I've started a medical supply business. How can I start billing insurance companies.

by mike
(baltimore, md)

I'm trying to start a business in medical supplies and I need to know how to bill insurance companies.


Answer:

Mike,

I assume you're talking about DME (Durable Medical Equipment) billing and that you're well versed in the nuances of DME. I personally haven't billed medical equipment but understand it can be a very lucrative specialty.

When it comes right down to it, DME medical billing isn't much different than billing for physicians. You still have to submit claims, keep up with co-pay's, co-insurance, write-offs, patient responsibilities, etc. - as well as be familiar with the CPT medical billing codes unique to medical supplies. I go into more detail on the billing process here.

To start billing insurance companies requires submitting claims on behalf of patients - either electronically or paper. This requires some sort of practice management or billing software.

As you probably know there's a lot of DME medical billing software programs available - or standard medical billing/practice management programs that can be used for DME billing.

It's almost overwhelming the choices available. I would recommend using one of the more popular programs like Lytec, AltaPoint, Medisoft - the list goes on... You can expect to spend around $1000 and up for a single user license.

To submit claims electronically requires a Clearinghouse - unless you want to submit to each individual carrier separately - but I wouldn't recommend. The cost starts at about $80/month. I use ENSHealth (www.enshealth.com) and have been very pleased with them.

Or you may want to checkout Kareo. They're an online medical billing service that starts at about $70/month with no long term contracts. It also includes electronic claim submission and can be accessed from any PC with a browser. I haven't started using it yet but plan to with our next client. I've read good reviews on it.

here's also a company called AdvanceMD - but I'm not as familiar with them or their pricing and services. I think online is the future for medical billing software - no upfront costs, upgrades, maintenance, servers, backup, etc.

If you're just getting started and don't have a lot of claims yet, the most economical route would be to file paper claims - it's a lot cheaper. The only drawback is it takes a little longer to get payments.

Speedysoft Speedy Claims file and print software available for about $115. The only problem is you still have to keep up with claim status and all the other accounting function (like co-insurance, co-pays, patient balances, etc.). But SpeedySoft also offers a Speedy Ledger for $75 that's compatible and complements Speedy Claims file and print. Check out SpeedSoft here.

Thanks for the question Mike - I hope I've not rambled too much and given you some helpful info. Feel free to look around the site and see if there's anything else that might be helpful.

Good Luck!

Gina

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Nov 19, 2014
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Quick Question
by: Anonymous

Hello Mike,

I am thinking about staring a medical billing company to bill just a few people's medical supplies. I will not be providing any services, but being the middle man between the supplier and the insurance provider. Do you have any tips how to get this started? Do I need to have an NPI #? Any info would be helpful! Thank you!

Apr 28, 2010
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Get Clients
by: Karen

From my experience the biggest challenge is having clients to bill for. I think the hardest part of starting a Medical Billing business is getting clients.

Of course if you already have clients getting set up to send claims to payers can be a real hassle. I recommend using a clearinghouse. That way you only have to transmit claims to them in one format and they send to all the different insurance companies. Otherwise you have to work out different file formats with every insurer you want to submit claims to.

Of course you can still send claims the old fashioned way - paper. There's a company called Speedy Claim that makes file and print software for around $115. Just do a Google search on Speedy Claim.

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