You work for someone else.  You do your job and take home a paycheck.  But one day you reach a point in that job and realize that it won't get any better.  So you look for a better position with "potential."  You change jobs with prospects of advancing up the ladder of success.  But, you still work for someone else.  The advancement is really not what you thought it would be.  All the while, a thought about working for yourself begins to take root and grow into a full-blown desire.  "I can do it," you tell yourself.  You make the decision to strike out on your own. 

Now comes the day of reckoning.   What does it take to have your own billing company?  What name will you call your new business?  Can you work from your home or do you need an office space?  If home based, what office equipment will you need to purchase and how much will it cost?  Then the dreaded software question comes up.  You discover that there are more billing software programs than you could ever check out.  Do you buy proprietary software or do you go with one of the web-based software systems.  Do you need DSL or Cable broadband?  How about a separate fax line? 

Now comes the contract issues.  You will need a Service Agreement that contains all the elements of a well thought out business plan.  This is the contract that governs how you will perform the work and the rate of service.  Will you charge a flat rate or percentage?  When will you close the month?  When do you expect to get paid?  What kind of reports will you provide your clients?   

You will need a business associate agreement that contains the acceptable elements of HIPAA.  This governs the compliance issues of the use of PHI.  You will have in your possession copies of the PHI, and upon termination of your service contract, this agreement governs the terms of disposing or returning said PHI.  This agreement also contains guidance on confidentiality and indemnification. A separate confidentiality agreement is necessary to protect yourself and your clients.  A separate AR Recovery agreement might be another contract to consider.  You will also need to have a clearinghouse agreement for electronic billing that you will have to negotiate, unless you go with the web-based software.  Other documents may include the Medicare paperwork, Railroad Medicare agreement, Tricare submission document, and your client's Blue Cross numbers submission. 

Then there are all of the elements of setting up business in your state.  Are you required to have a collection license?  How about a license to do business?  It would be prudent to have at least a million dollars liability coverage for errors and omissions. 

Now, you work for yourself.

And by the grace of God, you land a client.  You might have to do a crash course in some specialty because you just told your client that, sure you can do it!  You reason, what can be so hard about billing for this specialty when you already know how to bill?  After 30 days of billing, you realize that that your home office printer isn't big enough the print all your patient statements, so you load up the statements on a disc and run them down to office supply and print shop.  OOPS!  You forgot to negotiate with your client about who pays for the postage, and now you have to "eat" the cost.  Because you are now the biller, you begin taking calls from irate patients who cannot understand why they are getting a bill.  Your client is calling because patients are calling the office and complaining about the statement.  And so it goes.

But what if you decide to set up business in an office space?   This could open doors that a home-based business might not open.  Many providers want to do business with a company that has a long-range business plan.  When you have an office, you also go for the larger clients because you have a larger overhead that you need to address.  This requires a business model that includes what kind of staff you will hire, how you will control document storage, and many of the same issues already mentioned.  Such mundane items such as your business compliance plan, your compliance officer, office security, housekeeping, certification, and hours of operation must be considered.  And of course, there is the need to design and launch a website.  Do you pay for a Webmaster or do it yourself?  How do you choose a web name? 

Then there is the need to network with other professionals, such as coding professionals, medical attorneys, compliance professionals, and community business leaders.   Making contact with your state insurance board may open doors, but don't count on it. 

Time passes, and your client base is beginning to grow.  But one of your clients decides to take his billing in-house.  Now you have to get aggressive again in your marketing.  You are a biller, not a salesman.  You thought "cold calling" was over.  But no, you have to leave the office, that safe haven, and go back out into the deep waters and present yourself to that front desk person (who probably doubles as the biller) and is scared to death that you are there to take her job.  You get frustrated.  You cry out to the God of the universe for help.  Is he listening, you wonder?  Then the unbelievable happens.  A provider calls you because he saw your website and is looking to "out source" his billing.  Then that network of professionals you slowly put together begins to provide leads.  Hurray!  New clients become a reality.  Your business plan is beginning to take shape and now you feel confident that the day of stepping out on your own was a good day.
Now go forth and believe in yourself.  You can do it.

Dan Young, VP Operations
Resolutions Billing & Consulting, Inc.
www.resolutionsbilling.com