medical billing business plan

Medical Billing Business Plan Template

Written by Dave Lavinsky

Medical Billing Business Plan

Over the past 20+ years, we have helped over 1,000 entrepreneurs and business owners create business plans to start and grow their medical billing companies. We have the experience, resources, and knowledge to help you create a great business plan.

In this article, you will learn some background information on why business planning is important. Then, you will learn how to write a medical billing business plan step-by-step so you can create your plan today.

Download our Ultimate Business Plan Template here >

What is a Medical Billing Business Plan?

A business plan provides a snapshot of your medical billing business as it stands today, and lays out your growth plan for the next five years. It explains your business goals and your strategies for reaching them. It also includes market research to support your plans.

Why You Need a Business Plan for a Medical Billing Business

If you’re looking to start a medical billing business or grow your existing medical billing company, you need a business plan. A business plan will help you raise funding, if needed, and plan out the growth of your medical billing business to improve your chances of success. Your medical billing business plan is a living document that should be updated annually as your company grows and changes.

Sources of Funding for Medical Billing Businesses

With regard to funding, the main sources of funding for a medical billing business are personal savings, credit cards, bank loans, and angel investors. When it comes to bank loans, banks will want to review your business plan (hand it to them in person or email to them as a PDF file) and gain confidence that you will be able to repay your loan and interest. To acquire this confidence, the loan officer will not only want to ensure that your financials are reasonable, but they will also want to see a professional plan. Such a plan will give them the confidence that you can successfully and professionally operate a business. Personal savings and bank loans are the most common funding paths for medical billing companies.

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How to write a business plan for a medical billing business.

If you want to start a medical billing business or expand your current one, you need a business plan. The guide and sample below details the necessary information for how to write each essential component of your medical billing business plan.

Executive Summary

Your executive summary provides an introduction to your business plan, but it is normally the last section you write because it provides a summary of each key section of your plan.

The goal of your executive summary is to quickly engage the reader. Explain to them the kind of medical billing business you are running and the status. For example, are you a startup, do you have a medical billing business that you would like to grow, or are you operating a chain of medical billing businesses?

Next, provide an overview of each of the subsequent sections of your plan. 

• Give a brief overv iew of the medical billing industry. 
• Discuss the type of medical billing business you are operating. 
• Detail your direct competitors. Give an overview of your target customers. 
• Provide a snapshot of your marketing strategy. Identify the key members of your team. 
• Offer an overview of your financial plan.

Company Overview

In your company overview, you will detail the type of medical billing business you are operating.

For example, you m ight specialize in one of the following types of medical billing businesses:

• Light :These types of companies provide straightforward billing services and revenue management.
• Full Service :These types of companies provide a full suite of billing services including practice management, EHR, revenue cycle management & medical billing, patient engagement, care coordination, and population health management.
• Boutique :These are smaller companies who have expertise in specific medical practice and/or specialty.

In addition to explaining the type of medical billing business you will operate, the company overview needs to provide background on the business.

Include answers to questions such as:

• When and why did you start the business?
• What milestones have you achieved to date? Milestones could include the number of patients served, the number of cases with positive outcomes, reaching X number of clients served, etc.
• Your legal business structure. Are you incorporated as an S-Corp? An LLC? A sole proprietorship? Explain your legal structure here.

Industry Analysis

In your industry or market analysis, you need to provide an overview of the medical billing industry.

While this may seem unnecessary, it serves multiple purposes.

First, researching the medical billing industry educates you. It helps you understand the market in which you are operating. 

Secondly, market research can improve your marketing strategy, particularly if your analysis identifies market trends.

The third reason is to prove to readers that you are an expert in your industry. By conducting the research and presenting it in your plan, you achieve just that.

The following questions should be answered in the industry analysis section of your medical billing business plan:

• How big is the medical billing industry (in dollars)?
• Is the market declining or increasing?
• Who are the key competitors in the market?
• Who are the key suppliers in the market?
• What trends are affecting the industry?
• What is the industry’s growth forecast over the next 5 – 10 years?
• What is the relevant market size? That is, how big is the potential target market for your medical billing business? You can extrapolate such a figure by assessing the size of the market in the entire country and then applying that figure to your local population.

Customer Analysis

The customer analysis section of your medical billing business plan must detail the customers you serve and/or expect to serve.

The following are examples of customer segments: individuals, schools, families, and corporations.

As you can imagine, the customer segment(s) you choose will have a great impact on the type of medical billing business you operate. Clearly, individuals would respond to different marketing promotions than corporations, for example.

Try to break out your target customers in terms of their demographic and psychographic profiles. With regards to demographics, including a discussion of the ages, genders, locations, and income levels of the potential customers you seek to serve.

Psychographic profiles explain the wants and needs of your target customers. The more you can recognize and define these needs, the better you will do in attracting and retaining your customers. Ideally you can speak with a sample of your target customers before writing your plan to better understand their needs.

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Competitive Analysis

Your competitive analysis should identify the indirect and direct competitors your business faces and then focus on the latter.

Direct competitors are othe r medical billing businesses. 

Indirect competitors are other options that customers have to purchase from that aren’t directly competing with your product or service. This includes psychiatrists, other healthcare providers, or members of the clergy. You need to mention such competition as well.

For each direct competitor, provide an overview of their business and document their strengths and weaknesses. Unless you once worked at your competitors’ businesses, it will be impossible to know everything about them. But you should be able to find out key things about them such as

• What types of customers do they serve?
• What type of medical billing business are they?
• What is their pricing (premium, low, etc.)?
• What are they good at?
• What are their weaknesses?

With regards to the last two questions, think about your answers from the customers’ perspective. And don’t be afraid to ask your competitors’ customers what they like most and least about them.

The final part of your competitive analysis section is to document your areas of competitive advantage. For example:

• Will you provide options for the uninsured?
• Will you offer products or services that your competition doesn’t?
• Will you provide better customer service?
• Will you offer better pricing?

Think about ways you will outperform your competition and document them in this section of your plan.

Marketing Plan

Traditionally, a marketing plan includes the four P’s: Product, Price, Place, and Promotion. For a medical billing business plan, your marketing strategy should include the following:

Product : In the product section, you should reiterate the type o f medical billing company that you documented in your company overview. Then, detail the specific products or services you will be offering. For example, will you provide psychodynamic therapy, behavior therapy, cognitive therapy, or integrative therapy?

Price : Document the prices you will offer and how they compare to your competitors. Essentially in the product and price sub-sections of yo ur plan, yo u are presenting the products and/or services you offer and their prices.

Place : Place refers to the site of your medical billing company. Document where your company is situated and mention how the site will impact your success. For example, is your medical billing business located in a busy retail district, a business district, a standalone office, or purely online? Discuss how your site might be the ideal location for your customers.

Promotions : The final part of your medical billing marketing plan is where you will document how you will drive potential customers to your location(s). The following are some promotional methods you might consider:

• Advertise in local papers, radio stations and/or magazines
• Reach out to websites 
• Distribute flyers
• Engage in email marketing
• Advertise on social media platforms
• Improve the SEO (search engine optimization) on your website for targeted keywords

Operations Plan

While the earlier sections of your business plan explained your goals, your operations plan describes how you will meet them. Your operations plan should have two distinct sections as follows.

Everyday short-term processes include all of the tasks involved in running your medical billing business, including answering calls, planning and providing therapy sessions, billing insurance and/or patients, etc. 

Long-term goals are the milestones you hope to achieve. These could include the dates when you expect to book your Xth session, or when you hope to reach $X in revenue. It could also be when you expect to expand your medical billing business to a new city.

Management Team

To demonstrate your medical billing business’ potential to succeed, a strong management team is essential. Highlight your key players’ backgrounds, emphasizing those skills and experiences that prove their ability to grow a company. 

Ideally, you and/or your team members have direct experience in managing medical billing businesses. If so, highlight this experience and expertise. But also highlight any experience that you think will help your business succeed.

If your team is lacking, consider assembling an advisory board. An advisory board would include 2 to 8 individuals who would act as mentors to your business. They would help answer questions and provide strategic guidance. If needed, look for advisory board members with experience in managing a medical billing business or successfully running a small medical practice.

Financial Plan

Your financial plan should include your 5-year financial statement broken out both monthly or quarterly for the first year and then annually. Your financial statements include your income statement, balance s heet, and cash flow statements.

Income Statement

An income statement is more commonly called a Profit and Loss statement or P&L. It shows your revenue and then subtracts your costs to show whether you turned a profit or not.

In developing your income statement, you need to devise assumptions. For example, will you see 5 patients per day, and/or offer group therapy sessions ? And will sales grow by 2% or 10% per year? As you can imagine, your choice of assumptions will greatly impact the financial forecasts for your business. As much as possible, conduct research to try to root your assumptions in reality.

Balance Sheets

Balance sheets show your assets and liabilities. While balance sheets can include much information, try to simplify them to the key items you need to know about. For instance, if you spend $50,000 on building out your medical billing business, this will not give you immediate profits. Rather it is an asset that will hopefully help you generate profits for years to come. Likewise, if a lender writes you a check for $50,000, you don’t need to pay it back immediately. Rather, that is a liability you will pay back over time.

Cash Flow Statement

Your cash flow statement will help determine how much money you need to start or grow your business, and ensure you never run out of money. What most entrepreneurs and business owners don’t realize is that you can turn a profit but run out of money and go bankrupt. 

When creating your Income Statement and Balance Sheets be sure to include several of the key costs needed in starting or growing a medical billing business:

• Cost of equipment and office supplies
• Payroll or salaries paid to staff
• Business insurance
• Other start-up expenses (if you’re a new business) like legal expenses, permits, computer software, and equipment

Attach your full financial projections in the appendix of your plan along with any supporting documents that make your plan more compelling. For example, you might include your office location lease or a list of insurance plans you accept.

Writing a business plan for your medical billing business is a worthwhile endeavor. If you follow the template above, by the time you are done, you will truly be an expert. You will understand the medical billing industry, your competition, and your customers. You will develop a marketing strategy and will understand what it takes to launch and grow a successful medical billing business.

Medical Billing Business Plan FAQs

What is the easiest way to complete my medical billing business plan.

Growthink's Ultimate Business Plan Template allows you to quickly and easily write your medical billing business plan.

How Do You Start a Medical Billing Business?

Starting a medical billing business is easy with these 14 steps:

• Choose the Name for Your Medical Billing Business
• Create Your Medical Billing Business Plan
• Choose the Legal Structure for Your Medical Billing Business
• Secure Startup Funding for Your Medical Billing Business (If Needed)
• Secure a Location for Your Business
• Register Your Medical Billing Business with the IRS
• Open a Business Bank Account
• Get a Business Credit Card
• Get the Required Business Licenses and Permits
• Get Business Insurance for Your Medical Billing Business
• Buy or Lease the Right Medical Billing Business Equipment
• Develop Your Medical Billing Business Marketing Materials
• Purchase and Setup the Software Needed to Run Your Medical Billing Business
• Open for Business

Learn more about how to start your own medical billing company .

Where Can I Download a Free Business Plan Template PDF?

Click here to download the pdf version of our basic business plan template.

Our free business plan template pdf allows you to see the key sections to complete in your plan and the key questions that each must answer. The business plan pdf will definitely get you started in the right direction.

We do offer a premium version of our business plan template. Click here to learn more about it. The premium version includes numerous features allowing you to quickly and easily create a professional business plan. Its most touted feature is its financial projections template which allows you to simply enter your estimated sales and growth rates, and it automatically calculates your complete five-year financial projections including income statements, balance sheets, and cash flow statements. Here’s the link to our Ultimate Business Plan Template.

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OR, Let Us Develop Your Plan For You

Since 1999, Growthink has developed business plans for thousands of companies who have gone on to achieve tremendous success.   Click here to see how a Growthink business plan writer can create your business plan for you.

Other Helpful Business Plan Articles & Templates

How to start a medical billing company [2024 guide]

Want to start a home-based medical billing business but not sure of the process?

Don’t worry, we’ve got you covered.

There are numerous benefits to running your own home-based business. Working in comfort, building your schedule, being your boss, ditching the daily commute; the list goes on.

However, before investing money, effort, and time into establishing a medical billing business, you should determine if coding and billing is a good fit for you. It takes a lot to get up and running, including a rigorous certification course.

Rest assured, however, the returns of a well-run medical billing business are fantastic. With independence and a steady income, you’ll have a healthier work-life balance and the ability to decide how large you want your company to grow.

Here’s what we will cover in this article

Click on the links below to jump to a particular section.

• What is a Medical Billing Business?
• Is a Home-Run Medical Billing Business Right For You?
• Is There a Need For Your Service?
• What Are the Startup Costs Involved?
• Get Hands-On Experience in a Medical Role
• Apply For Medical Billing Training
• Watch Out For Scams
• Create a Business Plan
• Other Necessities
• A Clearinghouse
• A Medical Billing Software
• Other Equipment & Forms
• Choosing a Billing Software
• How to Charge Clients
• Income Potential
• Specialize Yourself
• Construct a Strong Marketing Plan
• Network & Grow
• Bonus: An Alternative Business Opportunity

Ready to get started? Let’s go!

What is a medical billing business?

Medical centers, hospitals, and private care professionals bill patients for appointments and services. These services can include check-ups, procedures, testing, treatments, and so on.

Medical coding and billing businesses translate these patient services into a bill, and then send and follow up on such medical claims with insurance companies.

Why do doctors and healthcare providers use outsourced billing methods in their revenue cycle management procedures?

Health insurance companies, Medicare, and Medicaid require billing departments to process medical bills through extensive software under strict rules and provisions.

These rules state that billers and coders submit claims with a series of particular codes specific to the medical procedure performed by the health provider. This makes the medical claims billing process far more streamlined and organized.

However, that isn’t all.

Revenue Cycle Management is the administration of medical financial transactions resulting from patient-provider encounters. These transactions include:

• Collections
• Payer contracting
• Provider enrollment
• Data analytics

Medical billers and coders play a significant role in carrying out these revenue cycle procedures. They follow the patient’s payment actions from the initial appointment or interaction with a medical provider to the final payment of the bill.

Billers and coding specialists help doctors earn revenue promptly through their coding and billing abilities and extensive knowledge of the requirements of insurance companies.

Through patient medical records and medical reports, billers and coding specialists can create and process accurate bills far quicker than health professionals.

Faster processing means more cash flow and decreased accounts receivables for care providers.

Is a home-run medical billing business right for you?

Running any business requires:

• Organization
• Data entry skills
• Management skills

If you want to run a successful medical billing service from home, nurture these qualities and skills within yourself.

If this is the first time you are starting a new business, check out our 10 entrepreneurial skills you need .

Next, determine if the healthcare industry interests you.

• Would you enjoy going through medical records and generating claims codes?
• Would you like working with both care providers and insurance companies to receive payment for services rendered?
• Would rejected claims and complications frustrate you? What about uncollectibles?
• Do you have an interest in learning more about medical procedures?
• Did you enjoy working in the medical field in the past?

The medical billing process in the United States can be very complicated. Be sure that you have a passion for the work.

Is there a need for your service?

Before putting time and money in your home business, first research if there is a need for third-party billing in your area.

Contact doctors and healthcare providers and ask them these questions:

• Does an outside company handle your billing or do you do it yourself?
• What software programs do you use/recommend?
• If you use an outside provider, what processes do you outsource?
• How many patients do you see and bill daily?

Tip – Nursing homes and hospitals also use medical billing services and can be a lucrative area of specialization.

The questions listed above will:

• Provide a clear idea of the need for your services in the area
• Give you tips on which software is the best
• Indicate what volume of claims you can expect from your prospective clients.

What are the startup costs involved?

Fortunately, a solo-run medical billing business is easy to start and requires a minimal investment of money. Startup costs typically range between $2,000-$10,000 .

Running a home-based small business lets you avoid overheads like renting out an office space and hiring and training employees.

The most expensive cost in starting your billing service is billing software . Prices can range from $100 to $10,000 based on the size of the company, the number of employees, the number of providers, and software features.

You will also need office supplies, including:

• A reliable computer ($500 – $3000)
• A printer and fax machine ($150+)
• Software licensing ($1500-$3500 per user)

Other costs you may need to consider are:

• Software upgrades ($500-$3500 per year)
• Backup hard drives ($50-$150 per drive)
• Ethernet switches and wires ($50-$100 per wire)
• IT support ($100+ per hour)

If you grow your business into a medium/large company, professional, in-house systems are required and can cost up to $50,000 to purchase and install. Servers will further cost another $3,000-$5,000, and training can cost $3,000+.

A. First steps to starting your own medical billing business

The multi-step process of starting your own medical billing home business can be extensive. We advise that you follow each step thoroughly and obtain every license and certificate required to be in legal standing and risk no chance of being shut down.

Here’s how to start.

1. Get hands-on experience in a medical role

If you are new to the medical industry, it is highly beneficial to work in the medical field for at least a few months before starting your business.

