Medical Billing: the Lights are on But is Anyone Home?

Medical billing outsourcing, also known as third-party medical billing, is regulated by the Office of the Inspector General (OIG). The OIG was created by Congress through the Inspector General Act of 1978 in response to a series of government scandals that occurred within nearly every major Federal Agency throughout the 1960s. Lawmakers believed that by creating an independent Office of Inspector General for each Federal Agency; the government would be better able to detect fraud and prevent the waste and abuse of Federal taxpayer monies. The hope was that these Federal watchdogs would reestablish the public’s confidence in government agencies.

The Office of the Inspector General, in conjunction with the U.S. Department of Health and Human Services, developed and released the Compliance Program Guidance for Third Party Medical Billing Companies on November 30, 1998. The intent of this program is to promote a higher level of ethical and lawful conduct throughout the entire health care industry; and to protect the solvency and stability of the Medicare Trust Fund (also known as Medicare).

Before we go on any further don’t get the impression that the U.S. Department of Health and Human Services (HHS) carries some sort of grudge against or questions the validity of medical billing outsourcing services. Prior to the Compliance Program Guidance for Third Party Medical Billing Companies was established, the HHS had already issued compliance programs for the clinical laboratory and hospital industries as well as home health care agencies.

The legislation comes in response to the proliferation of medical billing out sourcing companies throughout the health care industry; the undo influence these medical billing services could have on a physician’s billing and coding practices; and the potential negative effects of unscrupulous billing and coding practices by these medical billing services on Medicare.

Like most OIG-issued compliance programs, conformity to the Compliance Program Guidance for Third Party Medical Billing Companies is strictly voluntary. On other hand, issues that arise due to a failure on the part of the medical billing service to abide by these “voluntary” compliance programs could expose the billing service to legal actions brought on by the U.S Government. Protect yourself and your business by interpreting “voluntary” as “mandatory” or be prepared to suffer the consequences.

The OIG has identified seven fundamental elements to an effective compliance program. They are:

1. Implementing written policies, procedures and standards of conduct;

2. Designating a compliance officer and compliance committee;

3. Conducting effective training and education;

4. Developing effective lines of communication;

5. Enforcing standards through well publicized disciplinary guidelines;

6. Conducting internal monitoring and auditing; and

7. Responding promptly to detected offenses and developing corrective action.

In future articles I will continue to explain the Compliance Program Guidance for Third Party Medical Billing Companies in plain English so you can take the steps necessary to protect your medical billing service from unwanted government intervention.

If you are a health care professional outsourcing to a medical billing service you too should be interested in this program. Ask your medical billing service to provide you with documentation showing the steps they take to insure compliance to this very important program. Be a smart business owner and protect your practice from unwanted government action.

Medical Billing from Home – A Legitimate Business Opportunity?

Are you looking for a home-based business opportunity in which you can not only earn a living but also make a different in the process? If so, consider medical billing.

Perhaps you’ve seen television spots advertising medical billing opportunities and have questioned whether they are “for real.” After all, what exactly is medical billing? And is it really possible to earn a living by starting a home-based medical billing business?

There is no doubt that healthcare is a booming industry in developed countries throughout the world. And while many people automatically imagine that that a career in this field requires years of medical schooling, advanced degrees, and 16-hour work days, the fact is that the industry offers unique opportunities for people just like you to earn an income while working from the comfort of their own homes.

So what exactly is medical billing? Quite simply, it is a service that helps doctors get paid. According to Entrepreneur, “most doctors and other health-care providers have no idea how to get themselves paid quickly and efficiently, if at all, by either insurers or patients who are also waiting for that check to arrive in the mail.”

You see, in medical school, while physicians-in-training learn the intricacies of modern medicine, they do not learn the science of effectively running a business, which involves billing and receiving payment for services rendered. Medical billing services are the supports that allow doctors and healthcare providers to get paid so they can continue to do their jobs.

In fact, because of their value within the medical profession, medical billing businesses have won a spot in the top three work-from-home business opportunities.

Are you ready to jump on board?

WHY A MEDICAL BILLING BUSINESS?

One of the best aspects of owning your own medical billing business is that you have options. You can choose whether you want to service one medical specialty – such as pediatrics – or many. Additionally, you can target healthcare provider groups, nursing homes, medical device manufacturers, and more.

Let’s take a look at the basics that are required to start a successful home-based medical billing business.

As Entrepreneur points out, start-up costs for a medical billing business are relatively low, making this type of opportunity ideal for individuals who do not wish to make a hefty initial investment. Additionally, inventory requirements are also minimal, making the business easy to operate from your home. Entrepreneur has compiled the following list of everything you will need to launch your own medical billing business.

* Computer system with a modem and a printer

* Fax machine

* Medical billing software and/or business opportunity fee

* Clearinghouse

* Reference materials

* CMS 1500 forms (previously known as an HCFA 1500 form)*

* Phone

* Voice mail or answering machine

* Stationary and office supplies

* Postage

*A CMS 1500 form is simply a billing form maintained by the National Uniform Billing Committee.

