Interview: How to Start A Medical Billing Service – Part 2

This is part two of a two part interview. If you missed part one of this interview, you can read it here.

My guest today is the author of a new book called How to Start Your Own Medical Billing Service. Gina Thatcher has been medical billing since 2002 and has owned and operated her own medical billing company since 2005. In the eleven years that she’s been in the business, she’s amassed a wide range of tips and tricks for starting and succeeding in the field of medical billing. She’s boiled down those tips into a to fast-reading 106 page book that’s just right for the small business entrepreneur looking to start their own medical billing business.

So, Gina, what kind of money can you make being a medical biller?

You have the potential to make a lot of money being a medical biller. How many times have you thought that a doctor was paid too much for the services you were provided as a patient? Well think if you were receiving a percentage of that money. Every healthcare provider is different, they all see a different amount of patients per day and provide many different kinds of services, they also deal with many different types of insurance companies. The average primary care physician/family practice (with one full time physician) earns anywhere from $20,000 to $70,000 per month. Depending on the type of insurance companies the provider works with, where they are located and amount of patients they see, a medical billing service can charge anywhere from 6% to 10% (on average). A full time medical billing service with one employee would typically have 4-7 clients. My book walks you though how to determine your fees with all the variances.

What kinds of equipment do you need to become a medical biller?

A computer, high speed internet, all-in-one fax/copy/scanner/printer, medical billing software, coding software (which is often included in the billing software), a dedicated phone line and business/productivity software. Most of these things you will purchase one time and it will last you a long time. The medical billing software will have a monthly fee along with the phone and internet. Coding books and software if not included in your billing software will be a yearly cost as the codes are updated every year.

How much does it cost to get started?

Most people already have a computer, probably even a printer too. You could use your home or cell phone as your business line, you would just always have to answer it as if it was a business phone. You can slowly upgrade your equipment as you become more successful. The billing software may be your highest monthly expense. Medical billing software is a very competitive industry though and there are lots to choose from. Don’t just look at the price though you will need a good program to ensure the billing is done efficiently as possible. Many providers already have billing software integrated into their electronic medical records programs. You may decide to earn a lower percentage if the provider maintains the billing software. But in this case you may also have to learn several different medical billing software programs if you have multiple providers each using a different software program.

What kinds of personality traits are required? What kinds of traits are probably bad to have?

I am very meticulous, I will make the half hour phone call to the insurance company to ensure the provider will receive that last $24 he is owed. I believe that insurance companies deny small codes in hopes that the medical biller won’t peruse it. To me it’s not necessarily about the amount but that the services were provided and they should all be reimbursed. Medical billing can be tedious. Like I said earlier I like a challenge once and a while to mix things up. I like to earn the providers as much money as I possibly can, that also means I earn more money for myself and my business. It’s good to be patient, resourceful, friendly but firm, knowledgeable and confident. Bad traits would be impatience, and disinterest in learning new/changing things. The industry is constantly being updated, you have to keep on top of it.

What do you like to do for fun?

Spend time with my family, on our ranch, at the lake, on an adventure. Being in this business allows me to spend lots of time with my family. I can determine my own hours and take time off where others may not be able to.

What advice do you have for someone that wants to become a medical biller?

I would take a workshop for medical billing at a community college to learn the basics of medical billing. And I would purchase my book to learn how to start your own medical billing service.

How will Obamacare change the medical billing field?

Right now it is hard to say how it will directly effect the medical billing industry. It may be more difficult to get reimbursed from the private insurance companies due to stricter policy guidelines, meaning more appeals from the biller and better documentation from your providers. Government insurances will likely cut reimbursement rates and private insurances will likely follow.

What is the biggest headache in medical billing?

Calling patients that don’t pay their bills. I am not in this to be a collections agent. I don’t mind calling the insurance companies I know what to expect and how to deal with them. People that owe money and don’t want to or intend to pay you can be just downright rude. It’s a small part of the job though and it has to be done.

What’s the best thing about being a medical biller?

Helping people. It’s not always the most rewarding career. People go to the doctor because they have to not because they want to. But sometimes you get to help someone who truly appreciates what you have done for them. I used to do medical billing (in-house) and pre-authorization for specialty wheelchairs, we are talking up to $25,000 wheelchairs here. I actually got to meet the patients, talk to them and know who they were. It could take months to get a specialty wheelchair approved by insurance so you really grow a relationship with the patients. Most of them were truly appreciative for what I did for them.

Do you have any, or is any certification and or training required?

I personally do not have and do not particularly recommend any type of certification. I don’t think it is necessary. Becoming a “certified coder” is costly and time consuming. The only reason you would need to be a certified coder is if you were determining coding by reading a doctors dictation of a visit. In all my experience the doctors and specialists have a list of commonly used codes for their practice, listed on what is called a superbill. You may have seen one when you visit your own personal physician, it’s the piece of paper they clip to the front of your chart with all the columns, tiny writing and numbers all over it. I help the doctor create and maintain the superbill but he determines the services that were rendered and what to bill for. I may make suggestions and ask questions to make sure that everything that is being provided is being billed but the provider always has final say.

Tell us about the most hostile situation you’ve encountered as a medical biller.

