Medical Billing Vs Medical Coding Business

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How is a medical billing different from medical coding?

This is a question people ask me about daily.   Although these are two very different jobs, understanding both is essential in becoming an expert in your field. If you are thinking of starting a medical billing company, you don’t need a coding certification but it certainly helps to understand how medical coding works.

In the beginning, I went to Clark University for medical billing and coding. I had a very strong knowledge of medical terminology, anatomy, and coding when I graduated. I did not get certified after I finished.  I had researched medical billing businesses and found out how lucrative they could be. I went on to start a medical billing company and became a certified reimbursement specialist.

There were three factors that made me take this direction:

  • I wanted to be a business owner
  • I wanted to work from home
  • I wanted to make a lot of money
  • I wanted to support my children on my own

Think about what you want, are you ready to start a business of your own? Do you want the freedom of making your own work hours? You can visit me at www.jennifergomm.com if starting a medical billing business is the right path for you.

Job Duties of a Medical Coder

A medical coder analyzes the documentation of services with a healthcare provider (physician, nurse, chiropractor etc.) and determines the appropriate procedure code (CPT- Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) to match the services provided. They also use the diagnosis code (ICD10 International Classification of Disease) that has been documented by the healthcare provider.

Because of the extreme importance placed on accurate coding, medical coders must often coordinate with other members of the staff to get more details about a particular patient.

Choosing an incorrect code could result in a loss of income for health care provider. In a large professional setting where the two professions are separate, medical coders are more concerned with compliance to universal meanings of codes.

Often, a medical coder works freelance, in a facility, or a physician’s office and are paid an hourly salary. This makes it more difficult to go into business for themselves and make a lot of money.  

Job Duties of a Medical Biller

A medical biller takes the assigned codes that the coder or healthcare provider chooses and enters them into billing software and submits them to the insurance company or appropriate payer to be paid.

They follow up and complete the whole revenue cycle process (post payments, appeal denials, and bills patients) and ensures it is completed.

The biller also has daily interactions with insurance companies and patients to make sure the claims are paid correctly and timely.

Eligibility verification is another big part of the biller’s job.  Incorrect eligibility can lead to unhappy patients and lost revenue.

They have direct communication with patients and healthcare providers about understanding their payment obligations. These might include copays, coinsurance, and deductibles. As stated above, in a properly run office this is done before they are seen. 

They are responsible for choosing the correct billing format, payer id’s, addresses, modifiers, and any required documentation. Most of their efforts are spent making codes conform to specific payer requirements to describe medically necessary services for reimbursement purposes.

Lastly, medical billers are not allowed to choose the CPT code. This violates ethical practices as they might pick higher paying codes.

How Are Their Jobs Similar? 

Both medical billing and coding share some similarities. They both work in the healthcare setting. They do share some duties such as collecting documentation, collecting accurate facility and patient information. Both jobs are absolutely crucial to the cash flow of facilities and physician offices. It is also helpful for both to have a knowledge of how it all works to aid one another.  The U.S. Bureau of Labor Statistics classifies medical billers and medical coders as Medical Records and Health Information Technicians.

No matter the differences in the job duties, both billers and coders must be detail oriented, use correct coding, and stay compliant with the current government regulations. They need to have good communication skills as they deal with patients, doctors, and all other related staff. They need to have computer knowledge, as most of the software today is on a computer, cloud or server based. Lastly, both need to possess integrity, and the law requires the PHI (protected health information) follow HIPAA guidelines.

If after reading this, you are interested in starting your own medical billing business please visit me at www.jennifergomm.com.  I offer one-one business coaching and a monthly membership to assist you in your billing business startup.

Use Email Marketing In Your Medical Billing Business

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Email marketing campaigns are one of the most effective ways of keeping in touch with your target audience, marketing your products and moving prospects down the sales funnel. Here is how to get started.

What is email marketing for your medical billing business?