A great way to do this is by working in the billing department of a medical office or a hospital. You will experience the medical industry and billing process first hand, and will also gain an improved understanding of the average volume of patients that visit doctors daily.

Working in a doctor’s office will help you network and source potential clients for your business. You will handle a variety of medical records and insurance claims, and may even get to learn the electronic billing process if the practice supports it.

2. Apply for medical billing training

Why do you need medical billing training?

Medical billing differs from other types of invoices for two reasons:

• Medical bills go through an insurer before being sent to a patient.
• Medical bills require highly specialized codes and descriptions when sent to insurers.

Also, many medical procedures have similar names; therefore, billing specialists must have in-depth knowledge about anatomy, physiology, pharmacology, and health insurance terms.

A variety of colleges offer billing certification courses, both online and in-person. The completion of most billing certifications takes 9 to 18 months and requires 18 credits.

The Primary Coding Manuals & Certification Exams

When choosing a certification program, pick a course that includes all necessary code manuals and exam preparations.

Medical billing certificate programs should cover three primary code manuals:

• CPT: Current Procedural Terminology (set by the American Medical Association)
• ICD-10-CM: International Statistical Classification of Diseases and Related Health Problems (Maintained by the World Health Organization)
• HCPCS: Healthcare Common Procedure Coding System

Following the course, you should be prepared to take exams offered by the three medical billing and coding businesses listed below:

• Certified Medical Reimbursement Specialist exam – American Medical Billing Association (AMBA)
• Certified Coding Associate – American Health Information Management Association (AHIMA)
• Certified Professional Coder’s board exam – American Academy of Professional Coder’s (AAPC)

3. Watch out for scams

There are a plethora of medical billing opportunities that aid entrepreneurs in starting their own third-party billing business.

For example, a company may offer to set the entrepreneur up with training, the perfect electronic billing tools, and a list of potential clients that need outsourced billing services.

Sounds too good to be true, right?

Reliable services like this surely exist, however many of them are scams. The Federal Trade Commission has created a guide for how to detect and avoid scams.

It is crucial that you do thorough research on service providers if you choose to take this route.

The FTC suggests that you, “check with the state Attorney General’s office , consumer protection agency and the Better Business Bureau in your area and the area where the promoter is based to learn whether there are any unresolved complaints about the business opportunity or the promoter.”

4. Create a business plan

Determining what kind of business you want to run is the first step in creating an airtight business plan.

Do you want to run a sole proprietorship or a partnership with another person? Will your business be an LLC ? Will it be a large corporation?

Meet with a certified public accountant to understand which option suits your personal and tax needs.

Next, ask yourself a few questions:

• Who is your target audience?
• What are the initial costs?
• What kind of income can you expect?
• What is the name of the business?
• What do you need to get started?

5. Other necessities

Here are a few more things you will need to accomplish before starting your medical billing company:

• Apply for a business license
• Register for taxes
• Set up a business bank account
• Set up accounting
• Obtain necessary permits and licenses
• Get business insurance
• Start an LLC. Here are some free guides .

B. What you need to get up and running

Here are the essential items you will need to run a medical billing business smoothly:

1. A clearinghouse

A clearinghouse is a financial institution that processes and facilitates the exchange of payments, securities, or derivatives transactions. In your case, it is a company that electronically receives and transmits medical claims billing.

How much does this service cost?

The cost of a clearinghouse can range from below $100 to several hundred dollars depending on the bells and whistles. Some clearinghouses also demand additional fees for each new medical care provider or account you add.

2. A medical billing software

As mentioned earlier, the most expensive part of setting up your in-house company is medical billing software.

If you want some specific features of your choice and a billing software specifically made for your business, you can get a bespoke medical billing software developed for you.

Otherwise, billing software can range anywhere from a couple of hundred dollars to $10,000. While some are basic, others include features like marketing plans and lead generation.

Fortunately, many software companies provide free trials. Give your top choices a try before investing heavily in the most critical part of your business.

3. Other equipment & forms

There are a few other necessities you will need to have:

• A reliable computer with an internet connection
• A phone, printer, and fax machine
• Medical insurance forms
• Reference books (ICD-10, CPT, and HCPCS Expert 2000 coding books)
• A productive work environment

If you gain a plethora of clients, you can also use invoicing software to remain organized. If you run a high-volume business, electronic billing may be of use to you.

C. Choosing a billing software

As mentioned earlier, medical billing software pricing can vary widely based on software features and the size of your business.

Here are some of the most popular billing software of 2021:

A cloud-based medical practice management system that includes billing features like medical claims processing, claims scrubbing, code & charge entry, health insurance verification, and more.

• Solo Practice: $499 per month
• Mid-Sized: $4,990 per month
• Large Practice: $12,425 per month

Capterra rating: 4/5

A cloud-based medical practice management software with built-in billing and EHR capabilities. The billing feature is integrated with Xero accounting software and includes payment processing, invoice generation, claims management, and financial reporting tools. 

• Solo Practice: $23 – $93 per month
• Mid-Sized: $102 – $139 per month
• Large Practice: $150 – $270 per month

Capterra rating : 5/5

CareCloud EHR

A cloud-based medical practice management system with an integrated billing app that features claims processing, claims scrubbing, code & charge entry, health insurance verification, invoice history, and more.

• Solo Practice: $349 – $649 per month
• Mid-Sized: $3,490 – $6,290 per month
• Large Practice: $8,725 – $15,725

A web and mobile-available software that manages patient billing through cloud technology. Billing features include claims processing & scrubbing, health insurance verification, dunning management, and more.

• Solo Practice: $300 per month
• Mid-Sized: $3,000 per month
• Large Practice: $7,500 per month

CollaborateMD

A simple, efficient, and affordable cloud-based medical practice management and medical billing solution for your third-party billing needs. Billing features include claims processing, claims scrubbing, health insurance verification, remittance advice, and more.

• Solo Practice: $165 – $345 per month
• Mid-Sized: $1,650 – $3,450
• Large Practice: $4,125 – $8,625

Note – Pricing for billers and coders may vary based on the number of users, features, and number of clients.

For more options, check out Capterra’s list of the best medical billing software .

D. How to charge clients

There are a few ways to charge your clients in the medical billing process:

A percentage of collections –   The most popular method, as it often lends the highest return and revenue.

A per-claim fee –   This method includes charging a set fee for each claim that is submitted, whether paid or unpaid.

An hourly fee – Hourly fees are useful for medical billing businesses that provide complementary services. The current average hourly rate of a medical billing clerk employee in the U.S. is $18/hour . As an independent contractor, you will likely earn more.

The option you choose depends on the healthcare providers you partner with, as well as the billing and medical coding you perform.

Tracking billing hours

If you opt for charging hourly fees, try using Time Doctor to track your working hours.

If you have a team, Time Doctor follows the websites that they visit while clocked-in and will send reminders when it thinks they are visiting a site that is unrelated to work.

E. Income potential

As with all businesses, the income you earn largely depends on the success and size of the company. Whether you earn $20k or $100k per year will depend on the care providers you partner up with, as well as if you specialize yourself and run an efficient business.

F. Specialize yourself

Specializing yourself in one or two fields of healthcare can significantly benefit your knowledge and income in this business.

For one, you will eliminate the number of billing codes you need to use regularly. More importantly, much of your credibility as a medical billing clerk will depend on your knowledge of the industry and medical services at hand.

The more you speak their language, the more care providers will hire you for outsourced billing. Here are a few areas of specialty to consider:

• Cardiologists
• Veterinarians
• Chiropractors
• Family practitioners
• Psychiatrists

Note – A healthcare provider that charges a high copay doesn’t necessarily mean more income for you. Doctors with a low copay often require a higher patient billing volume to succeed, sending more insurance claims your way.

G. Construct a strong marketing plan

Your business, like all businesses, won’t grow itself.

Medical billing is a heavily saturated industry. You must create a rigorous marketing plan if you want to hit the ground running.

Getting your first client can be the biggest challenge. You have a head start if you have experience in the medical care industry and have maintained positive relations with healthcare providers in the past.

One of the best ways to market yourself in the medical billing industry is through in-person visits where you drop off marketing material and create relationships with providers.

Moreover, creating a website and business cards or vCards for your service, as well as offering incentives will stimulate growth and lead opportunities.

While generating leads, consider providing these free incentives to lure in prospects:

• An analysis of the benefits of outsourcing billing services for their specific medical practice.
• A code review. Analyze which codes are out-of-date or incorrect, and estimate the amount of lost revenue that has resulted from these codes.
• A free claim process and an estimate of the time your services saved them.
• An analysis of their Superbill and accounts receivable, and an estimate of why some of their medical claims are rejected.
• A consultation to evaluate if they comply with HIPAA and OIG.

If you struggle to bag your first client, you can also offer discounts and other incentives for some time. For instance, you could offer twenty percent off for the first month of your services.

Whatever route of marketing you choose to pursue, create a strategic plan ahead of time so that you are ready to go when it’s time to grow your business.

H. Network & grow

Knowing the right people can always help achieve your goals.

What’s more?

Word of mouth referrals and positive personal testimonies are fantastic for your business.

Embed yourself in the network of medical professionals and make a name for your business. Involving yourself can be done through joining professional organizations, getting in touch with your own family’s medical providers, and working in a medical office that allows you to come in contact with a variety of providers.

Expanding your network will increase your chances of obtaining new clients and growing your business.

I. Bonus: An alternative business opportunity

There is an alternative option for starting your own third-party billing business that can be fruitful if done well.

What is it?

Buying an already existing medical business.

Purchasing an already existing billing company can be done privately or through a broker and can help you avoid a few startup fees and client roundups.

Acquiring a successful business can also lead to high returns with less initial work.

However, before acquiring an already-existing business, ask a few critical questions:

• How many clients does the company have?
• How long have they been customers?
• Are they under contract?
• What method of payment do they use?
• What prices do they pay?

Establishing your own billing business can be both lucrative and enjoyable.

Keep in mind that a work-at-home business requires commitment, dedication, and organization. We at Time Doctor would know. Our team is made up of 80+ remote workers!

For tips on how to be more productive in your remote work, check out the Top 10 secrets to maximize remote work productivity .

With that said, there are numerous benefits to being your boss, including a flexible schedule and the freedom to make your own business decisions.

Furthermore, running a medical billing service out of your home avoids overhead costs and requires little capital to establish.

When done well, a medical billing business can give you the steady income and flexible schedule you have been desperately seeking!

Book a free demo of Time Doctor

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Is medical billing outsourcing the best option for my medical practice?

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Medical Billing Business Plan Template

Written by Dave Lavinsky

Medical Billing Business Plan

You’ve come to the right place to create your Medical Billing business plan.

We have helped over 1,000 entrepreneurs and business owners create business plans and many have used them to start or grow their Medical Billing businesses.

Below is a template to help you create each section of your Medical Billing business plan.

Executive Summary

Business overview.

TriMountain Medical Billing is a startup business located in Denver, Colorado. The company is founded by two friends, Nancy Linninger and Lacy Patton, both of whom have over 10 years of experience in the medical billing industry. They were team members in a large medical billing firm that was part of a national chain business and each has garnered a reputation for accuracy, excellent customer service, and offering the extra effort sometimes needed to assist in complex billing circumstances. Both Nancy and Lacy have been award recipients by associations for outstanding service to physician groups and individual physicians within their sphere of service and both partners have been awarded for their consistent care and devotion to “getting the job done correctly.”

With their outstanding reputations to carry their new business forward, the partners are talking with former customers about joining their new business and they are also gathering information to join industry events and citywide associations that will help spread the word of their new business.

Product Offering

The following are the services that TriMountain Medical Billing will provide:

• End-to-end revenue cycle management services
• Patient data entry
• Insurance verification
• Claim submission
• Denial management
• Payment posting
• Day to day client management

Customer Focus

TriMountain Medical Billing will primarily target the offices of physicians and various other healthcare providers. Secondarily, they will target the specialty and often unique billing needs of offices of cardiology, orthopedics, dermatology, and radiology.

Management Team

TriMountain Medical Billing is a startup company formed as a legal partnership. The partners, Nancy Linninger and Lacy Patton, carry an extensive background portfolio of accomplishments and awards within the medical billing industry. They are each known for stellar performance in complex medical billing issues and for their outstanding customer service in each medical billing case received. The partners have over 10 years of billing experience combined and have already determined from former clients that they will move to the new company as soon as it is open for business.

Nancy Linninger holds a bachelor of arts degree in Accounting, which she acquired from the University of Colorado. Her medical billing experience began before she attended the university, having started working at a small medical billing office while she was in high school.

Lacy Patton holds a bachelor of arts degree in Business, which she acquired from the College of the Redwoods. Her medical billing experience consisted of six years at her former employment, where as a Medical Billing Clerk III, she learned all aspects of medical billing, along with customer service and management of the newest software available for use in medical billing.

Success Factors

TriMountain Medical Billing will be able to achieve success by offering the following competitive advantages:

• Friendly, knowledgeable, and highly-qualified team of TriMountain Medical Billing.
• Exceptional customer service is the highest priority for the team at TriMountain Medical Billing and the staff will be trained to meet or exceed this service level.
• All billing is open to communication and discussion, with mediation set for any disputes that may arise. The phrase, “The customer is always right,” is one that TriMountain Medical Billing takes seriously.
• Comprehensive menu of services and an accurate and complete record and descriptions for the records that are delivered to the [physician groups every month.
• TriMountain Medical Billing offers the best pricing in the city. Their pricing structure is the most cost-effective when compared to the competition.

Financial Highlights

TriMountain Medical Billing is seeking $200,000 in debt financing to launch its TriMountain Medical Billing offices. The funding will be dedicated toward securing the office space and purchasing office equipment and supplies. Funding will also be dedicated toward three months of overhead costs to include payroll of the staff, rent, and marketing costs for the print ads and marketing costs. The breakout of the funding is below:

• Office space build-out: $20,000
• Office equipment, supplies, and materials: $10,000
• Three months of overhead expenses (payroll, rent, utilities): $150,000
• Marketing costs: $10,000
• Working capital: $10,000

The following graph outlines the financial projections for TriMountain Medical Billing.

Company Overview

Who is trimountain medical billing.

TriMountain Medical Billing is a newly established, full-service medical billing business in Denver, Colorado. TriMountain Medical Billing will be the most reliable, cost-effective, and efficient choice for healthcare providers in Denver and the surrounding communities. TriMountain Medical Billing will provide a comprehensive menu of medical billing services for any physicians group or clinic to utilize. Their full-service approach includes a comprehensive array of services and the latest software to support them.

  TriMountain Medical Billing will be able to manage every client with speed and accuracy. The team of professionals are highly qualified and experienced in medical billing and, more importantly, in customer service that is superior to all others. TriMountain Medical Billing removes all the headaches and issues of medical billing and ensures a reliable, fast and efficient medical billing system will support every client’s customer service needs.

TriMountain Medical Billing History

Since incorporation, TriMountain Medical Billing has achieved the following milestones:

• Registered TriMountain Medical Billing, LLC to transact business in the state of Colorado.
• Has a contract in place for a 10,000 square foot office at one of the midtown buildings
• Reached out to numerous contacts to include TriMountain Medical Billing as new partners in billing.
• Began recruiting a staff of two and three office personnel to work at TriMountain Medical Billing.

TriMountain Medical Billing Services

The following will be the services TriMountain Medical Billing will provide:

Industry Analysis

The medical billing industry is expected to surge in growth over the next five years to over $24 billion. The fast rate of growth will be driven by the increasing demand to outsource billing from healthcare providers to medical billing companies who specialize in services and accuracy. This allows practitioners to focus on patients rather than on billing. Additionally, the growth in the industry will be exponentially fast as a result of governmental programs and policies that are currently in motion to change. More services by medical billing companies, especially with the use of AI, will be required.

Costs will likely be reduced as AI is integrated into medical billing systems and input becomes less timely, which will lower costs. Additionally, costs will be reduced as software and other formats and systems continue to evolve to make time-consuming tasks easier and more efficient for medical billing processes and their requirements.

Customer Analysis

Demographic profile of target market.

TriMountain Medical Billing will target the offices of physicians and various other healthcare providers. Secondarily, they will target the specialty and often unique billing needs of offices of cardiology, orthopedics, dermatology, and radiology.

Customer Segmentation

TriMountain Medical Billing will primarily target the following customer profiles:

• Physician offices
• Medical groups that service physicians
• Specialty medical groups, such as cardiology, orthopedics, dermatology and radiology, each of which has unique medical billing requirements

Competitive Analysis

Direct and indirect competitors.

TriMountain Medical Billing will face competition from other companies with similar business profiles. A description of each competitor company is below.

MedBill of Colorado

MedBill of Colorado is owned by a physician’s group located in Provo, Utah. The focus of the medical billing company is on medical coding and the documentation that must accurately accompany coding. MedBill of Colorado offers physician groups an assurance that medical records are coded accurately and in compliance with coding guidelines, which is crucial for accurate billing and reimbursement.

