Home medical billing jobs and how to work from home in medical billing make up over a third of the questions we get on our site. So how realistic are jobs in medical billing from home?
Yes medical billing from home is possible for those with the knowledge and experience in billing to deliver results for a physicians office. There are a lot of opportunities for competent billing specialists. Many smaller practices have trouble attracting and retaining employees that know how to get insurance claims paid. I've found it's just a matter of getting a foot in the door to have the opportunity to prove it doesn't matter where the billing is done - someone working from home or in an office environment - it's the results that count.
But first we have to look at billing from the physician (or providers) perspective. A provider is relying on the medical billing specialist for the income of their practice. They must have a lot of confidence in your ability to get claims paid in promptly. If you have had any experience in billing, you know it can be complex and tedious at times.
What’s involved with Home Medical Billing Jobs?
The process of medical billing involves everything necessary to get a doctor or other health care professional paid for their services. This is both payment from the insurance carrier and the patient. It involves submitting claims to insurance companies (usually electronically) or government carriers such as Medicare or Medicaid.
When a patient visits a physician, the doctor evaluates the patient and documents the observed conditions and treatment as ICD diagnosis and CPT treatment codes. These codes are then entered on a superbill or patient encounter form. The medical billing specialist takes the superbill and inputs the information into the medical billing software along with patient demographics and insurance information. Sometimes paper claims are printed and mailed to the insurance carrier for those that don’t accept electronic claims. Electronic claims are sent either directly to the insurance company or a clearinghouse.
If the claim is rejected, the medical billing specialist follows up to find out why it was rejected, correct the claim, and resubmit. An appeal may also need to be written and submitted with supporting information to the insurance company.
When a payment is received from the insurance carrier, it is accompanied by remittance advice or an EOB (Explanation of Benefits). This information is then entered into the medical billing software to reconcile the patient accounts and apply any write-offs per the insurance agreements the doctor has with the insurance company. If there is any patient responsibility such as co-pays and co-insurance, a patient statement or bill is printed and mailed, usually on a monthly basis.
When insurance claims are not paid (rejected or denied), the medical billing specialist has to investigate why. This typically involves calling the insurance company or interpreting the error codes on the remittance advice or explanation of benefits. This is typically due to errors in insurance information, the patient no longer being covered, errors in demographics, or invalid treatment or diagnosis codes.
The medical billing process is extremely important to the financial health of the practice. If claims don't get submitted in a timely manner, the doctors don't get paid.
Who needs Medical Billing Services?
Just about every health care provider; doctors of every specialty, dentists, mental health providers (psychiatrists, psychologists), chiropractors, physical therapists, etc. There’s a good opportunity with smaller practices for home medical billing jobs for billing services. The larger billing services can be more expensive and not provide the personal attention and service a small billing provider can.
So how do you make money - and how much can you make?
There’s a variety of ways home medical billing jobs pay; a percentage of receipts, a fixed fee, per claim, or hourly. It’s typically a percentage of receipts as this gives incentive to the medical biller to make sure claims are paid. A typical percentage can be anywhere from 6% to 10% depending on the services offered, the specialty, and competition.
As far as income potential it depends on the size of the practice. A busy practice can bring in $70,000 to $80,000 a month in a busy month. Assuming an average 7.5% fee this is $5000 to $6000 a month in fees. But a practice this busy will require a lot of time - usually more than one person can handle. So you would need to count on hiring some help - at least part time.
On the other hand a smaller practice can typically be $20,000 to $30,000 a year. This would translate to $1500 to $2500 a month before expenses.
So as you can see the spectrum is pretty wide as far as income potential. When getting started it’s good to serve a smaller practice that you can grow and learn with.
What does it cost?
A decent PC based medical billing software can cost anywhere from several hundred to several thousand dollars. However there are online medical billing software services available that don't require a large upfront investment - just a monthly subscription fee. An example would be Kareo. They have options starting under $100 a month.
You also have to consider the normal costs of starting and operating a business like:
I'm sure I've left something out here but you get the idea.
Medical Billing Jobs From Home - What’s it take?
Good training in medical billing is so important. These cheap courses you see advertised typically only teach simple data entry tasks and provide general information you could probably find online. Probably the best training is the experience of working for a billing service or in a doctors office and learning on your own. I’ve listed a lot of the resources I’ve found helpful here. You will most likely need to have some in-office experience before a provider will trust a billing specialist to work out of the office for home medical billing jobs.
It’s important for the medical billing specialist to be familiar with medical billing terms and medical billing codes. You need to have a good background in this before attempting home medical billing jobs or starting a home based medical billing service.
Practicing medical billing does not require certification, but it is important to be experienced and knowledgeable in the field.
So knowledge, training, and experience are key to being successful in home medical billing jobs. It’s critical that claims are submitted and paid promptly with low denials. Not many practices can afford to wait a month to find out their claims are not being paid. That’s why having an experienced and diligent medical billing professional is important - whether its at home medical billing jobs or in the physicians office - it’s the results and the bottom line that counts.
One thing I’ve learned about medical billing is my job performance is clearly evident based on the claims paid.
Creative ways to get started in home medical billing jobs.
Here are some creative ways to get started in home medical billing jobs. These assume you are planning to establish a business which is a good idea for tax reasons. Here's some creative ways for getting home medical billing jobs:
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