Email marketing is an organized campaign of emails sent to your potential or existing medical billing clients. The emails can include many different pieces of information, for example:

  • Newsletters
  • Marketing Emails
  • Surveys
  • Blog Notices

The first piece of advice a professional marketer would tell you is, start collecting an email list. Build a list of emails from you target niche whom you want to build trust, show your expert status, and build a relationship with so they eventually buy your product or service. Whether you are starting from scratch or you already have some emails, now is the time to start using those connections to create a marketing campaign.

Keep Your Budget In Mind

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Email marketing is a very low-cost outlet for marketing to your ideal client, they can be customized to a specific demographic or need of the potential customer. You can reach a very large audience with a very low marketing budget.

This inexpensive form of marketing helps your track what works and what does not work. An example, if you offer a free analysis of a potential physician’s practice to suggest areas of improvement and do not get a response, then it’s time to try a different approach. If you offer a free consult on a difficult set of claims and offer a solution to one specific problem for free, and that works, then you know what to keep moving forward with. In business, it’s important to measure these success markers so you don’t keep repeating the same mistakes and lose money.

Know Your End Goal

Before starting, think of the goals that you want to achieve with your email marketing campaign. You can have several goals, each for a particular audience.This determines:

  • The type of campaign to use
  • The target audience
  • The type of content to use and how to measure success

Get Helpful Tools

There are so many low to no cost options for email marketing, such as Get Response and Mailchimp. Research has shown that an average adult attention span is eight seconds, so keep it simple and get right to the point. So make your email engaging and always giving value. A good strategy is to ask how you can help, this always opens the door for conversation so you can let them know how your service will solve their issue, and of course, images always create interest.

Use Networking Events, Social Gatherings, and Social Media Ads To Build Your List

Collecting emails being your top priority, start asking for them at networking events, create a lead ad on Facebook asking potential clients to enter their email, and the most popular “opt-in” style where you give away something for free, such as a how-to document, or ebook and give the potential client value so they give you their email. Giving a valuable incentive not only shows the knowledge you have but establishes trust in your abilities. The valuable incentive could be an eBook, a cheat sheet, and discounts on their next purchase, and so much more. Always ensure you have valuable content to create interest.

Give Value and Solve Their Pain Point

This was huge for me in the beginning, I always gave value. When electronic health records came out, I found the low-cost solution and included that in my marketing. When ICD 10 was coming down the road, I gave free resources to help physicians and get them ready. You get the point, really tap into what your ideal client’s issues are and give them solutions. You will secure a client for life this way.marketing tips

Speak To Your Ideal Client And Get Personal

Now that you are not only a medical biller but a business owner, you will have to think like a marketer.  In the beginning, I had no idea how to create a business, let alone market it. Always keep in mind what your potential client’s pain point is. Are there receivables low? Are they constantly hiring new staff and having to train them? How can you fix that? Are they confused with the new government coding regulations? How can you fix that? You can reach out to me at www.jennifergomm.com to brainstorm some of the issues in the medical billing industry today. Most email tools allow you to customize your email with header names, individual needs, and different groups.Use eye-catching graphics, words, and deals

Make Your Email Professional

Think of what colors are pleasing, it’s formatted properly, and your grammar is correct. Use eye-catching colors and images. I am a huge fan of bullet points and breaking text up. The average person only has a few seconds of room in their brain and time in their day to remember you so make it count. If your email is too wordy or starts to bore them, it will get deleted.

Add Your Social Media Buttons

If you’re in my membership then you know how important social media is. Add your social share buttons to all your email and encourage your customers to connect. It’s all about getting in front of as many people as possible to spread the word about your medical billing business.

Have A Compelling Subject Line

Many people will not even open the email if the subject line is boring, offensive, or unprofessional. Keep it simple and to the point. Here are some examples:

  • Are receivables shrinking?
  • Are you tired of training new staff?
  • Are you struggling to keep up with the new insurance regulations?
  • Are you getting paid for all your hard work?