The physician’s group that owns MedBill of Colorado is currently seeking a sizable loan in order to obtain software and AI-assisted programs that will speed the billing process for certain physician groups and individual clients. The cutting-edge technology, when placed into use, will reduce the time and effort spent in accurately coding.

Colorado Medical Claim Services

The Colorado Medical Claim Services group has a primary focus on claims submission, tracking, and follow-up. They work to speed the processing of claims, which ensure physician groups receive timely payments. They also work to accurately reduce claim denials, which removes the time-consuming tasks from the physician’s group. Colorado Medical Claim Services also works to maximize reimbursements for healthcare providers by cross-checking and verifying expenditures and allowable reimbursements.

Colorado Medical Claim Services was started in 2019 by a physician, Neil Baker, who saw the opportunity to garner profit in a fast-rising area of medical billing. The coding portion of the service is just the beginning for the Colorado Medical Claim Services business.

Denver Doctors Collection Group

Denver Doctors Collection Group has a primary concentration on accurate patient billing and the collection due to doctors as a result of those billings. The six employees within the company handle patient statements, payment plans, and collections to ensure that patients pay their bills promptly. If patients are unable to pay, the Denver Doctors Collection Group sets up efficient and effective repayment programs that ensure doctors are able to maintain a reasonable cash flow even as repayment plans often take a longer period of time to collect. The owner of the company, Dan Dorsee, started the company in 1999 and has maintained the company through sustained growth within this segment of medical billing.

Competitive Advantage

TriMountain Medical Billing will be able to offer the following advantages over their competition:

Marketing Plan

Brand & value proposition.

TriMountain Medical Billing will offer the unique value proposition to its clientele:

• Highly-qualified team of skilled employees who believe customer service is the highest priority for the team at TriMountain Medical Billing.
• The staff of TriMountain Medical Billing are fully trained to meet and exceed the requirements of each physician group in accuracy and reliability of their work.
• Billing questions are always open to communication and discussion, with mediation set for any disputes that may arise. The phrase, “The customer is always right,” is one that TriMountain Medical Billing takes seriously.
• Compared to other medical billing companies in the area, TriMountain Medical Billing offers comprehensive services at lower rates than other providers.

Promotions Strategy

The promotions strategy for TriMountain Medical Billing is as follows:

Word of Mouth/Referrals

Nancy Linninger and Tracy Patton have built up an extensive list of contacts over the years by providing exceptional service and expertise to former medical billing clients. The contacts and clients will follow them to their new company and help spread the word of TriMountain Medical Billing.

Professional Associations and Networking

National trade shows and regional networking events will be attended and the new company will be offered in sales and business development efforts. Physician conferences and medical coding conferences will be attended, as well, with similar goals.

Print Advertising

Printed brochures will be offered to all physician groups and clinics within the Denver region. Discounted pricing for one-year contracts will be offered during the first month of business. From time to time, additional messaging will be sent to physician groups to consider the services of TriMountain Medical Billing.

Website/SEO Marketing

TriMountain Medical Billing will fully utilize their website. The website will be well organized, informative, and list all the services that TriMountain Medical Billing provides. The website will also list their contact information. The website will engage in SEO marketing tactics so that anytime someone types in the Google or Bing search engine “medical billing company” or “medical billing near me,” TriMountain Medical Billing will be listed at the top of the search results.

The pricing of TriMountain Medical Billing will be moderate and on par with competitors so customers feel they receive excellent value when purchasing their services.

Operations Plan

The following will be the operations plan for TriMountain Medical Billing. Operation Functions:

• Nancy Linninger will be the owner and president of the company. She will oversee all business development and manage the accounting needs of the company.
• Nancy Linninger will seek investor funding to fully develop two additional locations of the company within outlying regions of Denver in areas of fastest population growth.
• Tracy Patton will direct programs and oversee client relations with resolution or conflict negotiation needs. She will also manage non-payment issues and repayment plans.
• Tracy Patton will be the owner and vice president of the company. She will assume the role of administrative director, overseeing all staff and operations within the company. She will also direct the software programs and other innovations within the company.
• Daniel Peterson will be the senior manager of billing processes. He will work directly with staff to train, conduct checks, supervise accuracy and oversee client relations.

Milestones:

TriMountain Medical Billing will have the following milestones completed in the next six months.

• 5/1/202X – Finalize contract to lease office space
• 5/15/202X – Finalize personnel and staff employment contracts for the TriMountain Medical Billing
• 6/1/202X – Finalize contracts for TriMountain Medical Billing clients
• 6/15/202X – Begin networking at industry events
• 6/22/202X – Begin moving into the TriMountain Medical Billing office
• 7/1/202X – TriMountain Medical Billing opens its doors for business

Daniel Peterson has been recruited as the senior manager of billing processes. He will work directly with staff to train, conduct checks, supervise accuracy and oversee client relations.

Financial Plan

Key revenue & costs.

The revenue drivers for TriMountain Medical Billing are the fees they will charge to physicians and specialty medical groups for their services. .

The cost drivers will be the overhead costs required in order to staff at TriMountain Medical Billing. The expenses will be the payroll cost, rent, utilities, office supplies, and marketing materials.

Funding Requirements and Use of Funds

Key assumptions.

The following outlines the key assumptions required in order to achieve the revenue and cost numbers in the financials and in order to pay off the startup business loan.

• Number of clients per Month: 100
• Average revenue per Month: $150,500
• Office Lease per Year: $100,000

Financial Projections

Income statement, balance sheet, cash flow statement, medical billing business plan faqs, what is a medical billing business plan.

A medical billing business plan is a plan to start and/or grow your medical billing business. Among other things, it outlines your business concept, identifies your target customers, presents your marketing plan and details your financial projections.

You can easily complete your Medical Billing business plan using our Medical Billing Business Plan Template here .

What are the Main Types of Medical Billing Businesses? 

There are a number of different kinds of medical billing businesses , some examples include: Light, Full Service, and Boutique.

How Do You Get Funding for Your Medical Billing Business Plan?

Medical Billing businesses are often funded through small business loans. Personal savings, credit card financing and angel investors are also popular forms of funding.

What are the Steps To Start a Medical Billing Business?

Starting a medical billing business can be an exciting endeavor. Having a clear roadmap of the steps to start a business will help you stay focused on your goals and get started faster.

• Develop A Medical Billing Business Plan - The first step in starting a business is to create a detailed medical billing business plan that outlines all aspects of the venture. This should include potential market size and target customers, the services or products you will offer, pricing strategies and a detailed financial forecast.  
• Choose Your Legal Structure - It's important to select an appropriate legal entity for your medical billing business. This could be a limited liability company (LLC), corporation, partnership, or sole proprietorship. Each type has its own benefits and drawbacks so it’s important to do research and choose wisely so that your medical billing business is in compliance with local laws.
• Register Your Medical Billing Business - Once you have chosen a legal structure, the next step is to register your medical billing business with the government or state where you’re operating from. This includes obtaining licenses and permits as required by federal, state, and local laws. 
• Identify Financing Options - It’s likely that you’ll need some capital to start your medical billing business, so take some time to identify what financing options are available such as bank loans, investor funding, grants, or crowdfunding platforms. 
• Choose a Location - Whether you plan on operating out of a physical location or not, you should always have an idea of where you’ll be based should it become necessary in the future as well as what kind of space would be suitable for your operations. 
• Hire Employees - There are several ways to find qualified employees including job boards like LinkedIn or Indeed as well as hiring agencies if needed – depending on what type of employees you need it might also be more effective to reach out directly through networking events. 
• Acquire Necessary Medical Billing Equipment & Supplies - In order to start your medical billing business, you'll need to purchase all of the necessary equipment and supplies to run a successful operation. 
• Market & Promote Your Business - Once you have all the necessary pieces in place, it’s time to start promoting and marketing your medical billing business. This includes creating a website, utilizing social media platforms like Facebook or Twitter, and having an effective Search Engine Optimization (SEO) strategy. You should also consider traditional marketing techniques such as radio or print advertising. 

Learn more about how to start a successful medical billing business:

• How to Start a Medical Billing Company

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Medical Billing Business

Back to All Business Ideas

How to Start a Medical Billing Business

Written by: Carolyn Young

Carolyn Young is a business writer who focuses on entrepreneurial concepts and the business formation. She has over 25 years of experience in business roles, and has authored several entrepreneurship textbooks.

Edited by: Mark Stewart

Mark Stewart is the in-house Certified Public Accountant, an accomplished author and financial media specialist.

Published on April 14, 2023 Updated on March 13, 2024

Investment range

$1,900 - $7,800

Revenue potential

$50,400 - $360,000 p.a.

Time to build

Profit potential

$45,360 - $144,000 p.a.

Industry trend

Medical billing is complicated, largely thanks to the Health Insurance Portability and Accountability Act (HIPAA) and its many regulations. Yet this is why most medical practices outsource billing, making medical billing services a fast-growing $5 billion US industry.

If you have medical billing certification and experience, or even if you don’t, you could start a medical billing company and help ensure patient privacy while making a very good living. 

But in addition to medical billing knowledge, you’ll need some business savvy. Fortunately, this step-by-step guide lays out all the information you need to start a successful medical billing business. 

Step by Step Business prioritizes real-life experience. Our Entrepreneur Spotlight Series features interviews with diverse industry leaders, offering direct insights to readers.

If you’re venturing into the world of medical billing or insurance advocacy, this interview with Adria Gross offers invaluable insights .

Looking to register your business? A limited liability company (LLC) is the best legal structure for new businesses because it is fast and simple.

Form your business immediately using ZenBusiness LLC formation service or hire one of the Best LLC Services .

Step 1: Decide if the Business Is Right for You

Pros and cons.

• Growing market
• Provide a valuable healthcare service
• Low startup costs
• Education and certification required
• Competitive industry

Medical billing industry trends

Industry size and growth.

• Industry size and past growth – The U.S. medical billing outsourcing industry was worth $4.7 billion in 2021 after modest growth the previous year.(( https://www.grandviewresearch.com/industry-analysis/us-medical-billing-outsourcing-market ))
• Growth forecast – The U.S. medical billing outsourcing industry is projected to grow an impressive 11.34% annually through 2030. 

Trends and challenges

• Technological advancements are automating many tasks in medical billing, boosting efficiency and enabling billing companies to handle more clients.
• Cloud-based Software as a Service (SaaS) options are reducing hardware costs for medical billing businesses.
• Medical billing and privacy laws are updated often and medical billing firms need to stay up-to-date with continuing education.
• Medical practices often fail to provide the correct information to billing companies, causing challenges and delays. 

Demand hotspots

• Most popular states – The most popular states for medical coders are Nevada, New Jersey, and Delaware. (( https://www.zippia.com/medical-coder-jobs/best-states/#maine ))
• Least popular states – The least popular states for medical coders are New Hampshire, Oklahoma, and Iowa.

What kind of people work in medical billing?

• Gender – 87% of medical coders are female, while 13% are male. (( https://www.zippia.com/medical-coder-jobs/demographics/ ))
• Average level of education – The average medical coder has an associate’s degree.
• Average age – The average medical coder in the US is 45.5 years old.

How much does it cost to start a medical billing business?

Startup costs for a medical billing business range from $2,000 to $8,000. Costs on the low end include medical billing software and a computer system, and assume that you already have medical billing certification. The higher end includes training and certification costs.

Learn more about training and certification at the American Medical Billing Association . 

You’ll need a handful of items to successfully launch your medical billing business, including: 

• Computer system
• Medical billing software

How much can you earn from a medical billing business?

Generally, medical billers charge 7% to 10% of monthly collections. These calculations assume an initial charge of 7% and a profit margin of about 90%.

In your first year or two, you could work from home and collect $60,000 per month, bringing in more than $50,000 in annual revenue. This would mean more than $45,000 in profit, assuming that 90% margin. 

As you gain traction, you could increase collections to $300,000 per month and increase your rate to 10%. At this stage, you might have an office and staff, reducing your margin to around 40%. With annual revenue of $360,000, you’d make a tidy profit of $144,000.

What barriers to entry are there?

There are a few barriers to entry for a medical billing business. Your biggest challenges will be:

• Getting the training and certifications needed
• Breaking into a competitive market

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Step 2: hone your idea.

Now that you know what’s involved in starting a medical billing business, it’s a good idea to hone your concept in preparation for entering a competitive market. 

Market research could give you the upper hand even if you’ve got the perfect product. Conducting robust market research is crucial, as it will help you better understand your customers, your competitors, and the broader business landscape.

Analyze your competitors 

Research medical billing businesses in your area to examine their services, price points, and customer reviews.

• Make a list of medical billing companies that offer similar services. 
• Review your competitors’ services – their features, pricing, and marketing strategies. This should give you information about what kind of medical practices they target. 
• Check their reviews and ratings on Google, Yelp, and Facebook to get an idea of what their customers like and dislike.
• Identify your competitors’ strengths and weaknesses. You want to capitalize on their weaknesses. For example, maybe your competitors don’t work with small practices, and you could make that your niche market. 

This should identify areas where you can strengthen your business and gain a competitive edge to make better business decisions.

Why? Identify an opportunity

You’re looking for a market gap to fill. For instance, maybe the local market is missing a medical billing company that specializes in veterinary practices or has a streamlined, tech-friendly billing processes. 

You might consider targeting a niche, such as dental practices .

This could jumpstart your word-of-mouth marketing and attract clients right away. 

What? Determine your products or services

Your medical billing services are pretty straightforward. You’ll work with insurance carriers and patients to collect monies owed. 

How much should you charge for medical billing?

Typical fees are between 7% and 10% of collections, but you’ll also want to consider your costs when setting your rates. 

Once you know your costs, use this Step By Step profit margin calculator to determine your markup and final price points. Remember, the prices you use at launch should be subject to change if warranted by the market.

Who? Identify your target market

Your target market will be medical practices. You might specialize in certain types of practices or work with a variety of clients. You can find medical practice managers on LinkedIn, but your best bet may be calling medical practices directly. 

Where? Choose your business premises

In the early stages, you may want to run your business from home to keep costs low. But as your business grows, you’ll likely need to hire workers for various roles and may need to rent out an office. You can find commercial space to rent in your area on sites such as Craigslist , Crexi , and Instant Offices .

When choosing a commercial space, you may want to follow these rules of thumb:

• Central location accessible via public transport
• Ventilated and spacious, with good natural light
• Flexible lease that can be extended as your business grows
• Ready-to-use space with no major renovations or repairs needed

Step 3: Brainstorm a Medical Billing Company Name

Your business name is your business identity, so choose one that encapsulates your objectives, services, and mission in just a few words. You probably want a name that’s short and easy to remember, since much of your business, and your initial business in particular, will come from word-of-mouth referrals.

Here are some ideas for brainstorming your business name:

• Short, unique, and catchy names tend to stand out
• Names that are easy to say and spell tend to do better 
• Name should be relevant to your product or service offerings
• Ask around — family, friends, colleagues, social media — for suggestions
• Including keywords, such as “medical billing” or “medical billing and coding”, boosts SEO
• Name should allow for expansion, for ex: “HealthCharge Network” over “Dental Bill Solutions”
• Avoid location-based names that might hinder future expansion
• Use online tools like the Step by Step Business Name Generator . Just type in a few keywords and hit “generate” and you’ll have dozens of suggestions at your fingertips.

Once you’ve got a list of potential names, visit the website of the US Patent and Trademark Office to make sure they are available for registration and check the availability of related domain names using our Domain Name Search tool. Using “.com” or “.org” sharply increases credibility, so it’s best to focus on these. 

Find a Domain

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Finally, make your choice among the names that pass this screening and go ahead and reserve your business name with your state, start the trademark registration process, and complete your domain registration and social media account creation. 

Your business name is one of the key differentiators that sets your business apart. Once you pick a name, reserve it and start with the branding, it’s hard to switch to a new name. So be sure to carefully consider your choice before moving forward. 

Step 4: Create a Medical Billing Business Plan

Every business needs a plan. This will function as a guidebook to take your startup through the launch process and maintain focus on your key goals. A business plan also enables potential partners and investors to better understand your company and its vision:

• Executive Summary: Summarize the key points of your business plan, including your target market, unique value proposition, and financial projections.
• Business Overview: Provide an overview of your medical billing company, its location, the healthcare providers you serve, and the specific medical billing services you offer.
• Product and Services: Detail the medical billing services your company provides, such as claim processing, revenue cycle management, denial management, and electronic health record integration.
• Market Analysis: Analyze the healthcare industry and the demand for medical billing services, considering factors like healthcare reforms, insurance trends, and the potential client base in your region.
• Competitive Analysis: Identify and evaluate competitors in the medical billing industry, emphasizing your company’s strengths, such as specialized expertise or advanced technology solutions.
• Sales and Marketing: Explain your strategies for acquiring clients, including outreach to healthcare providers, digital marketing, partnerships with medical practices, and referral programs.
• Management Team: Introduce key members of your team, emphasizing their qualifications, experience in medical billing, and any relevant certifications.
• Operations Plan: Describe the day-to-day operations of your medical billing business, covering areas like claims processing, compliance with healthcare regulations, software and technology usage, and customer support.
• Financial Plan: Present financial projections, including revenue forecasts, pricing strategies, expense budgets, and cash flow analysis, to demonstrate the financial viability and growth potential of your business.
• Appendix: Include any supplementary materials, such as client testimonials, case studies, or compliance documentation, to support your business plan.

