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Thread Topic: Home-Based Medical Billing Business
Topic Originator: Michelle Rimmer,CHI,CMRS,CBCS
Post Date March 20, 2008 @ 11:03 PM
Home-Based Medical Billing Business

Michelle Rimmer,CHI,CMRS,CBCS
March 20, 2008 @ 11:03 PM Reply  |  Email Friend   |  |Print  |  Top

Greetings Forum Members,

Have you wanted to start a home-based medical billing business-but don't know where to begin?

Try my new guide 'Starting Your Home-Based Medical Billing Business'
available at my new website for only $5.95!!

look forward to meeting you online!

Michelle Rimmer,CHI,CMRS,CBCS
Author-'Medical Billing 101'; a division of Shore Medical Billing

virginia Tubbs
March 31, 2008 @ 3:32 PM Reply  |  Email Friend   |  |Print  |  Top

is your website open?  It keeps sending me back to the begnning.

Michelle Rimmer
March 31, 2008 @ 9:26 PM Reply  |  Email Friend   |  |Print  |  Top

Hi Virginia,

Yes, my websites are up and running.  The previous email does not have a direct link.  If you type or in your browser--you will get there :-)

Cheryl H
April 20, 2008 @ 8:39 PM Reply  |  Email Friend   |  |Print  |  Top

I am very interested in finally getting my dream off the ground.  I am currently an instructor for medical billing.  I have also worked in medical offices and insurance companies.  I have started setting up my home based medical billing/consulting buisness.  My concern is the contracts between me and the physician.  Any help would be greatly appreciated.

Cheyl H, CPC

Michelle Rimmer
April 21, 2008 @ 4:21 PM Reply  |  Email Friend   |  |Print  |  Top


Check out the 'Contracts' topic.  A gentleman has provided a free sample contract if you email him.

April 21, 2008 @ 4:22 PM Reply  |  Email Friend   |  |Print  |  Top

Just to be brief

1)  Look for any timely filing clauses as to how much time the provider has to submit claims and this also includes any Medicare, Medicaid or Workers Comp appendices as well.  There may not be any exceptions in the contract.  Does the timeframe state the time is from the date of service and when the carrier receives the claim.  Are there exceptions  to the timeframe such as:
(a) the patient withholds info until after the deadline
(b) the patient give incorect insurance informaition.
(c) An insurance company demands the return of money because someone else is primary
Are all claims to be sent electronicaly?  If so, what about secondary claims.  What does the carrier accept as proof of timely filing.

2) Look to see how much time the carrier has to pay or deny the claims.  Is there anything listed regarding  what to do with incorrect or unpaid claims, or claims sent to someone else other than the provider?

3)  How much did the provider agee to be paid. is the payment based on the Medicar allowable and if so, when is teh medicare allowable effecitve each year.  How much is to be paid when the carrier is secondary and/or the carrier has a Medicare or Medicaid product and is secondatry?  Is payment based on the carriers definition of usual and customary and is that defined?  Does the patient have to pay anything above usual and customary. What happens if the patient never pays their copay coinsurance or deductible?

4)  Look at any appeals processes listed.  Is there a timeframe to submit an appal and is there a timeframe for the carrier to respond to the appeal. Are there multiple levels of appeals requird.

5)  Did he provider agree to include any associates  or affiliates which could mean it opens he door to silent PPOs.

6) Is there a termination clause and if so how much time is ther for contract termination. Howmany clauses vcrry one after termination.
How are you to be paid once terminated.  H

7)  Did the provider agree to carrier policies and procedures an do you have a opy of them.

8) Are there any blank appendies or attachments?

9) Is there a hold harmless clause, holding the carrier harmless.

10) Is there a hold patient harmless if the claim is denied or are you required to give any discounts to the patient when denied.

11)  Do you have to obtain authoriztion or precertification before treating patients.

12.  is there a clause for arbitration and does the clause outline what the arbitrator is or is not allowed to do.  Did the provider sign away his rights to any civil trial.