Have A Clear Call To Action (CTA)

Make sure you let them know what to do next, have a call to action in your email. In marketing, most people will follow exactly what you tell them to do. Be sure to tell them to reply with their biggest issue, call your number to schedule an analysis of their practice, or share the email with their colleagues. Whatever it is, make sure to keep the flow of communication going.

Reach out to me at the medical billing biz hub to find out how I can help you brainstorm your client’s pain points.

 Buying Emails is Illegal In Most States

Check with your state laws, in most areas it is illegal to purchase emails and you could find yourself facing fines.

Use Autoresponders

Autoresponder email marketing is such an effective tool in email marketing as it helps you engage with your email recipients even when you are not around, and you can set up emails to go out on in a timed sequence. This always your business to run, and engage customers while you are doing other tasks.

Monitor Your Success

Like all your marketing projects, this will need constant monitoring and tweaking. Find out what works and what does not. Change it up when needed.

Whether this is your first time doing an email marketing campaign, or you are a pro, I am here for you, just reach out at www.jennifergomm.com, join my $29 Monthly Membership, or get one-one coaching. I have successfully marketed, promoted, and built many businesses from the ground up. If Facebook ads have you stumped, no need to worry, they are my specialty and we will get the job done together.

Action Plan To Start Your Medical Billing Business From Your Home

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When you are working to create an action plan for your new medical billing business, there are several questions that you need to ask yourself. Consider the following steps and questions and write down your action plan.

Evaluate Experience

  • Do you have enough experience already, or do you need to gain some experience? What education do you already have? What certifications do you want to get?
  • Begin by researching certification courses through the American Medical Billing Association and American Academy of Professional Coders. Use these resources to plan your course.
  • Move on to researching HIPAA certification, and plan your course in this area, as well. When you get your billing certification, they should also educate you on HIPAA.

Review Practice Management Software

  • Make a list of pros and cons to each option. Which do you like? Look for time-saving tips like auto post electronic payments and aging report that sort and categorize your outstanding a/r.

Prepare Your Office

  • Organize and implement a plan for your office set up. Where will it be? Do you have all of the items that you need? Keep HIPAA in mind at all times, you will need to protect patient health information or you will get fined.  A secure place for storage with a deadbolt is a must. 

Get Legal Advice

  • Decide on the legal business entity you will choose to help you in creating your billing contract. Check with your local Chamber of Commerce and with your state officials about licensing requirements. Find out what the laws in your state are for billing on a commission or flat fee basis. Some states do not allow a medical billing company to collect a commission. 

Set Your Fees

  • As I said before, check the legality of billing on a commission basis. Most billing companies bill this way so make sure it’s ok in your state. Also, a good idea is to offer two options, figure out how long it will take to get the job done and give them a salary and a commission offer. This lets the doctor or facility feel in control. 

Choose Your Niche

  • What niche are you interested in? You’ll want to research the fees and the market in your area. Having a personal connection to the specialty you are choosing is a great marketing edge.

Create Your Mission Statement

  • Define your mission. What do you stand for? A powerful mission statement will definitely make that first impression count.

Build Your Brand

  • Establish your brand and develop your logo. There are so many free sites that help you get a good logo so make it pleasing to the eye.  Remember, your logo will be everywhere.

Get Visible Online

  • Create your website and start working on getting visible online. Build your website and social media business platforms so when your customers google you, they like what they see.

Create a marketing plan

  • Start traditional and online forms of marketing, networking, and getting your business out there. Talk to as many people about your business that you can, you never know where your next client will come from.

Seek Advice and Guidance

I am wishing success for you from the bottom of my heart. I have faith in you. If I can do it, then so can you. Go forward with total confidence and build your business.

“Fear of staying the same has to be greater than the fear of change” – Tony Robbins. 

 

10 Things I Wish I knew Before Starting My Medical Billing Business

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My medical billing business journey has definitely been full of incredible highs and a few lows.  It’s a journey filled with bumps, detours, and unexpected curves. In business ownership, it is essential to have a support group or mentor to support and let you know that all these bumps you hit are actually incredibly useful lessons in your entrepreneurial journey. You will learn from those lessons, and make necessary changes. Surprisingly, business owners wear these mistakes as badges of honor.