If you’ve never created a business plan, it can be an intimidating task. You might consider hiring a business plan specialist to create a top-notch business plan for you.

Step 5: Register Your Business

Registering your business is an absolutely crucial step — it’s the prerequisite to paying taxes, raising capital, opening a bank account, and other guideposts on the road to getting a business up and running.

Plus, registration is exciting because it makes the entire process official. Once it’s complete, you’ll have your own business! 

Choose where to register your company

Your business location is important because it can affect taxes, legal requirements, and revenue. Most people will register their business in the state where they live, but if you are planning to expand, you might consider looking elsewhere, as some states could offer real advantages when it comes to medical billing businesses. 

If you’re willing to move, you could really maximize your business! Keep in mind, it’s relatively easy to transfer your business to another state. 

Choose your business structure

Business entities come in several varieties, each with its pros and cons. The legal structure you choose for your medical billing business will shape your taxes, personal liability, and business registration requirements, so choose wisely. 

Here are the main options:

• Sole Proprietorship – The most common structure for small businesses makes no legal distinction between company and owner. All income goes to the owner, who’s also liable for any debts, losses, or liabilities incurred by the business. The owner pays taxes on business income on his or her personal tax return.
• General Partnership – Similar to a sole proprietorship, but for two or more people. Again, owners keep the profits and are liable for losses. The partners pay taxes on their share of business income on their personal tax returns.
• Limited Liability Company ( LLC ) – Combines the characteristics of corporations with those of sole proprietorships or partnerships. Again, the owners are not personally liable for debts.  Here’s how to form an LLC .
• C Corp – Under this structure, the business is a distinct legal entity and the owner or owners are not personally liable for its debts. Owners take profits through shareholder dividends, rather than directly. The corporation pays taxes, and owners pay taxes on their dividends, which is sometimes referred to as double taxation.  Read how to start a corporation here .
• S Corp – An S-Corporation refers to the tax classification of the business but is not a business entity. An S-Corp can be either a corporation or an LLC , which just need to elect to be an S-Corp for tax status. In an S-Corp, income is passed through directly to shareholders, who pay taxes on their share of business income on their personal tax returns.

We recommend that new business owners choose LLC as it offers liability protection and pass-through taxation while being simpler to form than a corporation. You can form an LLC in as little as five minutes using an online LLC formation service. They will check that your business name is available before filing, submit your articles of organization , and answer any questions you might have. 

Form Your LLC

Choose Your State

We recommend ZenBusiness as the Best LLC Service for 2024

Step 6: Register for Taxes

The final step before you’re able to pay taxes is getting an Employer Identification Number , or EIN. You can file for your EIN online or by mail or fax: visit the IRS website to learn more. Keep in mind, if you’ve chosen to be a sole proprietorship you can simply use your social security number as your EIN. 

Once you have your EIN, you’ll need to choose your tax year. Financially speaking, your business will operate in a calendar year (January–December) or a fiscal year, a 12-month period that can start in any month. This will determine your tax cycle, while your business structure will determine which taxes you’ll pay.

The IRS website also offers a tax-payers checklist , and taxes can be filed online.

It is important to consult an accountant or other professional to help you with your taxes to ensure you are completing them correctly.

Step 7: Fund your Business

Securing financing is your next step and there are plenty of ways to raise capital:

• Bank loans: This is the most common method but getting approved requires a rock-solid business plan and strong credit history.
• SBA-guaranteed loans: The Small Business Administration can act as guarantor, helping gain that elusive bank approval via an SBA-guaranteed loan .
• Government grants: A handful of financial assistance programs help fund entrepreneurs. Visit Grants.gov to learn which might work for you.
• Friends and Family: Reach out to friends and family to provide a business loan or investment in your concept. It’s a good idea to have legal advice when doing so because SEC regulations apply.
• Personal: Self-fund your business via your savings or the sale of property or other assets.

Bank and SBA loans are probably the best option, other than friends and family, for funding a medical billing business. You also may be able to obtain student loans for your training and certification.

Step 8: Apply for Medical Billing Business Licenses and Permits

Starting a medical billing business requires obtaining a number of licenses and permits from local, state, and federal governments.

Federal regulations, licenses, and permits associated with starting your business include doing business as (DBA), health licenses and permits from the Occupational Safety and Health Administration ( OSHA ), trademarks, copyrights, patents, and other intellectual properties, as well as industry-specific licenses and permits. 

You may also need state-level and local county or city-based licenses and permits. The license requirements and how to obtain them vary, so check the websites of your state, city, and county governments or contact the appropriate person to learn more. 

You could also check this SBA guide for your state’s requirements, but we recommend using MyCorporation’s Business License Compliance Package . They will research the exact forms you need for your business and state and provide them to ensure you’re fully compliant.

This is not a step to be taken lightly, as failing to comply with legal requirements can result in hefty penalties.

If you feel overwhelmed by this step or don’t know how to begin, it might be a good idea to hire a professional to help you check all the legal boxes.

Step 9: Open a Business Bank Account

Before you start making money, you’ll need a place to keep it, and that requires opening a bank account .

Keeping your business finances separate from your personal account makes it easy to file taxes and track your company’s income, so it’s worth doing even if you’re running your medical billing business as a sole proprietorship. Opening a business bank account is quite simple, and similar to opening a personal one. Most major banks offer accounts tailored for businesses — just inquire at your preferred bank to learn about their rates and features.

Banks vary in terms of offerings, so it’s a good idea to examine your options and select the best plan for you. Once you choose your bank, bring in your EIN (or Social Security Number if you decide on a sole proprietorship), articles of incorporation, and other legal documents and open your new account. 

Step 10: Get Business Insurance

Business insurance is an area that often gets overlooked yet it can be vital to your success as an entrepreneur. Insurance protects you from unexpected events that can have a devastating impact on your business.

Here are some types of insurance to consider:

• General liability: The most comprehensive type of insurance, acting as a catch-all for many business elements that require coverage. If you get just one kind of insurance, this is it. It even protects against bodily injury and property damage.
• Business Property: Provides coverage for your equipment and supplies.
• Equipment Breakdown Insurance: Covers the cost of replacing or repairing equipment that has broken due to mechanical issues.
• Worker’s compensation: Provides compensation to employees injured on the job.
• Property: Covers your physical space, whether it is a cart, storefront, or office.
• Commercial auto: Protection for your company-owned vehicle.
• Professional liability: Protects against claims from a client who says they suffered a loss due to an error or omission in your work.
• Business owner’s policy (BOP): This is an insurance plan that acts as an all-in-one insurance policy, a combination of the above insurance types.

Step 11: Prepare to Launch

As opening day nears, prepare for launch by reviewing and improving some key elements of your business. 

Essential software and tools

Being an entrepreneur often means wearing many hats, from marketing to sales to accounting, which can be overwhelming. Fortunately, many websites and digital tools are available to help simplify many business tasks.  

You may want to use industry-specific software, such as  RXNT or Kareo , to manage your billing, workflows, accounts receivables, and reporting.  

• Popular web-based accounting programs for smaller businesses include Quickbooks , Freshbooks , and Xero . 
• If you’re unfamiliar with basic accounting, you may want to hire a professional, especially as you begin. The consequences for filing incorrect tax documents can be harsh, so accuracy is crucial.

Create a website

Website development is crucial because your site is your online presence and needs to convince prospective clients of your expertise and professionalism. You can create your own website using services like WordPress, Wix, or Squarespace . This route is very affordable, but figuring out how to build a website can be time-consuming. If you lack tech-savvy, you can hire a web designer or developer to create a custom website for your business.

Your customers are unlikely to find your website, however, unless you follow Search Engine Optimization (SEO) practices. SEO will help your website appear closer to the top in relevant search results, a crucial element for increasing sales. 

Make sure that you optimize calls to action on your website. Experiment with text, color, size, and position of calls to action such as “Schedule Consultation Now”. This can sharply increase purchases.  

Here are some powerful marketing strategies for your future business:

• Targeted Educational Content: Develop informative content that educates healthcare providers on the complexities of medical billing, showcasing your expertise and positioning your business as a valuable resource in the field.
• Partnerships with Healthcare Consultants: Collaborate with healthcare consultants who can refer their clients to your services, leveraging their trust and expertise in the industry to build credibility for your medical billing business.
• Specialized Webinars and Workshops: Host webinars or workshops focusing on specific medical billing challenges or updates, attracting healthcare professionals seeking insights and solutions while establishing your business as an authority in the niche.
• Social Proof and Testimonials: Collect and showcase success stories from satisfied clients, using them as social proof on your marketing materials to build trust and demonstrate the effectiveness of your medical billing services.
• Leverage Local Publications: Feature your business in local healthcare publications or community newsletters, reaching out to nearby medical practices and clinics to increase your visibility within the local healthcare ecosystem.
• Targeted Direct Mail Campaigns: Develop targeted direct mail campaigns to reach healthcare providers in your area, emphasizing the cost-effectiveness and efficiency of your medical billing services.
• Engage in Online Forums and Groups: Participate in online forums and groups where healthcare professionals discuss industry challenges and solutions, providing insightful contributions that position your business as a knowledgeable and supportive partner.
• Utilize SEO for Niche Keywords: Optimize your online content for niche keywords related to medical billing challenges and solutions, ensuring that your business appears prominently in search engine results for relevant queries.
• Referral Programs for Clients and Partners: Implement referral programs that reward both existing clients and healthcare partners for referring new business to your medical billing services, creating a mutually beneficial network.
• Attend Healthcare Conferences: Actively participate in healthcare conferences and trade shows, where you can network with potential clients and showcase the benefits of your medical billing services through engaging presentations or booth displays.

Focus on USPs

Unique selling propositions, or USPs, are the characteristics of a product or service that sets it apart from the competition. Customers today are inundated with buying options, so you’ll have a real advantage if they are able to quickly grasp how your medical billing business meets their needs or wishes. It’s wise to do all you can to ensure your USPs stand out on your website and in your marketing and promotional materials, stimulating buyer desire. 

Global pizza chain Domino’s is renowned for its USP: “Hot pizza in 30 minutes or less, guaranteed.” Signature USPs for your medical billing business could be: 

• Streamlined collection to get your practice paid fast
• Medical billing and coding designed for cardiology practices
• Lowest medical billing rates in town

You may not like to network or use personal connections for business gain. But your personal and professional networks likely offer considerable untapped business potential. Maybe that Facebook friend you met in college is now running a medical billing business, or a LinkedIn contact of yours is connected to dozens of potential clients. Maybe your cousin or neighbor has been working in medical billing for years and can offer invaluable insight and industry connections. 

The possibilities are endless, so it’s a good idea to review your personal and professional networks and reach out to those with possible links to or interest in medical billing. You’ll probably generate new customers or find companies with which you could establish a partnership. 

Step 12: Build Your Team

If you’re starting out small from a home office, you may not need any employees. But as your business grows, you will likely need workers to fill various roles. Potential positions for a medical billing business include:

• Medical Billers and Coders – assist with medical billing and coding
• Sales Reps – call on medical practices, make sales
• Marketing Lead – create and implement marketing strategies
• General Manager – scheduling, accounting

At some point, you may need to hire all of these positions or simply a few, depending on the size and needs of your business. You might also hire multiple workers for a single role or a single worker for multiple roles, again depending on need. 

Free-of-charge methods to recruit employees include posting ads on popular platforms such as LinkedIn, Facebook, or Jobs.com. You might also consider a premium recruitment option, such as advertising on Indeed , Glassdoor , or ZipRecruiter . Further, if you have the resources, you could consider hiring a recruitment agency to help you find talent. 

Step 13: Run a Medical Billing Business – Start Making Money!

If you’re experienced in medical billing, or if you want to learn, now’s a great time to get in on the action, as the industry is booming. You’d be providing an invaluable service while making a good living at the same time. Once you’re certified, you’d just need a computer and software and off you’ll go! 

You’ve now got some real business knowledge, so it’s time to start your entrepreneurial journey into medical billing. 

• Medical Billing Business FAQs

Medical billing can be quite profitable. The more you collect for your clients, the more you make. It is, however, a competitive industry and you need to be a good sales person to acquire clients.

Since so much is done digitally, you’re not limited by geography, so there’s really no limit to how much your business could grow. You’ll just need to grow your team of certified medical billers over time.

Medical billing companies provide billing and collection services for medical practices. They make a percentage of the monies collected, usually 7–10%.

You could start a medical billing business on a small scale as a side hustle. Your regular job would probably have to allow flexible hours to make sure you can handle billing issues as they arise.

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• Decide if the Business Is Right for You
• Hone Your Idea
• Brainstorm a Medical Billing Company Name
• Create a Medical Billing Business Plan
• Register Your Business
• Register for Taxes
• Fund your Business
• Apply for Medical Billing Business Licenses and Permits
• Open a Business Bank Account
• Get Business Insurance
• Prepare to Launch
• Build Your Team
• Run a Medical Billing Business - Start Making Money!

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Medical Billing Business Plan

High demand, low startup costs, and a recurring revenue model make starting a medical billing business a lucrative and rewarding profession.

Anyone can start a new business, but you need a detailed business plan when it comes to raising funding, applying for loans, and scaling it like a pro!

Need help writing a business plan for your medical billing business? You’re at the right place. Our medical billing business plan template will help you get started.

Free Business Plan Template

Download our free business plan template now and pave the way to success. Let’s turn your vision into an actionable strategy!

• Fill in the blanks – Outline
• Financial Tables

How to Write A Medical Billing Business Plan?

Writing a medical billing business plan is a crucial step toward the success of your business. Here are the key steps to consider when writing a business plan:

1. Executive Summary

An executive summary is the first section planned to offer an overview of the entire business plan. However, it is written after the entire business plan is ready and summarizes each section of your plan.

Here are a few key components to include in your executive summary:

Introduce your Business:

Start your executive summary by briefly introducing your business to your readers.

Market Opportunity:

Medical billing services:.

Highlight the medical billing services you offer your clients. The USPs and differentiators you offer are always a plus.

Marketing & Sales Strategies:

Financial highlights:, call to action:.

Ensure your executive summary is clear, concise, easy to understand, and jargon-free.

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2. Business Overview

The business overview section of your business plan offers detailed information about your company. The details you add will depend on how important they are to your business. Yet, business name, location, business history, and future goals are some of the foundational elements you must consider adding to this section:

Business Description:

Describe your business in this section by providing all the basic information:

Describe what kind of medical billing company you run and the name of it. You may specialize in one of the following medical billing businesses:

• Third-party medical billing
• Medical coding services
• Medical billing software companies
• Medical billing consulting services
• Specialty-specific medical billing business
• Describe the legal structure of your medical billing company, whether it is a sole proprietorship, LLC, partnership, or others.
• Explain where your business is located and why you selected the place.

Mission Statement:

Business history:.

If you’re an established medical billing service provider, briefly describe your business history, like—when it was founded, how it evolved over time, etc.

Future Goals

This section should provide a thorough understanding of your business, its history, and its future plans. Keep this section engaging, precise, and to the point.

3. Market Analysis

The market analysis section of your business plan should offer a thorough understanding of the industry with the target market, competitors, and growth opportunities. You should include the following components in this section.

Target market:

Start this section by describing your target market. Define your ideal customer and explain what types of services they prefer. Creating a buyer persona will help you easily define your target market to your readers.

Market size and growth potential:

Describe your market size and growth potential and whether you will target a niche or a much broader market.

Competitive Analysis:

Market trends:.

Analyze emerging trends in the industry, such as technology disruptions, changes in customer behavior or preferences, etc. Explain how your business will cope with all the trends.

Regulatory Environment:

Here are a few tips for writing the market analysis section of your medical billing business plan::

• Conduct market research, industry reports, and surveys to gather data.
• Provide specific and detailed information whenever possible.
• Illustrate your points with charts and graphs.
• Write your business plan keeping your target audience in mind.

4. Products And Services

The product and services section should describe the specific services and products that will be offered to customers. To write this section should include the following:

Describe your services:

Mention the medical billing services your business will offer. This list may include services like,

• Claims processing
• Medical coding
• Insurance verification
• Accounts receivable management
• Patient billing & collections
• Practice management software
• Compliance & regulatory assistance
• Consulting & advisory services

Quality measures:

Additional services.

In short, this section of your medical billing plan must be informative, precise, and client-focused. By providing a clear and compelling description of your offerings, you can help potential investors and readers understand the value of your business.

5. Sales And Marketing Strategies

Writing the sales and marketing strategies section means a list of strategies you will use to attract and retain your clients. Here are some key elements to include in your sales & marketing plan:

Unique Selling Proposition (USP):

Define your business’s USPs depending on the market you serve, the equipment you use, and the unique services you provide. Identifying USPs will help you plan your marketing strategies.