The low start-up costs coupled with this limited inventory make it easy to see why medical billing from home is growing in popularity among entrepreneurs.

Medical Billing Software: The Most Important Tool for Your Business

Once you’ve decided to start a home-based medical billing business, you will need to purchase appropriate computer program to manage your business.

Many people will tell you that selecting the right software is one of the most important business decisions you will make, as your software will serve as the core of all your business operations. While it is true that the program you select is vital, there are alternatives available that are internet-based and require no software installation at all.

USA FOR HEALTHCLAIMS

This comprehensive business opportunity is a medical billing service business – and more. In fact, USA for Healthclaims is a full-service marketing firm. What does this mean for you? It means that not only does the company provide the software that you need to run your business, but it also helps you market your services to medical professionals.

When you begin with USA for Healthclaims, the company will actually provide you with the names, addresses, and phone numbers of up to 250 potential clients in your area. However, you are not limited to servicing healthcare providers only in your area, and with USA for Healthclaims, you can process claims for clients anywhere in the country.

This is truly a unique business opportunity, providing great income potential as well as the ability to work from home. For more information on how you can join this growing industry, click here.

AMERICAN BILLING SYSTEMS, INC.

American Billing Systems is more than a home-based business opportunity. It is an anywhere-based business opportunity. That’s right. With American Billing Systems, you can carry out your business from any location; all you need is a computer and an Internet connection.

The reason is that American Billing Systems does not offer medical billing software; rather, it offers an Application Service Provider (ASP) which allows you to process claims 24 hours a day, 7 days a week from any Internet-connected computer.

Additionally, because of this unique feature, you have the option of allowing doctors’ staff to have limited access to patient records. The benefit of this is that the staff can enter claims directly from their offices. Then, all you need to do is process the claims from the comfort of your own home – or from an Internet cafe anywhere in the world!

If you’d like to receive more information on American Billing Systems, simply click here and fill out the information request form.

As the healthcare industry continues to grow, healthcare providers will continue to need topnotch medical billing services. Get started today, and become a part of this exciting industry.

Related Medical Billing Articles

Looking To Work From Home? Cash in on the Boom in the Medical Billing Industry Today

For many people there would be nothing better than to be able to tell the boss where to stick the old job, and go out and try something completely new…maybe even something that you can do from home. If this sounds like you to a tee, then at home medical billing might be something that you should consider.

The amazing growth in information technology has led to a huge boom in the growth of new jobs, especially administrative or office jobs that no longer have to be done from a cubicle or stuffy office. At home medical billing falls into this category. Software programs that automate at home medical billing are now spreading all over the Internet, and some of them are even available for free download at various online sites. With the advancements made today including high-speed internet service, voip phone service and various outsourcing sites such as www.elance.com, there’s really no major obstacle that is stopping you from taking the plunge into the at home medical billing arena.

So why should you consider at Home Medical Billing? Your reasons for choosing at home medical billing have to be your own, but many of the people who chose to take the plunge into this new field have often done so, and taken advantage of the lucrative income possibilities, for the same reasons. The most common of these reasons include:

1. To be near the family and still bring money into the household 2. To be financially independent 3. To be your own boss, without anyone else telling you what to do 4. To plan your own time and schedules 5. To show what you are able to do 6. To break away from a monotonous rut

If any of your reasons for why you want to consider a new job or profession match any of the reasons on this list, then you might be a prime candidate to consider the possible benefits of at home medical billing. If nothing else, this job certainly has its perks for the simple reason that it is a work at home business opportunity that will allow you to escape the day-to-day drudgery of office work.

Make no mistake that at home medical billing is not as simple as it sounds, but as long as you have the necessary skills, an understanding of the medical coding and billing industry, and some experience in the medical field, then you should be able to survive the first challenging years of your medical billing business, and turn it into a thriving home business.

You should also have at least some working knowledge of how a private business is run. For more small business information, check out www.sba.gov or your local bookstore. There are plenty of books available today that can walk you through the steps needed to establish your business correctly. Personal ambition, high self-motivation, and high organizational ability are some of the driving forces that can enable you to be successful at home medical billing business.

More Medical Billing Articles

Medical Billing As A “Work From Home Job” Vs. “Business Ownership”

Medical Billing as a “JOB-Working from home” Vs. “Business Ownership”

As someone who is very involved in the industry today, and follows all news and forums related to the medical billing industry, one constant question seems to continuously come up… “I have completed a course in medical billing and/or coding and I cannot seem to find a job.” Or I hear/see someone saying they have taken or want to take a course in medical billing and then work from home.  Let’s take a realistic look of the probability and job market of a position as a work at home employee for a medical practice.