Trust me, some mistakes I could have gone without and cringe when I think about it, but would I be here today if I had not done it the same way? I honestly don’t think so.  

Here are 10 things I wish I knew before starting my businesses:

1. Business Ownership is 24/7

You actual “work” is a small portion of what you actually do, the rest of the time is spent developing strategies, marketing, bookkeeping, invoicing, payroll, customer service. So in short, you suddenly become a web designer, social media expert, psychiatrist, you name it!

It is a lot more than going to your 9-5, working, and then going home and forgetting about it all. IT NEVER LEAVES YOU!  Now, in my opinion, most people don’t get rich by working for someone else. The payoff of all that hard work, at the end of the day, is the freedom you have to decide how your business runs, who you are going to work with, and the SIZE OF YOUR PAYCHECK.

To maintain a successful business, you learn how to juggle all and eventually outsource. Some suggest growing slowly is a good way to learn, I did not take that route. I grew very quickly and was thrown into it all.  

2. Serve Your Customers

Of course, you want to make money, in the beginning, I took any paying job I was offered. It becomes easy to focus on just that and lose a sense of serving your customers. You can be the best medical biller on the planet, I have no doubt you are, but if you become preoccupied with the money, your client will lose out. Eventually, they might look elsewhere. I read a quote the other day that really got to me, it was  ‘pretend your services are bad”.  If you are thinking huh? This quote made me stop and think, you do always need to improve your services, focus on your customers, and realize you can really make a difference in someone else’s life.

When I started my billing company, I knew that I could streamline the billing process for physicians, increase their revenue, and give them time to focus on patients. Don’t lose sight of the mission of your company, this can easily happen when the cash flow starts coming in.

3. Manage Your Cash Flow

Yes, cash flow will enable your business to run.  When times are good, it’s easy to think that the money will keep coming in. Years ago, I decided business was good and I’ll redo my kitchen.  What a beautiful kitchen it was.  Two months later, my biggest account got sold to a big corporation with an in-house biller. My nest egg was gone. Boy, did I learn a newbie lesson.  Managing the money coming in, the expenses, and keeping a cushion are essential.  Make a budget and stick to it.

4. Consider Keeping Your Day Job Until You Are Financially Able To Make It

In the beginning, the business can be stressful and not having enough money to survive?  Well, you can’t be successful if you are filled with stress and worry all the time.

There isn’t a one-size-fits-all approach, but you should consider doing something like keeping your current job for as long as you can. This gives you time to build an emergency fund, conduct market research, and start gaining some traction. Even when it’s to make to take that giant leap you need to hire the right team and constantly develop your skills.

5. Never Stop Marketing

NEVER STOP MARKETING.  I can’t stress this enough, even though I have doctors contacting me, have given work away because I have too much, and get tons of referrals I never stop updating my websites, posting on social media, and developing new marketing plans.  

Don’t ever fall into the thinking that you have plenty of business, therefore I’ll coast for a bit mindset. Things can change fast and you always want to be prepared.

6. Check Out Your Competition

This is crucial in business, see what the top experts in your field are doing. Find out who they serve and why.  This is much easier today because we have the internet, years ago you did not have a bird’s eye view of your competitors.

What comes up when you google your competition, spend a few hours checking it all out so you will be clear about what you would and could offer.

7. Don’t Put All Your Eggs In One Basket

A big lesson I learned three years in, one of my biggest accounts sold out to a big corporation that had an in-house biller. I lost over half of my income.  From that, I learned two really important lessons.

Keep your accounts diverse with big, small, and in between clients. Never rely on any one client for your some income. You may have a client get a cheaper offer (let the go if that is the case, you get what you pay for!) they might sell, or change the direction of their business.