Pricing Strategy:

Marketing strategies:, sales strategies:, customer retention:.

Overall, this section of your medical billing company business plan should focus on customer acquisition and retention.

Have a specific, realistic, and data-driven approach while planning sales and marketing strategies for your medical billing business, and be prepared to adapt or make strategic changes in your strategies based on feedback and results.

6. Operations Plan

The operations plan section of your business plan should outline the processes and procedures involved in your business operations, such as staffing requirements and operational processes. Here are a few components to add to your operations plan:

Staffing & Training:

Operational process:, equipment & software:.

Include the list of equipment and software required for medical billing, such as computers, printers & scanners, telephone systems, medical billing software, practice management system, data security measures, etc.

Adding these components to your operations plan will help you lay out your business operations, which will eventually help you manage your business effectively.

7. Management Team

The management team section provides an overview of your medical billing business’s management team. This section should provide a detailed description of each manager’s experience and qualifications, as well as their responsibilities and roles.

Founders/CEO:

Key managers:.

Introduce your management and key members of your team, and explain their roles and responsibilities.

Organizational structure:

Compensation plan:, advisors/consultants:.

Mentioning advisors or consultants in your business plans adds credibility to your business idea.

This section should describe the key personnel for your medical billing services, highlighting how you have the perfect team to succeed.

8. Financial Plan

Your financial plan section should provide a summary of your business’s financial projections for the first few years. Here are some key elements to include in your financial plan:

Profit & loss statement:

Cash flow statement:, balance sheet:, break-even point:.

Determine and mention your business’s break-even point—the point at which your business costs and revenue will be equal.

Financing Needs:

Be realistic with your financial projections, and make sure you offer relevant information and evidence to support your estimates.

9. Appendix

The appendix section of your plan should include any additional information supporting your business plan’s main content, such as market research, legal documentation, financial statements, and other relevant information.

• Add a table of contents for the appendix section to help readers easily find specific information or sections.
• In addition to your financial statements, provide additional financial documents like tax returns, a list of assets within the business, credit history, and more. These statements must be the latest and offer financial projections for at least the first three or five years of business operations.
• Provide data derived from market research, including stats about the industry, user demographics, and industry trends.
• Include any legal documents such as permits, licenses, and contracts.
• Include any additional documentation related to your business plan, such as product brochures, marketing materials, operational procedures, etc.

Use clear headings and labels for each section of the appendix so that readers can easily find the necessary information.

Remember, the appendix section of your medical billing service business plan should only include relevant and important information supporting your plan’s main content.

The Quickest Way to turn a Business Idea into a Business Plan

Fill-in-the-blanks and automatic financials make it easy.

This sample medical billing business plan will provide an idea for writing a successful medical billing plan, including all the essential components of your business.

After this, if you still need clarification about writing an investment-ready business plan to impress your audience, download our medical billing business plan pdf .

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Steps for Preparing Business Plan

Frequently asked questions, why do you need a medical billing business plan.

A business plan is an essential tool for anyone looking to start or run a successful medical billing business. It helps to get clarity in your business, secures funding, and identifies potential challenges while starting and growing your business.

Overall, a well-written plan can help you make informed decisions, which can contribute to the long-term success of your medical billing company.

How to get funding for your medical billing business?

There are several ways to get funding for your medical billing business, but self-funding is one of the most efficient and speedy funding options. Other options for funding are:

• Bank loan – You may apply fora loan in government or private banks.
• Small Business Administration (SBA) loan – SBA loans and schemes are available at affordable interest rates, so check the eligibility criteria before applying for it.
• Crowdfunding – The process of supporting a project or business by getting a lot of people to invest in your business, usually online.
• Angel investors – Getting funds from angel investors is one of the most sought startup options.

Apart from all these options, there are small business grants available, check for the same in your location and you can apply for it.

Where to find business plan writers for your medical billing business?

There are many business plan writers available, but no one knows your business and ideas better than you, so we recommend you write your medical billing business plan and outline your vision as you have in your mind.

What is the easiest way to write your medical billing business plan?

A lot of research is necessary for writing a business plan, but you can write your plan most efficiently with the help of any medical billing business plan example and edit it as per your need. You can also quickly finish your plan in just a few hours or less with the help of our business plan software .

How do I write a good market analysis in a medical billing business plan?

Market analysis is one of the key components of your business plan that requires deep research and a thorough understanding of your industry. We can categorize the process of writing a good market analysis section into the following steps:

• Stating the objective of your market analysis—e.g., investor funding.
• Industry study—market size, growth potential, market trends, etc.
• Identifying target market—based on user behavior and demographics.
• Analyzing direct and indirect competitors.
• Calculating market share—understanding TAM, SAM, and SOM.
• Knowing regulations and restrictions
• Organizing data and writing the first draft.

Writing a marketing analysis section can be overwhelming, but using ChatGPT for market research can make things easier.

About the Author

Upmetrics Team

Upmetrics is the #1 business planning software that helps entrepreneurs and business owners create investment-ready business plans using AI. We regularly share business planning insights on our blog. Check out the Upmetrics blog for such interesting reads. Read more

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How to Start a Medical Billing Business: A Step-by-Step Guide

Starting a medical billing business can be a lucrative venture, offering you the opportunity to provide essential services to healthcare providers while enjoying the benefits of running your own business. In this comprehensive guide, we’ll walk you through the step-by-step process of launching your own medical billing business, from understanding the industry to setting up operations and attracting clients.

Why Start a Medical Billing Business?

The medical billing outsourcing market is a fast-growing industry. According to Grand View Research , the U.S. market size was valued at 5.2 billion dollars in 2022, and is expected to grow to 12.3 billion by 2030. 

This is mainly because healthcare providers are increasingly relying on outsourced medical billing services due to complex coding systems, growing healthcare costs and federal mandates for electronic health records, or EHR. More and more, doctors are looking to outsource time-consuming administrative functions such as revenue management.

Understand the Medical Billing Industry

Before diving into the business, it’s crucial to have a solid understanding of the medical billing industry. Research the latest industry trends, regulations, and best practices to ensure you’re well-prepared to provide accurate and up-to-date services.

Gain Relevant Education and Training

While formal education isn’t always mandatory, obtaining relevant training and certifications will significantly enhance your credibility. Consider enrolling in medical billing and coding courses, obtaining certifications such as Certified Professional Biller (CPB), and staying informed about changes in healthcare laws.

In order to bill appropriately, a medical biller and coder should also have a basic understanding of anatomy, physiology and pharmacology. They should also understand medical and insurance terminology. There are three basic types of coding that a biller must be familiar with:

• CPT : Current Procedural Terminology
• HCPCS: Healthcare Common Procedure Coding System, produced by the Centers for Medicare and Medicaid Services
• ICD-11 : International Classification of Diseases

Programs are available ranging from one to four years, from certifications and Associates Degrees to Bachelor’s, Master’s and even Doctorate’s in the field. Shorter programs are often available at community colleges and technical/vocational schools, whereas higher level degrees come from in-person and on-line schools. There is financial aid available for many of these programs.

Once you have completed your education, you will need to pay and sit for the exam from your chosen organization to become credentialed:

• American Medical Billing Association (AMBA)
• American Academy of Professional Coder’s (AAPC)
• American Health Information Management Association (AHIMA)

These organizations offer a range of certifications from Certified Coding Associate to Registered Health Information Administrator, depending on the level of education you choose to obtain.  The costs for these tests range from $300 and up.

Develop a Business Plan

Creating a well-thought-out business plan is essential for the success of your venture. Outline your business goals, target market, services offered, pricing strategy, and marketing approach. A comprehensive business plan will guide your decisions and attract potential investors or partners.

Choose a Legal Structure

Decide on the legal structure of your business, such as sole proprietorship, partnership, LLC, or corporation. Each structure has its own implications for liability, taxes, and management, so consult a legal professional to determine the best fit for your business.

Secure Necessary Licenses and Permits

Depending on your location and the nature of your medical billing business, you may need to obtain specific licenses and permits. Research the requirements in your area and ensure compliance before launching your business.

Set Up Your Office and Equipment

Create a functional workspace equipped with the necessary tools, such as computers, medical billing software , and office supplies. Invest in reliable software that can handle the complexity of medical billing tasks and ensure data security, such as TotalMD.

Look for medical billing software that is catered for medical billers and not just for healthcare providers. This will save you a lot of money because most medical software programs are priced per provider, not per user. TotalMD has a great pricing structure specifically for medical billers.

Develop Pricing and Services

Determine the pricing structure for your services. Research competitors’ rates and consider the complexity of the tasks you’ll be handling. Offer a range of services, including insurance claims submission, reimbursement tracking, and patient billing, to cater to different client needs.

There are three ways that billing is done through a billing service:

• Per-Claim Billing:  a set amount is charged for each claim, regardless of the amount of work it takes to get it ready to bill.  If the claim is rejected on the front-end, those corrections are included in the price. If the claim denies on the backend, an additional fee can be charged for the resubmission.  These fees can range from between $1 to $8 per claim.  
• Hourly:  Hourly may be the best way to go if you are also doing practice management for the providers.  The Bureau of Labor Statistics shows that an average hourly wage for a medical billing clerk is $16.50 per hour.  Providers can expect to pay more to an independent contractor.
• Percentage of Collections: This is popular as it encourages the biller to maximize reimbursement for their providers.  These percentages can range from 4% – 10% depending on many different factors.

Establish Billing Processes

Design efficient billing processes to ensure accuracy and timely submissions. Implement systems for verifying patient information, coding procedures correctly, and communicating with healthcare providers and insurers. This is where reliable medical billing software comes in.

Build a Strong Online Presence

In today’s digital age, having a professional website and active social media profiles is crucial for reaching potential clients. Optimize your website with relevant keywords, clear service descriptions, and client testimonials to boost your online visibility.

Network and Market Your Services

Network with local healthcare providers, clinics, and medical offices to build relationships and gain referrals. Attend industry events, join medical associations, and leverage online platforms to showcase your expertise and establish credibility.

Conclusion:

Starting a medical billing business requires careful planning, dedication, and a commitment to staying informed about industry changes. By following this step-by-step guide, you’ll be well-equipped to launch your business, provide valuable services to healthcare providers, and carve out a successful niche in the medical billing industry. Remember that persistence and a focus on delivering accurate and efficient billing services will be key to your business’s long-term success.

Andrea Jaramillo

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July 31, 2023

Practice Growth

Starting a Practice

How to start a medical billing company: key steps and strategies

Make the most of market demand and set up your own medical billing business. Learn how to start a medical billing company, get the right tools, and make sure you’re properly equipped to expand your client base.

Most Popular

At a glance.

• Starting a medical billing company is a promising business move due to the growing demand for this service.
• It’s important to use professional services for back-end processes such as insurance coverage, legal counsel, and accounting.
• Joining medical billing associations can provide guidance, resources, and networking opportunities.

Medical billing is a service in high demand, so starting a medical billing company could be a smart business move. According to the U.S. Bureau of Labor Statistics , employment for medical records and health information technicians — under which medical billers are classified — is expected to grow 7% from 2021 to 2031. In a Tebra study, 96% of medical billing service companies expect their organization to grow over the next year or at least remain stable. Some forecast revenue increases of over 20%.

The time that medical providers spend on administrative tasks related to generating bills and collecting payments is a major problem for them. As a result, the demand for outsourcing medical billing has steadily increased. For those aspiring to start a company in medical billing, the outlook is promising. By learning how to start a medical billing company with a strong foundation, you can set the stage for substantial growth in your patient billing business. In this article, we'll review the 9 basic steps to starting a medical billing company:

• Select your medical billing software
• Get a business license
• Decide on a pricing structure
• Build your dream team
• Join medical billing associations
• Use marketing to grow your business
• Design a simple client onboarding process
• Expand your service offerings
• Manage your online reputation

1. Select your medical billing software

Knowing how to start a medical billing company involves making crucial decisions. The first one is selecting the right billing and payment software . The software should integrate seamlessly with electronic health records (EHR) and electronic medical records (EMR) systems used by healthcare providers. It should also allow you to get started easily, avoid technology breakdowns, and give your clients the services they need to be profitable.

A modern medical billing system often includes the following features:

• End-to-end claims management
• Invoicing templates
• Invoice automation
• 95% clean claims submission
• No response alerts
• Denial alerts
• Patient collections
• Credit card processing/credit card on file
• Paper and electronic claims
• Electronic receipts
• Secure online bill pay

An integrated EHR system significantly improves the billing process by enhancing coding accuracy, eliminating duplicate data entry, and streamlining the management of electronic superbills. Even if you serve only a single provider to start, it’s important to plan for the growth of your company. A simpler billing system will be easier to scale while still having the tools to manage multiple practices over time. It will also have a comprehensive dashboard and a one-time login. Best of all, it will be designed with electronic invoicing and billing services in mind.

Of course, medical centers expect billing companies to handle medical coding and billing. Potential customers also need practice management services as well as insurance eligibility verification and scheduling solutions. This is why it's smart to choose an online invoicing system that is compatible with add-on medical billing features, such as:

• Chart audits
• Practice technology support
• Credentialing
• Payer contract negotiations
• Compliance consulting
• Practice marketing consulting

Further Reading

2. get a business license.

Regardless of size, when you launch a billing company in the medical industry, you must obtain a business license to operate legally within the healthcare landscape. This applies even if you run the company out of your home. A license helps to ensure compliance with regulations and instills trust among healthcare stakeholders, including health insurers and providers. Licensing also upholds standards in health care delivery and promotes transparency and accountability within the industry. It’s best to get this out of the way early on to avoid fines, fees, and regulatory challenges later. 

Types of licenses and insurance that you may need include:

• Business license
• Medical malpractice
• Business interruption
• Office contents
• Umbrella policy
• Workers’ compensation
• Health/disability/life
• Employee fidelity bond

3. Decide on a pricing structure

Determining how much to charge for your billing services is a key part of knowing how to start a medical billing company. There are 3 main pricing models : percentage of collections, per claim, and hourly . The most common model is percentage-of-collection pricing. Among those using it, 1 in 4 medical billers charge 6% to 7% of the revenue they collect.

The following questions might be helpful for determining prices:

• Should you charge a set-up fee for new customers?
• Will you set a minimum volume requirement for customers?
• What is the expected volume for your customers’ specialization?
• Do your customers have any special requirements that necessitate additional staff or technology resources?

Your answers to the questions listed above will help shape a pricing strategy that aligns with the dynamic healthcare landscape. It must consider factors such as medical innovation and patient demand to ensure sustainable patient revenue cycle management. You might also benefit from keeping abreast of healthcare payment startups and looking at their pricing decisions, competitiveness, and adaptability.

4. Build your dream team

Knowing how to start a medical billing company also requires selecting the appropriate professional assistance. Numerous back-end processes are essential. You'll need insurance policies, legal counsel for contracts, and accounting services. It's also smart to build contacts with reliable collection firms to whom you can direct customers with overdue accounts. Additionally, integrating electronic health record vendors and healthcare applications can enhance medical information provision and streamline processes. Collaborating with clinical decision support startups and patient support programs can further optimize operations.

Understanding legal prerequisites is vital when initiating a medical billing company.

An attorney can help with:

• Choosing your business structure
• Reviewing your policies/procedures
• Navigating compliance
• Adhering to HIPAA regulations
• Developing or reviewing client contracts
• Reviewing your office lease (if applicable)

An accountant can help with:

• Arranging your financial structure
• Obtaining a tax ID number
• Processing your quarterly and annual business and employment taxes

5. Join medical billing associations

Another pivotal aspect of knowing how to start a business involves establishing connections within the industry. Let's review some key associations that can significantly benefit a medical billing business.

Healthcare Billing & Management Association (HBMA)

• Founded in 1993, the HBMA boasts thousands of members and offers conferences and training nationwide.
• Represents over 47,000 employees at nearly 500 Revenue Cycle Management (RCM) firms.
• Provides tools, resources, and a certification and education program.
• Membership dues range from $500 to $1,500 a year based on company size.

American Association of Professional Coders (AAPC)

• Established in 1988, the AAPC has over 190,000 members, focusing on education and professional certification for medical coders.
• Local chapters facilitate networking opportunities.
• Annual dues are $170 a person, with discounts available.

American Medical Billing Association (AMBA)

• Founded in 1998, the AMBA offers industry and regulatory education, networking, and a certification program (CMRS).
• Welcomes in-office billers and billing services.
• Annual dues are $199, with business membership options for over 3 employees.

Medical Group Management Association (MGMA)

• Established in 1926, the MGMA caters to medical practice executives and leaders, offering publications, research, and education.
• Provides the ACMPE certification.
• Annual membership dues range from $35 to $399.

Additionally, associations like the Chamber of Commerce and the Better Business Bureau can be helpful to people starting a new business . Collaborating with health startups, digital health companies, and hospital partners can provide valuable insights and opportunities for growth. Partnering with these entities can give you networking opportunities in the healthcare market, help to build your firm's reputation, and provide access to valuable resources.