In today’s economy the unemployment rate is soaring. Businesses in general are making cut-backs in staff, salaries and benefits. Healthcare providers have been feeling these economic crunches for years with cut-backs in Medicare, Medicaid and other insurance carriers. The healthcare crisis in the U.S has been a long-standing issue among providers for quite some time. What benefits will a physician see by hiring someone (as employee) to oversee their revenue and cash-flow? NONE. In fact it will cost the provider MORE and here is why:

Taxes – As an employer, the physician is still libel to pay both state and federal income tax Software/Business Supplies, Equipment – your employer (physician/provider) will be responsible for all equipment/supplies, such as computer, practice management software, internet connection, claim forms, coding books, postage, envelopes, phone lines and fax line. As your “Employer” he/she must legally own these supplies/equipment Liability & Accountability – When you go to work in an office there is a procedure in place, whether it’s punching a clock or just beginning your day at the place of your employment. Asking an employer to just “trust” that you will be there for the hours you are being paid for is asking for instant trust/faith. Add to that the liability that comes with the duties of a medical biller and patient privacy along with HIPAA rules and regulations and you have an employer who has now doubled his liability with someone NOT working within his office. In turn the employer (provider) needs to have additional insurance to protect themselves from errors & omissions. Continued education – This is an ever-changing industry with constant requirements for keeping up on both state and federal mandates in a highly regulated industry. As an employer, he/she would be responsible for such things as seminar attendance, continued education and certification up-keep, coding books, publications, etc.

Now, let’s take another approach and examine the benefits a provider/physician would see if they were to hire a “Third Party Billing Company”:

Everything above that was noted as being the reasons why a physician would NOT hire an employee to work from home…becomes MOOT.

As a business owner you would be responsible for all of the above items.

We cannot say there are NO work-at-home positions out there, because that wouldn’t be honest. But realistically the provider / physician who has an employee working from home MOST LIKELY:

Has a history and good standing with the employee Has extenuating circumstances behind the reasons for allowing the employee to work at home

The fact of the matter is that these circumstances are few and far between.

What’s in it for me if I did start my own business?

GOOD Question, let’s now discuss the BENEFITS of being your OWN business, benefits that are not only for YOU as a business owner, but your “CLIENT” the healthcare provider by reducing his overhead costs, increasing his revenue, and at the same time MAKING YOU MONEY!

Make your own hours – This is probably one of the best perks to being in business for yourself. You can take on as many clients as you want in order to maintain the hours you want to work, what’s better is that you can arrange your schedule around another job, a hobby, or your family. Be your own Boss – Who wouldn’t want to be their own boss? Enough said on that top topic! Set your own Goals – Whether you want to supplement a spouse’s income or grow your business, you get to decide this. If your goal is to be a single business owner/operation you can plan to take only as many clients as you want. If you want to grow your business to create more free time for yourself you can do that as well. Create your own Salary – Another great perk… you decide how much you want to make. You create your fees according to what you want to make and also keeping in mind your competitive market. Creative Freedom – I love this one. A medical billing clerk that works a 40 hour week usually does the same thing day in and day out. As a business owner you can be creative with your job description and the services your business will offer. To be competitive you can offer other services to healthcare providers that ultimately result in an increase in revenue for both YOURSELF and YOUR CLIENT! There are so many additional services a billing company can offer that will not only profit the healthcare provider but provide additional revenue and job stability to the business owner! Security/Stability – This perk will depend on YOU. If you create a goal and a good business plan for success and you maintain a good reputation with your clients, you will have security and along with security you will create the sense of accomplishment most successful business owners strive for. There will always be a need for doctors, people will always be sick and need medical care and with that you can build the success of your business around those securities.

To start your own business you need to first be committed, goal oriented, creative and yes there has to be start-up funds. The success of your business will be what you want out of it and what you put into it.

Now let’s be realistic. One thing I pride myself on is my honesty, pride, and integrity for this industry. It’s one of the reasons I wanted to write this MUCH needed article to hopefully shed some light on the truth behind some of those ad’s that advertise you can make money from home in your pj’s just as soon as you purchase their package! Does that mean all business opportunity packages are bad? No, not at all. A business opportunity can be exactly that… an “Opportunity” to be your own business and it can be profitable The key is to choose the right solution for you, and then going after your goal. Research is vital. Being realistic, and understanding how this business works FIRST is very important and hopefully we have dispelled one of the biggest misconceptions.

This is a great time to start a medical billing company!

I don’t consider myself an expert on economic or political issues; however I have taken an extreme interest in today’s politics given the economic situation we are in.

In the past several months I have spoken with many providers who are feeling the crunch of the economy, many of them cannot afford to add staff and some are now considering outsourced solutions, we are seeing an economic trend like we did in the late 80’s and early 90’s when the home based business market was booming. Its different this time, our overall economy is in danger; the healthcare industry is a mess as it’s been for years, but yet… IT REALLY IS A GREAT TIME TO BE A MEDICAL BILLING COMPANY!

By Linda Walker
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