8. Your Time Is Gold, Optimize, Outsource, and Automate  

Yes, you will burn out fast by doing it all.  Been there, and got a one-way ticket to burnout village.  Your time is worth everything so find ways to free up that time. I hated patient statements, it took hours.  Printing, checking, stuffing envelopes, and going to the post office. Early on, I started using Billflash (statement mailing company). Took me a few minutes to look over the statements and then upload a file.  Boom, the patient was mailed or emailed a bill with a nice return envelope. This saved tons of time off my week. It was worth every penny.

Another huge time saver for me, electronic reitts (insurance payments). I will not work in an office without them. What used to take 10 plus hours years ago, takes me 20 minutes today.

Marketing falls into this category as well.  Upwork, Guru, Fiverr, and SimplyHired, are all great.   Want a logo, website tweak, or SEO issue taken care of?  No problem.  I also use a remote VA, let them handle little things that would take the hours away from your day. This is smart business, and you are a business owner now, so think like one.  

You need to keep the focus on your clients at all times.

9. Get Personal With Marketing, Engage With Your Audience

Your customers don’t want to do business with some faceless, nameless organization. Get personal on all social media outlets, websites, and newsletters. Connect with them, let them know why you are in this business, why you want to help them, and how you can solve their pain point.

This always keeps you in touch with what your customers are looking for as well, I like to ask, ‘what is your biggest struggle right now’?  That gives me insight on how I can help. When you do help, it builds confidence, trust, and makes you an authority figure.

Way back, I did a very generic website, I still see this today. It did not reflect what I am about at all. Get your mission statement and post it up near your workstation. Remember is and let it shine in your online presence.

Reach out to me at www.jennifergomm.com and join one of my programs so we can work out a plan for you to connect with your potential clients.

10. Enjoy Your Business

I know what you’re thinking. There is so much work to do!  Years ago,  I was so deep in the building, marketing, and getting doctors part of my business that I missed out on enjoying victories along the way.  I skipped vacations, parties, and weekends away. DO NOT DO THIS!  Remember to keep that balance, life is short and take the time to enjoy the little moments.

It is hard in the hustle/startup phase of the business but recharging your batteries is crucial   Celebrate your wins and don’t work yourself to death.

Honestly, I could go on and on. These are just a few pieces of advice I wish I had. No one is mistake free in business and when it happens to you, go easy on yourself. I took these hits very hard, that is one HUGE thing I would change. You have support in the medical billing business hub, $29 Monthly Membership and One-One Coaching Program.

Reach out and let me know how I can support you!

 

 

How can I find the right medical billing program?

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Medical coding and billing jobs are in high demand and growing according to the Bureau of Labor Statistics. That is great news if you are thinking of starting a medical billing business from your home.

 

Like all other “work from home” promises, you should look for qualified coaches, programs, and tools to help you.

 

Quality online medical billing courses do exist so be sure to do your research and choose one that is legit.

 

Watch out for these red flags:

 

  • Programs promising instant success, without doing all the hard work necessary to start a business or get certified.
  • Programs that are not taught by certified medical billers, coders, and or successful medical billing business owners.  
  • Programs that don’t specialize in medical billing.
  • Programs that don’t have a large social media following or credentialing.
  • Programs that cost more than $2500.00.
  • Programs that offer a “certification” from a company not recognized in the USA.
  • Programs that don’t offer payment options.
  • Programs that don’t have references; you should be able to talk to past students.

 

You want to look for programs that prepare you for the certification exams recognized by the industry. They include:

 

AAPC – The American Academy of Professional Coders

AMBA – The American Medical Billing Association

AHIMA – The American Health Information Management Association

 

Make sure your program includes all areas of billing including:

 

  • Anatomy
  • Medical terminology
  • Coding
  • Insurance rules and regulations
  • Billing software programs

Do your research, ask how long the school has been around, if it’s accredited, ask about instructor experience, and if they help you get placed in a position upon completion. Ask if there is a refund policy. The time you put into researching the program you choose will ensure your success upon completion. If you are ready to start your own business and would like to know how I went from zero to six figures in just two years, visit me at www.jennifergomm.com and join my membership or one-one coaching program.