6. Use marketing to grow your billing company

Customer acquisition is crucial to the success of any new medical billing company. You may have locked down every other aspect of establishing your business, but you need at least 1 customer to get things off the ground. To get started with your medical billing company's marketing , you’ll need the following:

• Your ideal customer profile
• Marketing plan
• Professional website
• Professional email address
• Professional business Facebook page
• Google Business page
• LinkedIn profile

Search for conferences that cater to healthcare executives, primary care providers, and professionals in the health industry. Pick one that seems promising and attend as a registrant — or rent a booth to display your new company and the services you offer. Create social media pages on different platforms to engage clients through digital marketing, focusing on automated invoicing and healthcare technology. Make sure that all your marketing materials emphasize your particular expertise, such as patient records, healthcare strategy, and engagement with primary care providers.

Once you get your first client , prioritize exceptional service to drive referral programs and success in the healthcare industry.

Many medical billing companies find success through differentiation , meaning they stand out by offering unique and valuable services or features. This could involve specializing in a particular medical field, providing exceptional customer service, implementing cutting-edge technology, or developing innovative billing solutions tailored to the healthcare software development and medical device industry. Ultimately, differentiation allows medical billing companies to carve a niche in the market, attract specific clientele, and build a competitive edge.

Eventually, you can expand your client base by cultivating strong relationships with medical practices and healthcare providers. To demonstrate expertise in billing processes and showcase your negotiation skills, make sure to offer competitive pricing tailored to invoices and healthcare delivery needs. Building trust and delivering exceptional service will position your company as a preferred choice in the healthcare industry, fostering growth and attracting new clients.

7. Design a simple client onboarding process

Now it's time to focus on securing your first client . This requires designing a simple client onboarding process.

The majority of medical practices have already done 60% to 80% of their research before contacting medical billing companies they may want to partner with. They have already researched you online, perusing your website, Facebook, and LinkedIn. But your real chance to make a good first impression comes during the discovery call .

Make onboarding easy and highlight your industry expertise by preparing detailed answers to expected client questions. Prepare a standard practice set-up form for your initial meetings with practice managers. This will allow you to gather all the onboarding information you need at one time. The form should cover all the information needed to set up with your clearinghouse and payers, including:

• National Provider Identifier (NPI)
• Employer Identification Number (EIN)
• Location, address, and hours
• Appointment types/times
• Provider Transaction Access Number (PTAN)
• Insurance ID numbers for each provider
• Fee schedules (if they have them)

The most important piece of paperwork to prepare is your contract. A standard medical billing company contract covers:

• Terms, conditions, and fees
• The specific services provided and at what rate
• The pay schedule and what happens if not paid
• How either party may end the contract
• Responsibilities of each party
• Any additional services

8. Expand your service offerings

Integrating services like practice management, marketing, and patient engagement into your core offerings allows you to present your company as a one-stop solution for practices. A benchmark report by Tebra — The state of the U.S. medical billing industry — identified the most popular services among high-growth companies:

• 91% offer appeals services
• 84% offer patient support
• 38% offer practice technology consulting or support
• 31% offer credentialing
• 31% offer compliance consulting
• 22% offer practice marketing consulting

9. Manage your online reputation

Your company’s online reputation will significantly affect your client acquisition abilities. Audit your reputation by looking for mentions and profiles of your company on the internet. Leverage positive reviews to get referrals, and address negative reviews as quickly as possible. Schedule feedback meetings at least once a year with the main contact at your client's practice. These communications can help you address issues in real-time and make your company more successful as you grow.

Learn how to start a medical billing company

These 9 steps can help you jumpstart your medical billing company, set up your workflow for success, and give you the tools you need to grow over time. But if you really want to stay ahead of the curve, it helps to see what high-growth companies are doing by accessing Tebra's State of the US Medical Billing Industry report . This report makes it easier to gain insights into revenue models, operations, and industry trends, providing you with the information you need to learn how to start a medical billing company.

You Might Also Be Interested In

• Medical billing company best practices: Learn why diversifying, digitizing, and operational transparency are your keys to growth in our 2023 benchmark report . 

Subscribe to The Intake: A weekly check-up for your independent practice

Tolu Ajiboye

Tolu Ajiboye is a writer and marketing consultant with over 7 years of experience helping biopharma and healthcare companies with marketing communications strategy and execution. She’s worked with multiple Fortune 500 companies, and has had her work appear in publications like NBC News and The Guardian UK. She also has a law degree.

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How to Start a Medical Billing Business

Billing a patient for medical services can be complicated. Plus, not all patients can afford to pay the entire bill in full. And then there's the paperwork. With laws like the Health Insurance Portability and Accountability Act of 1996 (HIPAA), it can be confusing and difficult to know which documents need to go where. If a hospital or doctor messes things up, it's a huge legal liability.

This is where a medical billing businesses can help. They take care of billing clients on behalf of doctors, hospitals, and other healthcare providers. Medical billing companies try to simplify the process by coordinating multiple providers and billing systems, while incorporating processes to adhere to changing regulations, so healthcare providers stay compliant and can get paid for their services.

Learn how to start your own Medical Billing Business and whether it is the right fit for you.

Ready to form your LLC? Check out the Top LLC Formation Services .

Start a medical billing business by following these 10 steps:

• Plan your Medical Billing Business
• Form your Medical Billing Business into a Legal Entity
• Register your Medical Billing Business for Taxes
• Open a Business Bank Account & Credit Card
• Set up Accounting for your Medical Billing Business
• Get the Necessary Permits & Licenses for your Medical Billing Business
• Get Medical Billing Business Insurance
• Define your Medical Billing Business Brand
• Create your Medical Billing Business Website
• Set up your Business Phone System

We have put together this simple guide to starting your medical billing business. These steps will ensure that your new business is well planned out, registered properly and legally compliant.

Exploring your options? Check out other small business ideas .

STEP 1: Plan your business

A clear plan is essential for success as an entrepreneur. It will help you map out the specifics of your business and discover some unknowns. A few important topics to consider are:

What will you name your business?

• What are the startup and ongoing costs?
• Who is your target market?

How much can you charge customers?

Luckily we have done a lot of this research for you.

Choosing the right name is important and challenging. If you don’t already have a name in mind, visit our How to Name a Business guide or get help brainstorming a name with our Medical Billing Business Name Generator

If you operate a sole proprietorship , you might want to operate under a business name other than your own name. Visit our DBA guide to learn more.

When registering a business name , we recommend researching your business name by checking:

• Your state's business records
• Federal and state trademark records
• Social media platforms
• Web domain availability .

It's very important to secure your domain name before someone else does.

Want some help naming your medical billing business?

Business name generator, what are the costs involved in opening a medical billing business.

Software for a startup can be outsourced through a cloud-based billing software company. The price points here range from $60 per month, per user to $250 per month, per user.

Of course, you can grow your medical billing practice quite large. A medium-to large-scale operation requires professional, in-house, systems which can cost upwards of $50,000 to install. Servers add another $3,000 to $5,000 to the cost, and training adds another $3,000 to the startup total.

You'll also need backup hard drives at $50 to $150 per drive, ethernet switches and wires at $50 - $100 per wire, depending on length, software licensing at $1,500 to $3,500 per user, software upgrades at $1,500 to $3,500 per year, and IT support at $150 to $200 per hour.

What are the ongoing expenses for a medical billing business?

Ongoing expenses include software, insurance, utilities, and office supplies, along with labor costs. These costs range from $100 per month just for software, up to $10,000 or more per month if you have a small medical billing company. Medium and large companies spend hundreds of thousands of dollars per month just to keep the business running.

Who is the target market?

The target market is as wide as the healthcare industry. You can narrow your focus, of course, and target specific types of practitioners and providers. This is what most small to medium-sized medical billing companies do.

How does a medical billing business make money?

A medical billing business makes money in any of several ways: billing by the hour, billing by the claim, or taking a percentage of the money collected from claims.

The industry standard rate is $4 to $6, per claim. If a company charges fees as a percent of total sums collected, fees range between 5% and 10%. Some companies charge upwards of 15%. Hourly rates are rare these days, but may range between $20 and $50 per hour. You can also charge a flat-fee per clinician or an initial fee plus a percent of sums collected on claims.

How much profit can a medical billing business make?

Profit potential varies a lot but typical gross margins are between 5% and 10%.

How can you make your business more profitable?

Making the business more profitable involves specializing. Most successful medical billing companies don't work with everyone and anyone. A business might become known in the Chiropractic community, for example, or choose to work exclusively with veterinarians or family doctors. Some medical billing companies customize their services for specialists like cardiologists or ENTs.

Another way to improve profits for your company is to hire talented medical billing specialists who are good at collecting payments. Since this business only thrives when collections are high, your employees need good people skills, empathy, and raw sales talent to succeed at collecting current and past-due medical bills.

Want a more guided approach? Access TRUiC's free Small Business Startup Guide - a step-by-step course for turning your business idea into reality. Get started today!

STEP 2: Form a legal entity

The most common business structure types are the sole proprietorship , partnership , limited liability company (LLC) , and corporation .

Establishing a legal business entity such as an LLC or corporation protects you from being held personally liable if your medical billing business is sued.

Form Your LLC

Read our Guide to Form Your Own LLC

Have a Professional Service Form your LLC for You

Two such reliable services:

You can form an LLC yourself and pay only the minimal state LLC costs or hire one of the Best LLC Services for a small, additional fee.

Recommended: You will need to elect a registered agent for your LLC. LLC formation packages usually include a free year of registered agent services . You can choose to hire a registered agent or act as your own.

STEP 3: Register for taxes

You will need to register for a variety of state and federal taxes before you can open for business.

In order to register for taxes you will need to apply for an EIN. It's really easy and free!

You can acquire your EIN through the IRS website . If you would like to learn more about EINs, read our article, What is an EIN?

There are specific state taxes that might apply to your business. Learn more about state sales tax and franchise taxes in our state sales tax guides.

STEP 4: Open a business bank account & credit card

Using dedicated business banking and credit accounts is essential for personal asset protection.

When your personal and business accounts are mixed, your personal assets (your home, car, and other valuables) are at risk in the event your business is sued. In business law, this is referred to as piercing your corporate veil .

Open a business bank account

Besides being a requirement when applying for business loans, opening a business bank account:

• Separates your personal assets from your company's assets, which is necessary for personal asset protection.
• Makes accounting and tax filing easier.

Recommended: Read our Best Banks for Small Business review to find the best national bank or credit union.

Get a business credit card

Getting a business credit card helps you:

• Separate personal and business expenses by putting your business' expenses all in one place.
• Build your company's credit history , which can be useful to raise money later on.

Recommended: Apply for an easy approval business credit card from BILL and build your business credit quickly.

STEP 5: Set up business accounting

Recording your various expenses and sources of income is critical to understanding the financial performance of your business. Keeping accurate and detailed accounts also greatly simplifies your annual tax filing.

Make LLC accounting easy with our LLC Expenses Cheat Sheet.

STEP 6: Obtain necessary permits and licenses

Failure to acquire necessary permits and licenses can result in hefty fines, or even cause your business to be shut down.

Federal Business Licensing Requirements

Medical billing companies are legally required to operate under federal regulations regarding health information set forth by the Health Insurance Portability and Accountability Act (HIPAA) .  

State & Local Business Licensing Requirements

Certain state permits and licenses may be needed to operate a medical billing business. Learn more about licensing requirements in your state by visiting SBA’s reference to state licenses and permits .

Most businesses are required to collect sales tax on the goods or services they provide. To learn more about how sales tax will affect your business, read our article, Sales Tax for Small Businesses .

Certificate of Occupancy

A medical billing business is generally run out of an office. Businesses operating out of a physical location typically require a Certificate of Occupancy (CO).  A CO confirms that all building codes, zoning laws and government regulations have been met.

• If you plan to lease a location :
• It is generally the landlord’s responsibility to obtain a CO.
• Before leasing, confirm that your landlord has or can obtain a valid CO that is applicable to a medical billing  business.
• After a major renovation, a new CO often needs to be issued. If your place of business will be renovated before opening, it is recommended to include language in your lease agreement stating that lease payments will not commence until a valid CO is issued.
• If you plan to purchase or build a location :
• You will be responsible for obtaining a valid CO from a local government authority.
• Review all building codes and zoning requirements for your business’ location to ensure your medical billing business will be in compliance and able to obtain a CO.

STEP 7: Get business insurance

Just as with licenses and permits, your business needs insurance in order to operate safely and lawfully. Business Insurance protects your company’s financial wellbeing in the event of a covered loss.

There are several types of insurance policies created for different types of businesses with different risks. If you’re unsure of the types of risks that your business may face, begin with General Liability Insurance . This is the most common coverage that small businesses need, so it’s a great place to start for your business.

Another notable insurance policy that many businesses need is Workers’ Compensation Insurance . If your business will have employees, it’s a good chance that your state will require you to carry Workers' Compensation Coverage.

FInd out what types of insurance your Medical Billing Business needs and how much it will cost you by reading our guide Business Insurance for Medical Billing Business.

STEP 8: Define your brand

Your brand is what your company stands for, as well as how your business is perceived by the public. A strong brand will help your business stand out from competitors.

If you aren't feeling confident about designing your small business logo, then check out our Design Guides for Beginners , we'll give you helpful tips and advice for creating the best unique logo for your business.

Recommended : Get a logo using Truic's free logo Generator no email or sign up required, or use a Premium Logo Maker .

If you already have a logo, you can also add it to a QR code with our Free QR Code Generator . Choose from 13 QR code types to create a code for your business cards and publications, or to help spread awareness for your new website.

How to promote & market a medical billing business

Promoting and marketing your medical billing company isn't easy. Since this market is saturated, it's best to build up a good referral network. Network with individuals just graduating med school, those in residency, and those who are just starting their practice.

Make contacts with hospital administrators. They may not need your services, but may be able to help you better understand the medical billing industry.

How to keep customers coming back

Keeping customers is easy if you do a good job on the billing. Since it's difficult to change billing companies, it's difficult to take business away from your competitors. Providers simply don't like switching. At the same time, it's difficult to take away your business once you become established.

STEP 9: Create your business website

After defining your brand and creating your logo the next step is to create a website for your business .

While creating a website is an essential step, some may fear that it’s out of their reach because they don’t have any website-building experience. While this may have been a reasonable fear back in 2015, web technology has seen huge advancements in the past few years that makes the lives of small business owners much simpler.

Here are the main reasons why you shouldn’t delay building your website:

• All legitimate businesses have websites - full stop. The size or industry of your business does not matter when it comes to getting your business online.
• Social media accounts like Facebook pages or LinkedIn business profiles are not a replacement for a business website that you own.
• Website builder tools like the GoDaddy Website Builder have made creating a basic website extremely simple. You don’t need to hire a web developer or designer to create a website that you can be proud of.

Recommended : Get started today using our recommended website builder or check out our review of the Best Website Builders .

Other popular website builders are: WordPress , WIX , Weebly , Squarespace , and Shopify .

STEP 10: Set up your business phone system

Getting a phone set up for your business is one of the best ways to help keep your personal life and business life separate and private. That’s not the only benefit; it also helps you make your business more automated, gives your business legitimacy, and makes it easier for potential customers to find and contact you.

There are many services available to entrepreneurs who want to set up a business phone system. We’ve reviewed the top companies and rated them based on price, features, and ease of use. Check out our review of the Best Business Phone Systems 2023 to find the best phone service for your small business.

Recommended Business Phone Service: Phone.com

Phone.com is our top choice for small business phone numbers because of all the features it offers for small businesses and it's fair pricing.

Is this Business Right For You?

This business is perfect for individuals who are passionate about running a business in the healthcare industry and want to help both patients and providers make the billing process easier and more streamlined. Business owners should be naturally detail-oriented and task-focused thinkers. Medical billing is all about systems, processes, and completing tasks in a specific order to comply with federal regulation as well as internal healthcare provider policies.

Want to know if you are cut out to be an entrepreneur?

Take our Entrepreneurship Quiz to find out!

Entrepreneurship Quiz

What happens during a typical day at a medical billing business?

A medical billing company stays busy. The owner of the business oversees day-to-day operations which include collecting delinquent accounts and establishing payment arrangements with patients, monitoring patients' payments, and following up with patients when payments do not arrive on time.

The business also subcontracts business out to collection companies when payments cannot be collected within a reasonable amount of time. It maintains a medicare bad-debt cost report, which tracks billings and collections. It also initiates claims against estates for backpayment of medical bills. Medical billing companies maintain an active list of contacts with various legal departments and law firms as well as local governments (e.g. clerk of the court), which they use to help with collection attempts.

Medical billing companies also do normal bill collections by sending out bills for payments on behalf of hospitals, doctors, and other healthcare providers.

What are some skills and experiences that will help you build a successful medical billing business?

To run this business, you'll need data entry skills, management skills, and knowledge of the healthcare and billing industry.

What is the growth potential for a medical billing business?

