to work twice as hard and employ every tool at their disposal to attract and retain new clients.

Location Isn’t Everything, But It Helps

It’s tempting to rent office space in a highly visible venue, but it may not be the best solution for the budget. Discount pricing doesn’t necessarily mean a low-rent district. It’s possible to strike an equitable deal for space in under-utilized structures.

Many business owners are choosing to rent a home to house their enterprise. It can offer a cost effective solution that provides a user friendlier atmosphere. Medical insurance billers that take this route should check local laws and ordinances to confirm they can legally conduct business from the location before committing to a specific property.

Appearance Counts

The face a business displays to the public has a significant impact on clientele. Potential clients that see a structured and organized office will perceive the business as professional and the medical insurance billers as someone who are efficient and get results.

Accommodate the Customer

Business expansion dictates that the MIB assume new clients and that may necessitate moving out of their comfort zone to land new accounts. They may be asked to provide services not currently offered. Medical insurance billers should always be willing to learn new things and do whatever is necessary to accommodate clients.

Medical insurance billers should endeavor to provide the customer with what they want, as long as they have the appropriate professional skills and knowledge to do so.

Growth and Expansion

Medical insurance billers typically move out of their homes and into the public domain when their customer base will support it. Beware of rapid expansion and acquiring too many new clients. The result is an MIB that feels overwhelmed, with the inability to provide each client with the personal attention they deserve. An over-abundance of work entails hiring additional staff that may require significant training.

Be realistic when planning goals and anticipating revenues. Always expect the unexpected, from replacing equipment and hiring staff to unforeseen accidents. Medical insurance billers may need to increase their rates, but use caution or run the risk of losing even established clients. Think quality, not quantity.

The Little People

Being charming, gracious and accommodating is easy when physical therapy billing business owners are seeking their first clients.

The same rules apply when medical insurance billers are at the helm of a growing enterprise. No business owner should ever forget the individuals, clients and subsequent referrals that helped them reach their current level of success.

Medical insurance billing encompasses much more than entering numbers in a pre-made form. Medical insurance billers (MIBs) must have a strong working knowledge in a variety of fields and understand the many terms they’ll encounter.

Whether MIBs choose to work in a medical facility or launch a home-based business, they’ll find it extremely difficult to find employment or clients if they’re not familiar with the terms of the trade. Nitin Chhoda discusses more.

Medical Terms and Codes

CPT and ICD-10 codes are the method MIBs use to describe to insurance companies the diagnosis and treatment that each patient received.

Most healthcare providers only use a fraction of the thousands of available codes, but MIBs must be familiar with the lexicons used by their clients.

Billing software or electronic medical record (EMR) technology is an essential. It’s capable of handling all the coding needs and tasks MIBs will require.

Insurance Idioms

Insurance coverage is available as an individual policy (purchased by individuals) group (provided by employers) and government programs (Medicare, Medicaid, CHIP, CHAMPUS VA, TRICARE and Workers’ Compensation). Each will have its own set of rules dictating what type of services and procedures are covered. Terms to know include:

• Beneficiary – who is eligible for services;
• The insured – the primary person who has the policy, making it possible for his/her dependents to receive services;
• Dependents – a spouse or children;
• Co-pays and deductibles – costs paid by patients as individuals or as a family;
• Provider – healthcare professionals, from those who treat clients to facilities that provide medical supplies;
• Exclusions – services, procedures and treatments that are not covered;
• Pre-existing condition – a medical condition that existed before the policy took effect;
• Maximums – the maximum amount an insurance company will pay within a year or lifetime;
• Pre-approval – services or treatments that must be approved by the payer prior to receiving them;
• Co-insurance – a second policy that provides medical coverage and shares the cost of an individual’s costs.

Payers and Clearinghouses

Clearinghouses use EMR software to receive reimbursement claims and forward them on to insurance companies for payment. Insurance companies (payers) have a language all their own that’s employed when dealing with practitioners and medical billing professionals. Common terms include:

• Usual fee – the cost doctors charge for specific services;
• Customary fees – are based on 90 percent of fees charged within a geographic location;
• Reasonable fees – is the lesser of what the doctor bills, usual fees, customary fees or a special fee that must be justified;
• Provider network – is a network of medical providers and facilities that beneficiaries are allowed to see that are covered under their insurance policy.

Numerous educational and certification resources are offered by professional MIB organizations to assist individuals in learning the lingo of the medical insurance billing field. Individuals can find informative books at the library, subscribing to online MIB lists and forums and asking questions, and gain experience through mentoring.

An MIB who can talk the talk with providers and payers will find multiple avenues in which to demonstrate their acumen.