I have a few doozies but due to HIPAA regulations I am not able to discuss them in specifics. Let’s just say people who owe money that don’t want to owe money can be mean.

Whats the greatest thing you’ve ever done for a patient as a medical biller?

Again for HIPAA reasons I cannot share specifics. I would have to say when I did billing and pre-authorizations for wheelchairs I had some pretty happy and grateful patients in the end.

For a doctor?

I feel like I keep repeating myself but I really like getting a new provider and showing them what I can do for them. I like to find them lost money. Money that their previous biller or billing service didn’t or couldn’t. Often times an in-house biller will just do what they need to get by and get a paycheck. One of the great selling points of a medical billing service is that I will fight for your every penny. I like to say, if you don’t get paid, I don’t get paid.

What’s an average day look like?

I start work early, do my data entry, reply to my emails, organize my day usually long before the providers offices open for the day. I use the early business hours to call insurance companies and patients when necessary. I usually send out patient statements at the beginning of the month so my calls are heavier in the first and second week of the month. If I am not sitting at desk answering calls then I make sure to check my messages frequently throughout the day. I would say an average size medical office work takes 2-4 hours per day 3-5 days per week.

What so you foresee changing in the field in the next few years? Decade?

More control over patient care by the government. Like I said earlier in regards to Obamacare it is unclear how it will directly effect medical billing right now. As it is, the healthcare industry is being forced to convert to electronic medical records which I have seen negatively effect patient care. It’s costing more and more money each day for a medical practice to stay open. One thing is for sure though, they will always need a medical biller. That gives me comfort in this ever changing industry. The healthcare providers will always need someone that can keep up with all the changes and keep the reimbursement coming. Healthcare will never go away.

How stressful is medical billing? What is the most stressful part?

It can be stressful at the end of the month. Typically an office will make a last deposit on the last business day of the month, the provider will try to get the months charges completed by the last business day of the month. Sometimes things get away from us and when there are deadlines people are forced to “catch up”. It can be overwhelming when you have five different offices sending you all their “catch up” charges and deposits on the same day.

How do you juggle working from home with a young child with your business?

I start work very early before my son wakes up. He still naps every couple days, so I work then too. Since he doesn’t nap every day I am working on getting him to have “quiet time” in my office at his desk. I have a special desk with lots of special little toys and books for him in it. He may not use his desk or those things except during “quiet time” while I am working. This keeps those toys and books special for him because he is limited on his playing time with them. If I need to I work in the evenings. And of course there are always Grandma days. My son is almost 3 and he understands that mommy has to work sometimes. He often comes with me to pick up paperwork from doctors offices and likes to “help” me in the office when he can. He is my special little helper.

What kinds of hours do you work?

I often start work at 4am, work for two or three hours before my family wakes up. Then I work a couple hours during the day between nap and quiet time. All my offices have different ways of transferring my paperwork to me; scanner, mail, fax, etc. I don’t have the same amount of work every day, so my hours vary from day to day. I go to the local doctors office weekly or bi-weekly and the out of town ones monthly.

What other books would you recommend for someone considering this kind of business?

I have actually never purchased a book about medical billing so I couldn’t really say. I feel that you learn how to do medical billing itself from experiencing it first hand. There are so many scenarios that they cannot all be taught. Of course you need to learn the basics and the constants, which is why I recommend a workshop to learn those things.

Any websites you can recommend for hints, tips, etc?

Google is your best friend, you can Google anything and almost always find what you are looking for. Wikipedia actually lists ICD-9 and ICD-10 codes on most of their diagnosis definition pages. That won’t replace a coding book or software though, I use Optum Encoder Pro. I Google medical abbreviations written on superbills that I don’t know as well. I follow all the government insurance webpages and some of the private insurance ones too. They keep you up to date on insurance policy and industry updates. This is the main site for government insurance; Centers for Medicare and Medicaid (CMS) it links you to your local ones. Another good one is Healthcare Billing and Management Association though it does require a membership for most of the website information. You can receive email newsletters from most of the websites that briefs you on new articles you may want to read.

What kinds of continuing education do you have to do as a medical biller?

I like to attend seminars and webinars put on by the insurance companies. I prefer seminars because you get to network with other billers and physicians. It is good to know a lot of people in this industry. They can be great recourses for you. Centers for Medicare and Medicaid (CMS) put their webinars on Youtube you can watch them at your convenience if you are unable to attend the webinars. The only downside is you can’t join the question and answer session. There is a section of the CMS website called education and outreach where you can find information on the Medicare Learning Network. Joining and keeping up on the email updates is very important and helpful as well. All the seminars give out continuing education credits to certified coders if you are one.

Thanks Gina. This has been fun. One final question that we’re all dying to know: In your opinion, why do doctors have such bad handwriting?

I wouldn’t necessarily call it bad handwriting, each doctor has his own unique handwriting. I think doctors have much more important things to worry about than nice neat handwriting. Once you have worked with a doctor for a few months you get used to his handwriting and it’s pretty easy to read.

Thanks again for the opportunity, Dane!

Last, but not least, how can someone find out more about you, and your book?

The book How to Start Your Own Medical Billing Service is available on Amazon in both paperback and Kindle formats.

My company’s website is SmartBillingSolutions.net and our blog is smartbillingsolutions.blogspot.com.