Medical billing can be done on a small or large scale. Starting out of your home, you can get a medical billing company up and running with a laptop computer and basic accounting and billing software. Larger operations require a staff, ranging from 5 to 10 employees up to thousands.

TRUiC's YouTube Channel

For fun informative videos about starting a business visit the TRUiC YouTube Channel or subscribe to view later.

Take the Next Step

Find a business mentor.

One of the greatest resources an entrepreneur can have is quality mentorship. As you start planning your business, connect with a free business resource near you to get the help you need.

Having a support network in place to turn to during tough times is a major factor of success for new business owners.

Learn from other business owners

Want to learn more about starting a business from entrepreneurs themselves? Visit Startup Savant’s startup founder series to gain entrepreneurial insights, lessons, and advice from founders themselves.

Resources to Help Women in Business

There are many resources out there specifically for women entrepreneurs. We’ve gathered necessary and useful information to help you succeed both professionally and personally:

If you’re a woman looking for some guidance in entrepreneurship, check out this great new series Women in Business created by the women of our partner Startup Savant.

What are some insider tips for jump starting a medical billing business?

Make contacts early on to get up and running quickly. This is a saturated market. If you know anyone in the healthcare industry, find out what events they go to and network with them. Find out who does their medical billing. New doctors just out of residency can also be a good source of leads.

Since many hospitals already have a medical billing system, it's best to stick with practices that are just starting.

How and when to build a team

Building a team isn't necessary in this business. However, if you want to grow your business, add medical billers as fast as you can. They are the core revenue generators of the company.

Useful Links

Industry opportunities.

• American Medical Billing Association
• ClaimTek (franchise opportunity)
• American Family Care (franchise opportunity)

Real World Examples

• Physician Billing Associates

Further Reading

• Interview with a successful business owner
• Considerations when starting this business

Have a Question? Leave a Comment!

How to Start a Medical Billing Business

Main Sections In This Post Steps To Starting A Medical Billing Business Points to Consider Knowledge Is Power Featured Video

In this post, you’ll find a step-by-step guide to starting a medical billing business.

In addition, we will give you an overview of what you can expect from operating a medical billing business and help you make better decisions and gain clarity.

You can access the latest resources in our “Knowledge Is Power” section, which can be used during the startup phase and once your medical billing business is fully operational.

There is an abundance of information available to explore. If you like this post, consider sharing it with others and bookmarking it for future reference.

Let’s get started with the steps.

The Steps to Start Your Medical Billing Business

Below are the steps to starting a medical billing business.

Each step is linked to a specific section, allowing you to jump to your desired section or scroll to follow the steps in order.

• An Overview of What You’re Getting Into
• Medical Billing Business Overview
• Researching Your Medical Billing Business
• Looking Startup and Operating Costs
• Creating Your Mission Statement
• Creating A Unique Selling Proposition (USP)
• Choose a Medical Billing Business Name
• Register Your Company
• Create Your Corporate Identity
• Writing a Business Plan
• Banking Considerations
• Getting the Funds for Your Operation
• Software Setup
• Business Insurance Considerations
• Supplier and Service Provider Considerations
• Setting Your Prices
• Physical Setup
• Creating a Website
• Hiring Employees
• Getting Customers Through the Door

1. An Overview of What You’re Getting Into

It is essential to have a strong understanding of what you’re getting into. The more you know what to expect, the better your decisions will be and the fewer surprises you’ll encounter.

Before starting your medical billing business, there are many points to consider, the pros and cons of owning and operating your business, how passionate you are about your business, getting the right advice, and more.

When you consider these crucial points, you’ll better understand what you are getting into and can avoid many problems you could encounter if you bypass these issues.

Take the time to look at these considerations from the following link before starting your business, and you will gain the information to help you make the right decisions.

See our page on Critical Points to Consider before starting your business.

2. Gaining an Overview of Owning a Medical Billing Business

Next, let’s discuss the issues that will give you an overview of what to expect from owning and running a medical billing business.

In this step, we will be looking at the following sections:

a.) A Quick Overview of Owning a Medical Billing Business b.) Medical Billing Business Models c.) Challenges You Could Face When Starting and Operating a Medical Billing Business

a.) A Quick Overview of Owning a Medical Billing Business

A medical billing business is a service-oriented enterprise that handles the intricate process of medical billing and coding for healthcare providers.

Its primary function revolves around translating medical services rendered to patients into billable claims for insurance companies or patients themselves.

These businesses act as intermediaries between healthcare providers and payers, ensuring accurate reimbursement for services provided.

Day-to-Day Tasks in Running a Medical Billing Business

Client Communication and Onboarding

Initial client interactions involve understanding the unique needs of healthcare providers. This includes assessing their current billing practices, software systems used, and any specific requirements.

Onboarding new clients entails gathering necessary documentation, such as patient records and insurance information, to establish a seamless billing process.

Data Entry and Coding

A significant portion of daily tasks involves entering patient information, diagnoses, and treatment codes into billing software accurately.

Medical billers must have a thorough understanding of medical coding systems such as ICD-10 and CPT, ensuring that codes are correctly assigned to each service provided.

Claim Submission and Follow-Up

Once claims are generated, they are submitted electronically to insurance companies or other payers for processing. Medical billers monitor the status of claims, identifying any rejections or denials.

Follow-up activities involve investigating and resolving issues that may arise, such as missing information or discrepancies in billing.

Payment Posting and Reconciliation

As payments are received from insurance companies or patients, medical billers post these transactions to the appropriate accounts within the billing system.

They reconcile payments with outstanding claims, identifying any discrepancies or underpayments that require further attention.

Reporting and Analysis

Regular reporting is essential for tracking key performance indicators, such as claim submission rates, reimbursement rates, and average payment times.

Analyzing these metrics helps identify areas for improvement and ensures the financial health of the medical billing business and its clients.

Compliance and Regulation

Staying up-to-date with evolving healthcare regulations and compliance standards is crucial in the medical billing industry.

Medical billers must adhere to guidelines set forth by entities such as HIPAA (Health Insurance Portability and Accountability Act) to safeguard patient privacy and maintain data security.

In summary, running a medical billing business involves managing a range of tasks essential for efficient revenue cycle management in healthcare settings.

From client communication to claim submission and compliance, attention to detail and expertise in medical billing processes are paramount for success.

b.) Medical Billing Business Models

Types of Setups and Business Models for a Medical Billing Business

Outsourced Billing Services :

• Operating remotely, providing billing services to multiple healthcare providers.
• Typically, billing specialists handle tasks from claim submission to payment posting.

In-House Billing Departments :

• Healthcare providers establish their billing departments, hiring staff to handle billing processes.
• Offers greater control over the billing process but requires significant investment in infrastructure and personnel.

Specialized Billing Software Companies :

• Developing and selling billing software tailored to the needs of healthcare providers.
• Revenue generated through software sales or subscription fees.

Consulting and Training Services :

• Providing consulting services to healthcare practices on optimizing their billing processes.
• Offers training programs for medical billers and coders.

Hybrid Models :

• Combining elements of outsourced billing services with in-house software solutions.
• Allows for customization while leveraging external expertise.

Niche Focus :

• Specializing in serving a particular medical specialty or type of healthcare provider.
• Enables targeted marketing and tailored services to meet specific industry needs.

Choosing a suitable business model from the beginning is crucial, as switching your model later is more challenging.

Focusing on a niche allows you to adapt your products and services to a specific group of customers.

Consider becoming a specialist instead of trying to be a business that offers everything to everyone.

Identifying a business model that feels right to you is essential and can give you a better chance of succeeding.

c.) Challenges You Could Face When Starting and Operating a Medical Billing Business

Challenges in the Startup Phase of a Medical Billing Business

Regulatory Compliance:

Navigating complex healthcare regulations, such as HIPAA, requires meticulous attention to detail to ensure compliance and avoid penalties.

Establishing Credibility:

Building trust with potential clients in a competitive market can be challenging without a track record or established reputation.

Technology Implementation:

Investing in suitable billing software and ensuring staff are trained to use it efficiently can be a significant hurdle, especially for new businesses with limited resources.

Client Acquisition:

Securing initial clients can be difficult without a solid marketing strategy and networking efforts, particularly when competing against established firms.

Cash Flow Management:

Balancing expenses with limited revenue during the startup phase requires careful budgeting and financial planning to sustain operations.

Challenges When Operating a Medical Billing Business

Client Retention:

Maintaining long-term client relationships and ensuring satisfaction amid changing industry standards and client needs can be challenging.

Staff Turnover:

Recruiting and retaining skilled billing specialists in a competitive job market is crucial to maintaining service quality and client satisfaction.

Technology Updates:

Keeping up with advancements in billing software and technology to remain competitive and meet evolving client demands requires ongoing investment and adaptation.

Claims Processing Errors:

Minimizing errors in claims submission and coding is essential to avoid payment delays or denials, requiring continuous training and quality control measures.

Market Saturation:

Navigating a saturated market with increasing competition from both established firms and new entrants poses challenges in maintaining market share and profitability.

In summary, starting and operating a medical billing business involves overcoming various challenges, from regulatory compliance and technology implementation to client acquisition and retention.

Addressing these challenges requires strategic planning, adaptability, and a commitment to delivering high-quality services.

3. Research

Quality information plays a significant role in achieving success.

Continuous research is vital. The more you know, the easier it is to operate your business.

a.) Demand, the Competition and Your Location b.) Target Audience

a.) Demand, the Competition and Your Location

Determining the demand for your products and services before starting your medical billing business is essential. Offering high quality and reasonable prices is not enough.

There must be enough demand for what you plan to offer, or opening your business doesn’t make sense.

A lack of demand will lead to closing before you see any success, and you could have a mountain of debt that’s challenging to repay.

In addition to market demand, you need to consider if the market is saturated with what you plan to offer.

With a saturated market, gaining market share won’t be easy unless you offer something your competitors don’t.

You also need to consider if the competition could easily copy your idea. If so, competitors are already established, so they could take most of the market share for your idea.

Competition:

When looking at the competition, focus on what you are up against. Understand your competition, what they provide and their strengths and weaknesses.

You may be able to bring something new to the marketplace instead of just going head-to-head with the competition.

Understanding what you are up against is crucial when starting a new business.

Choosing Your Location:

Ideally, you should focus on a location that balances sufficient demand with a manageable level of competition. Moreover, affordability is another crucial consideration.

While a highly populated area might provide greater exposure, you must ensure that the increased expenses won’t outweigh your profits.

Opting for cheaper rent may seem tempting, but you must ensure the location has enough customers to provide enough revenue for your medical billing business to be profitable and survive.

In conclusion, choosing the right location with balanced supply and demand is crucial for your business’s success.

Take the time to thoroughly research and analyze potential locations to make an informed decision.

For more, see the Demand for Your Products and Services and Choosing The Best Location for Your Business.

b.) Target Audience

Benefits of Understanding Your Target Audience:

• Customization: Understanding your target audience allows you to tailor your products, services, and offers to meet their specific needs and preferences. This customization increases the likelihood of satisfying customers and fostering loyalty.
• Efficiency: With a thorough understanding of your target audience, you can focus your resources on providing the products and services that are most relevant and appealing to them. This targeted approach improves efficiency and minimizes wasted effort and resources.
• Competitive Advantage: By catering to the needs and preferences of your target audience, you differentiate yourself from competitors who may offer a one-size-fits-all approach. This competitive advantage can help you attract and retain customers in a crowded market.
• Market Insights: Understanding your target audience provides valuable insights into market trends, preferences, and behavior. This knowledge allows you to anticipate changes in demand and stay ahead of the competition by adapting your offerings accordingly.
• Customer Satisfaction: Meeting the needs and preferences of your target audience results in higher levels of customer satisfaction. Satisfied customers are more likely to return for repeat business and recommend your products or services to others, contributing to long-term success.

Target Market Ideas:

• Small to Medium-sized Healthcare Practices
• Independent Physicians
• Dental Clinics
• Physical Therapy Centers
• Chiropractic Clinics
• Mental Health Practices
• Outpatient Surgery Centers
• Urgent Care Facilities
• Specialty Medical Practices (e.g., Dermatology , Cardiology, Oncology)
• Home Healthcare Agencies
• Medical Billing Software Companies
• Healthcare Consulting Firms
• Medical Coding Schools and Training Institutes
• Medical Billing Associations and Organizations
• Healthcare Startups and Entrepreneurs

Understanding your target audience enables you to identify and prioritize potential customers and businesses most likely to benefit from the services of a medical billing business.

A targeted approach increases the effectiveness of your marketing efforts and enhances your overall business strategy.

4. Looking Startup and Operating Cost:

Understanding the financial aspect of your business and making good decisions based on the facts are crucial factors in succeeding.

You will struggle to manage a successful operation without investing the time and effort necessary to understand the financials of your medical billing business.

This section has a lot to cover, and these are critical steps in starting and operating your business.

The section is broken up into the following:

a.) Start-up Cost:

In this step, we will look at the importance of getting accurate estimates and a simple list to help you understand your needs.

b.) Monthly Expenses:

Expenses must be monitored, or the operation could be jeopardized. A sample list of monthly expenses is provided, which can be used to generate ideas for your setup.

c.) Best  Practices

Well take a look at what you can do to ensure you are always on top of the financial well being of your operation.

Let’s get started!

a.) Start-Up Costs:

Accurately estimating startup costs is crucial for a smooth transition from planning to opening your medical billing business. Underestimating may lead to running out of funds before opening, while overestimating can deter potential investors due to perceived high risk.

Factors influencing costs include business model, operational size, location, employment needs, equipment purchases, and leasing expenses. To estimate, compile a comprehensive list of requirements and obtain price quotes. Researching may uncover additional expenses to include.

Sample estimates can offer insights, but exact startup costs vary widely due to individual setup variations. Considering numerous variables, from software needs to office space expenses, precise figures are elusive.

Conclusively, researching and obtaining accurate estimates remain the best method for determining if starting a medical billing business aligns with your financial capabilities and objectives.

Sample List: Startup Costs for a Medical Billing Business

The purpose of the list below is to focus on the items more than the numbers because these are general samples, and your figures will be different.

Office Space:

• Rent or Lease: $2,500 – $5,000 (First month’s rent plus security deposit)

Equipment and Software:

• Computers: $1,500 – $3,000
• Medical Billing Software: $1,000 – $2,500
• Office Furniture: $1,000 – $3,000

Licenses and Permits:

• Business License: $100 – $500
• HIPAA Compliance: $500 – $1,000

Initial Marketing and Advertising:

• Website Development: $500 – $2,000
• Marketing Materials (Business Cards, Brochures): $200 – $500

Professional Services:

• Legal Fees (Incorporation, Contracts): $1,000 – $2,000
• Accounting Services (Setup, Initial Consultation): $500 – $1,500

Employee Expenses (if applicable):

• Employee Salaries (First month): $3,000 – $6,000
• Employee Benefits (Health Insurance, Payroll Taxes): $1,000 – $3,000

Miscellaneous Expenses:

• Office Supplies: $200 – $500
• Utilities (First month): $200 – $500

Grand Total (Estimated Range): $12,500 – $31,000

For more, refer to our article on Estimating Startup Costs.

b.) Monthly Operating Costs:

Your monthly expenses will largely mirror the startup costs discussed earlier, with numerous variables influencing the final figures.

Factors such as staffing levels—whether you run the business independently or with a full team—significantly impact monthly expenses.

Additionally, the location of your business plays a pivotal role, with prime areas demanding higher costs compared to less-desirable locations.

Specific monthly expenses may vary, including loan payments, marketing initiatives, and maintenance costs. Typical expenses encompass utilities, payroll, and operational costs.

Maintaining optimal business operations and managing revenue fluctuations necessitates keeping expenses low.

However, it’s imperative to prioritize cost reduction without compromising quality, customer service, or productivity. Achieving this balance ensures the sustainability and profitability of your medical billing business over time.

Sample List of Monthly Expenses for a Mid-Sized Medical Billing Business

Again, the purpose of the list below is to focus on the items in the list more than the numbers. The numbers are a general idea, and your numbers will differ.

Loan Repayments:

• $1,000 – $3,000 (Varies based on loan amount and terms)
• Salaries for Employees: $5,000 – $10,000
• Payroll Taxes and Benefits: $1,000 – $3,000
• Electricity: $200 – $500
• Water and Sewer: $100 – $300
• Internet and Phone: $100 – $300

Office Rent or Lease:

• $2,500 – $5,000
• Liability Insurance: $200 – $500
• Workers’ Compensation: $100 – $300

Marketing and Advertising:

• Online Marketing (SEO, PPC): $500 – $2,000
• Print Advertising: $200 – $500
• Legal Consultation: $500 – $1,500
• Accounting Services: $500 – $1,500

Office Supplies and Maintenance:

• Repairs and Maintenance: $100 – $300

Software Subscriptions:

• Medical Billing Software: $200 – $500
• Other Software Tools: $100 – $300

Grand Total (Estimated Range): $11,600 – $28,000

Effective financial management is crucial for your business. By doing so, you will clearly understand its performance.