How to thrive in this economy by starting a home based medical billing business.

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There are two industries that seem to defy the tough economic times. These are IT and health services businesses. Medical billing happens to be a combination of the two.

Watch the on-demand webinar to find out how I started my business and reached six figures in two years.

Why is it lucrative?

Most medical billing companies operate on a commission basis.  They generally get 4-10% commission on all revenue that they generate for the practice or facility.  For a company that has multiple clients, this income really adds up.  Also, you maintain complete control of how your business will run, how big it will get, and who your clients will be.  Gone are the days when you worked for one boss and had to put up with mistreatment just to collect a paycheck.

In these economic times, is this a good business to start?

Many healthcare providers are now outsourcing the billing due to ever changing regulations and in office time management.  These constant regulation changes make it hard for the organizations to stay profitable. Outsourcing is helping them cut costs and increase their efficiency. Common areas that outsourcing is being done include medical claims processing, accounts receivable management, and patient statements. Moreover, given that healthcare is rarely affected by the economic pressures, you can be sure to be in business even during an economic recession. The healthcare billing industry is booming, making this a job with longevity.

The demand is being fueled by:

  • Ever changing insurance regulations
  • Increase in cash flow
  • In office time management
  • Technology experience requirements (most billers are not proficient in computers)
  • More focus on patient care
  • Reduced stress in the workplace
  • Reduced errors
  • Less need for in-house staff

Do I need a certification?

Although a certification will definitely make you a standout, it is not a requirement. Many medical billing business owners do not have an official certification but they have enough experience to qualify as a competent business owner and medical biller.

You can get a certification in this business at a very low cost, the American Academy of Professional Coders and the American Medical Billing Association offer great certification programs and are considered reputable in this business.

Why is it a business for you?

This is a business that you don’t need a college degree to start, has very little overhead costs, and you can run right from your own home.

This is a business that is great for single moms, retirees, and anyone that has a desire to become an entrepreneur. The business gives you the flexibility of setting your own hours.  Although most insurance companies are open Mon-Friday, 9am-5pm you can decide to make important phone calls at that time but do your other work at night or on weekends.

The best part about starting your own medical billing business is, you can also operate the business remotely anywhere in the world.

Would a coach or mentor be helpful?

Absolutely!  To avoid many mistakes in business, and also in the medical billing field, it would be advantageous to have a coach or mentor to turn to for advice. You can join my membership and get all the benefits of my webinar, book, and direct email to me to map out your action plan in starting your business.

You can also sign up for one-on-one coaching 

Three Life Changing Business Books

  1.  Emyth – I read this book when I had been in business for over 7 years and it completely changed the way I strategized.  In the beginning, I took work just to have income, I did not consider whether is was the right job for me.  I ended up spending a lot of wasted time on needy and demanding clients that in the end became an income loss. When I streamlined the work, found a niche, and set up systems that flowed, it all came together.
  2. The 7 Habits of Highly Successful People – This was another huge life changer for me.  I started to prioritize what was important before making big decisions.  I started to think about how I wanted people to feel when they had contact with me.  This was a turning point when I started to give freely with no intention of getting something in return.  What I realized was that I got it back 100 times over.  It was my reputation that I built and networking that launched me to another level of success
  3. Awaken The Giant Within – I was never a self-help kind of person.  This was on a top business book list so I purchased it this year.  Boy, it was another wake-up call.  Emotional intelligence is ESSENTIAL in business.  You can’t sit around worrying about what everyone thinks of you.  You have to stop negative behaviors and patterns right when they happen and clear your mind.  Emotionally intelligent people are successful.

There are many more books I would recommend; I have a love for reading and I will keep sharing.  It’s important to grow and change as a business owner.  I always tell my coaching clients to have an open mind, embrace change, and don’t continue the same patterns that yield unhappy results.

“Education is the most powerful weapon which you can use to change the world”

Nelson Mandela