This is not all inclusive but it should get you started.  Also, I am not giving any legal advice, just training information.  You should have contracts reviewed by n attorney specializing in provider -insurance contracts.

April 22, 2008 @ 4:56 AM Reply  |  Email Friend   |  |Print  |  Top

Are you talking about contracting between the medical billing co and the provider or between the provider and insurance co? was just curious

Cheryl H
April 25, 2008 @ 9:44 AM Reply  |  Email Friend   |  |Print  |  Top

I was talking about my contract with the provider.  I have the % I want to charge for my inital bill out but I was interented in how would I charge for all the clean up.  I have several doctors interested but they have had really poor billing companies that have let claims go.  They take more work and I really want to be fair.  Any ideas?

Thank You!

Cheryl H
April 25, 2008 @ 9:45 AM Reply  |  Email Friend   |  |Print  |  Top


Thank you for your reply.  I must not be looking in the right area I don't see the Contract topic.  How do I get to the example?

Thank you!

Cheryl H
April 25, 2008 @ 9:49 AM Reply  |  Email Friend   |  |Print  |  Top

Thank you!

I am looking into an attorney who deals with medical insurance policy contracts in my area.

Michelle Rimmer
April 25, 2008 @ 10:32 AM Reply  |  Email Friend   |  |Print  |  Top

Hi Cheryl,

Oh, I thought you were interested in a provider/billing co. contract.


Michelle :-)

August 5, 2008 @ 7:30 PM Reply  |  Email Friend   |  |Print  |  Top

Hi, I am new here, I have a question thatI thought you could possibly help me with.  My husband and I are in the process of forming an LLC to start out own Medical Billing Service from home.  We want to start small and I wanted to know if anyone had any suggestion on software , th good, the bad, and the ugly.  I would really appreciate your input and suggestions.  Thanks.  KLA

Michelle Rimmer
August 6, 2008 @ 12:44 AM Reply  |  Email Friend   |  |Print  |  Top


Are you interested in purchasing software or contracting with a company providing web-based billing?  For software, Medisoft is a popular 'home-based' software, lytec too.  If you are interested in using a revenue cycle management application, I like KAREO.  You can view their site at

Much Luck to you and your husband!!

August 10, 2008 @ 11:01 PM Reply  |  Email Friend   |  |Print  |  Top

Michelle, thank you for your reply.  I am not sure what is better to use, web based or plain software, any suggestions?

Michelle Rimmer,CHI,CBCS
August 12, 2008 @ 11:19 PM Reply  |  Email Friend   |  |Print  |  Top


Good question. It is really a personal preference.  I like web-based. Check out KAREO at

Years ago when I started back in 97', I used Medisoft--LOL old old version!!

Some home-based billers still go with Medisoft today, or lytec, etc....there really are alot out there.

For software I LOVE LOVE LOVE Medical Manager, however, it is a very expensive package, and I wouldn't recommend it to start out--unless you feel you can afford it!

Back in 95', I worked for a Medical Billing company who used 'Medical Manager', and I have adored the program ever since!!

Tammy Harlan
August 21, 2008 @ 8:36 PM Reply  |  Email Friend   |  |Print  |  Top

These days, information is readily available to physicians seeking advice on choosing a medical billing outsourcing company.  One of the "red flags" they have been informed to watch for is cheap software programs used by their outsourcing agendy.  

Don't get me wrong, starter medical billing software programs do have their place (even though they end almost costing as much as better programs when you factor upgrades and add ons, etc.) but physician's are being advised to NOT take outsourcing agencies seriously when the tool of their trade falls in the same category as Medisoft or Lytec.  

Tammy Harlan
Medical Billing

August 11, 2008 @ 12:44 PM Reply  |  Email Friend   |  |Print  |  Top

I am currently billing for two physicians, but am looking for more.  I have my tax id and company name. What next?

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