With this information and understanding you will have the ability to to manage your business with more control.

For more, see, Critical Points About Small Business Finances

5. Create Your Mission Statement

A mission statement serves as a guiding principle for your medical billing business, articulating its purpose and core values.

It helps you stay focused on your objectives and clarifies the main benefit you provide to customers and the community.

By defining your mission, you establish a clear direction for your business and align your actions with your overarching goals.

This clarity enables you to make informed decisions and prioritize activities that contribute to your business’s success.

Examples of Mission Statements for a Medical Billing Business:

• “Our mission is to streamline revenue cycle management for healthcare providers by delivering accurate, efficient, and personalized medical billing solutions.”
• “We are committed to maximizing reimbursements and minimizing administrative burden for healthcare practices through innovative billing technologies and unparalleled customer service.”
• “Our mission is to empower healthcare providers to focus on patient care by providing reliable, transparent, and cost-effective medical billing services tailored to their unique needs.”
• “At our medical billing business, we strive to enhance the financial health of healthcare organizations by optimizing revenue streams and ensuring compliance with industry regulations.”
• “Our mission is to become the trusted partner of healthcare providers nationwide, delivering comprehensive billing solutions that drive efficiency, profitability, and patient satisfaction.”

For more, see How To Create a Mission Statement.

6. Creating A Unique Selling Proposition (USP)

A Unique Selling Proposition (USP) is crucial for distinguishing your medical billing business from competitors in the market.

It helps identify and create something that sets your business apart, attracting customers and driving growth.

By highlighting your unique strengths, capabilities, or value proposition, you can effectively communicate why potential clients should choose your services over others.

Developing a clear USP enables you to target specific market segments, address customer needs more effectively, and establish a memorable brand identity.

Examples of Unique Selling Propositions for a Medical Billing Business:

• “Guaranteed Faster Reimbursements”: Offering a promise of expedited reimbursement processing compared to industry standards, ensuring healthcare providers receive payments promptly.
• “Personalized Revenue Optimization Solutions”: Tailoring billing strategies and solutions to the specific needs and goals of each healthcare practice, maximizing revenue potential and efficiency.
• “Comprehensive Compliance Assurance”: Providing comprehensive compliance services and expertise to ensure adherence to regulatory standards, reducing the risk of audits and penalties.
• “Advanced Technology Integration”: Leveraging cutting-edge billing software and technology to streamline processes, enhance accuracy, and improve overall efficiency.
• “Dedicated Customer Advocacy Team”: Offering a dedicated team of billing experts committed to advocating for clients’ financial interests, resolving issues promptly, and providing exceptional customer service.

7. Choose a Business Name

Choosing a Name for Your Medical Billing Business:

When selecting a name for your medical billing business, opt for something catchy, appropriate for the industry, easy to pronounce, and memorable.

Take your time in this process, as business names are often permanent.

Additionally, ensure the availability of a matching domain name for your online presence, and verify that your desired name isn’t already registered by another business.

Here Is a List of Sample Medical Billing Business Names:

• MedFin Solutions
• Precision Billing Services
• Apex Revenue Management
• SwiftClaim Solutions
• AccuMed Billing
• ClearView Healthcare Billing
• ProClaim Partners
• EliteMed Revenue Solutions
• VitalEdge Billing
• PrimeCare Billing Group
• AlphaMed Revenue Services
• RevenueGuard Solutions
• MedStream Billing Experts
• OptiBill Healthcare Solutions
• MedSync Billing Services
• Reliance Medical Billing
• Visionary Revenue Management
• Excelerate Billing Solutions
• AlphaClaim Healthcare Billing
• MedPro Revenue Partners
• Pinnacle Healthcare Billing
• Streamline Medical Billing
• RevenueMax Solutions
• SwiftCare Billing Experts
• NovaMed Revenue Management
• PrecisionMed Billing Group
• Optima Revenue Services
• MedWave Billing Solutions
• Summit Healthcare Billing
• PrimoMed Revenue Management

This list can serve as inspiration to spark your creativity and develop an original name that resonates with your business vision and objectives.

For more, see the following articles:

• How To Register a Business Name
• Registering a Domain Name For Your Business

8. Register Your Company

Ensuring Legal Compliance for Your Medical Billing Business:

Ensuring the legality of your medical billing business is crucial for long-term success and credibility.

Consulting with a legal professional can help ensure that your business is set up correctly, benefiting from tax advantages, mitigating liability risks, and remaining compliant with relevant regulations.

Common Types of Registrations for a Medical Billing Business:

• Sole Proprietorship: A simple and common structure where an individual operates the business.
• Partnership: Formed when two or more individuals share ownership and responsibility for the business.
• Limited Liability Company (LLC): Offers personal liability protection while maintaining flexibility in management and taxation.
• Corporation: Provides the highest level of personal liability protection but involves more complex legal requirements and formalities.

Permits and Licenses for a Medical Billing Business:

• Business License: Obtained from local authorities to legally operate your business in a specific area.
• Professional License: Depending on state regulations, medical billing professionals may require specific licenses or certifications.
• HIPAA Compliance: Ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations to protect patient information.
• Tax ID Number (EIN): Required for tax purposes and often necessary for opening business bank accounts and hiring employees.
• Sales Tax Permit: If your business sells taxable goods or services, you may need a permit to collect sales tax from customers.
• Zoning Permit: Ensures that your business location complies with local zoning regulations and is suitable for commercial use.
• Health Department Permit: If your business involves handling medical records or sensitive information, you may need a permit from the health department.

Ensuring compliance with these registrations, permits, and licenses is essential for the legality and credibility of your medical billing business.

It’s advisable to consult with legal and regulatory professionals to navigate the requirements effectively.

Registration:

• How to Register Your Business
• How To Register a DBA
• How to Register a Trademark
• How to Get a Business License

Business Structures:

• How to Choose a Business Structure
• Pros & Cons of a Sole Proprietorship
• How To Form an LLC
• How To Register a Business Partnership
• How To Form a Corporation
• How To Choose a Business Registration Service

9. Create Your Corporate Identity

A Corporate Identity (ID) is a visual representation of your business, encompassing components like your logo, business cards, website, signage, stationery, and promotional materials.

Maintaining a consistent and professional design across these elements is essential for making a lasting impression on both new and existing customers.

A cohesive corporate identity reinforces brand recognition, communicates professionalism, and builds trust with your target audience. Investing in a strong corporate identity can significantly enhance the overall perception and reputation of your medical billing business.

You can see our pages for an overview of your logo , business cards , website , and business sign , or see A Complete Introduction to Corporate Identity Packages.

10. Writing a Business Plan

A business plan serves as a vital document, essential for securing financing and attracting investors. It also acts as a guiding tool, providing direction during both the startup phase and full operation of your medical billing business.

Creating a Vision:

When crafting a business plan, you’re essentially painting a picture of what your business will look like when fully operational. This process requires significant time, consideration, and effort to articulate essential details.

Various Options Available:

You have several options for creating your business plan. You can start from scratch, enlist the help of a professional, utilize templates, or leverage specialized business plan software.

Regardless of the approach, active participation is crucial, especially when seeking external assistance.

Adaptability and Optimization:

It’s important to recognize that your business plan and operations may evolve over time.

Market changes, operational insights, and experience may prompt adjustments to your initial plan.

Regularly reviewing and optimizing your business plan ensures its relevance and effectiveness in guiding your business towards success.

Business Plan Sample Template for a Medical Billing Business

Below is a business plan that serves as a template.

You can adapt it to fit your medical billing business.

Business Plan Template for a Medical Billing Business

1. Executive Summary: Provide an overview of your medical billing business, including your mission statement, business goals, target market, competitive advantage, and financial projections.

2. Company Description: Detail your business structure, ownership, location, and legal considerations. Explain the nature of your medical billing services and your unique value proposition.

3. Market Analysis: Conduct market research to understand the demand for medical billing services, target demographics, industry trends, and competitor analysis.

4. Organization and Management: Outline the organizational structure of your business, roles and responsibilities of key personnel, and any strategic partnerships or outsourcing arrangements.

5. Services Offered: Describe the range of medical billing services you will provide, including coding, claims processing, revenue cycle management, and any additional value-added services.

6. Marketing and Sales Strategy: Detail your marketing plan , including branding, advertising, lead generation, and customer acquisition strategies. Outline your sales approach and tactics for converting leads into clients.

7. Funding Request: If seeking financing, specify the amount of funding required, its purpose, and how it will be used to support your business growth and operations.

8. Financial Projections: Present detailed financial forecasts, including income statements, cash flow projections, and balance sheets for the next three to five years.

9. Appendix: Include any additional information or supporting documents relevant to your business plan, such as resumes of key team members, market research data, legal documents, and industry certifications.

See How to Write a Business Plan for information on creating yours.

11. Banking Considerations

When selecting a bank for your medical billing business, opt for one with a strong focus on small businesses, a solid reputation, and a local presence.

Cultivating a professional relationship with your banker can provide valuable advice and support, particularly during challenging times.

Maintaining separate business accounts simplifies financial management, aiding in expense tracking and tax preparation.

Additionally, having a merchant account facilitates credit and debit card payments, enhancing customer convenience and boosting sales.

Choose your banking partner wisely to streamline financial operations and ensure smooth business transactions.

For more, see How to Open a Business Bank Account. You may also want to look at What Is a Merchant Account and How to Get One.

12. Getting the Funds for Your Operation

Securing funding for your medical billing business is crucial for a successful start.

Here are some tips to navigate the process:

• Exploring Funding Options: Investigate traditional lenders, private loans, investors, and asset sales as potential sources of funding. Additionally, research government grants tailored to small businesses.

Considerations When Meeting with a Loan Officer:

• Business Plan: Present a detailed business plan outlining your business model, target market, revenue projections, and financial forecasts.
• Credit History: Be prepared to discuss your personal and business credit history, demonstrating your ability to manage finances responsibly.
• Collateral: Understand the lender’s requirements for collateral, which may include business assets or personal guarantees.
• Loan Terms: Discuss the loan amount, interest rates, repayment terms, and any associated fees or penalties.
• Risk Assessment: Address potential risks associated with your business venture and outline strategies to mitigate them.

Documents Needed to Apply for a New Medical Billing Business Loan:

• Business Plan: A comprehensive plan detailing your business goals, strategies, and financial projections.
• Financial Statements: Provide personal and business financial statements, including income statements, balance sheets, and cash flow projections.
• Credit History: Submit your personal and business credit reports to demonstrate your creditworthiness.
• Legal Documentation: Include legal documents such as business licenses, permits, and registrations.
• Collateral Information: Provide details of any collateral you are offering to secure the loan.
• Tax Returns: Submit personal and business tax returns for the past few years to assess your financial stability.

By preparing thoroughly and providing necessary documentation, you can increase your chances of securing the funding needed to launch your medical billing business.

For more, see the following:

• Getting a Small Business Loan
• SBA Small Business Grants
• Search: Medical Billing Business Start-up Loans
• Search: Grants For a Medical Billing Business

13. Software Setup

Researching software for your medical billing business is crucial for efficient operations. Here’s why:

• Implementation Ease: It’s simpler to adopt software from the outset rather than switching systems later.
• Company Reliability: Opt for established software providers to ensure ongoing support and reliability.
• Trial Periods: Utilize demos to assess software suitability before committing.
• User Feedback: Reviews and forums offer valuable insights from other users.
• Training Availability: Check if training is provided, either by the company or external sources, to maximize software utilization.
• Financial Management: Look into software for expense tracking and financial document preparation, crucial for tax filing.

Common software types for medical billing businesses include:

• Medical Billing Software: Manages patient billing, claims processing, and reimbursement tracking.
• Practice Management Software: Facilitates scheduling, patient records management, and administrative tasks.
• Accounting Software: Tracks finances, generates invoices, and prepares financial statements.
• Electronic Health Record (EHR) Software: Records patient health information, treatment plans, and medical history.
• Data Security Software: Ensures compliance with data protection regulations and safeguards sensitive patient information.

Consulting with your accountant or bookkeeper can help determine the best software solutions for your business needs.

Check out Google’s latest search results for software packages for a medical billing business.

14. Get The Right Business Insurance

Business Insurance for a Medical Billing Business:

Importance of Insurance:

• Business insurance is crucial to protect your medical billing business against unforeseen incidents and liabilities that could arise during operations.

Comprehensive Coverage:

• Ensure your insurance coverage encompasses protection for customers, employees, yourself, visitors, property, and other potential liabilities associated with your business activities.

Professional Liability Insurance:

• Consider acquiring professional liability insurance, also known as errors and omissions insurance, to safeguard your business against legal claims and lawsuits arising from errors or negligence in your services.

Business Interruption Insurance:

• Business interruption insurance provides financial coverage in the event of an involuntary shutdown due to unforeseen circumstances such as natural disasters, fires, or other incidents. It helps cover lost income and operating expenses during the period of disruption, ensuring continuity of your business.

Home-Based Business Considerations:

• If you operate or manage your medical billing business from home, inform your home insurance provider about your business activities. Operating a business from home could impact your existing home insurance policy, so it’s essential to ensure proper coverage for your business operations.

Expert Guidance:

• Utilize the expertise of a competent insurance broker to assess your business’s unique insurance needs and recommend suitable coverage options. An experienced broker can help you navigate through various insurance policies and ensure you have adequate protection tailored to your business requirements.

Continuous Review:

• Regularly review your insurance coverage to accommodate any changes in your business operations, growth, or new risks that may emerge over time. Keeping your insurance policies up-to-date ensures comprehensive protection for your medical billing business against potential liabilities and risks.

For more, see What to Know About Business Insurance . You can also browse the latest Google search results for medical billing business insurance .

15. Suppliers and Service Providers

Importance of Supplier and Service Provider Relationships:

Crucial Partnership:

• Establishing strong relationships with suppliers and service providers is essential for the success of your business operations.

Reliability and Trustworthiness:

• Reliable and trustworthy suppliers ensure consistent access to quality products and services, minimizing disruptions in your business operations.

Cost Efficiency:

• Partnering with reputable suppliers allows you to negotiate competitive prices, enabling you to offer cost-effective solutions to your customers while maximizing your profit margin.

Inventory Management:

• Suppliers play a vital role in inventory management, ensuring that you always have the necessary supplies to meet customer demands and maintain operational efficiency.

Mutual Benefit:

• Treating suppliers and service providers with respect and ensuring mutual financial benefit fosters a positive working relationship, leading to long-term collaboration and support.

Items and Services from Suppliers and Service Providers:

• Medical billing software and technology solutions
• Office supplies and equipment (computers, printers, etc.)
• Billing and coding resources and reference materials
• Training and education programs for staff
• IT support and maintenance services
• Data security and compliance solutions
• Marketing and promotional materials
• Legal and regulatory compliance services
• Financial services (accounting, bookkeeping, etc.)
• Customer support and assistance services

For more information, see How To Choose a Supplier.

16. Setting Prices

Benefits of Researching Pricing for Starting a Medical Billing Business:

Optimized Sales Strategy:

• Researching pricing allows you to develop a competitive pricing strategy tailored to your target market, maximizing sales potential.

Profit Maximization:

• By setting prices appropriately, you can ensure profitability and cover operational expenses without compromising quality or service.

Market Alignment:

• Understanding the current market landscape enables you to align your pricing with industry standards and customer expectations, enhancing market acceptance and competitiveness.

Value Emphasis:

• Researching pricing allows you to emphasize the value proposition of your services, ensuring that customers perceive your offerings as worthwhile investments.

Balanced Approach:

• Striking a balance between competitive pricing and value perception ensures that you attract customers while maintaining profitability, contributing to the long-term sustainability of your medical billing business.

See the following for more:

• Setting the Price of Your Products and Services
• Search Results for Pricing Strategies for a Medical Billing Business.

17. Physical Setup

Considerations for Medical Billing Business Layout:

• Efficiency: Arrange workstations and equipment to optimize workflow and minimize unnecessary movement.
• Accessibility: Ensure easy access to essential tools, documents, and resources to streamline tasks.
• Safety: Implement safety protocols and ergonomic designs to prevent accidents and promote employee well-being.
• Privacy: Maintain confidentiality by creating designated areas for sensitive information and client interactions.

Business Signs:

• Main Business Sign: Install a prominent sign displaying your business name and logo for visibility and brand recognition.
• Interior Signs: Add signs to guide clients to relevant areas such as waiting rooms, consultation rooms, and restrooms.
• Safety Signs: Place signs near exits, emergency exits, and hazardous areas to ensure compliance with safety regulations.
• Professionalism: Invest in well-designed signs that reflect professionalism and attention to detail, enhancing the overall image of your business.

Office Setup:

• Time Management: Organize your office layout to facilitate efficient time management and task prioritization.
• Productivity: Maintain a clutter-free workspace to minimize distractions and maximize productivity.
• Equipment: Ensure your office is equipped with necessary tools, software, and technology to support effective business operations.
• Organization: Implement storage solutions and filing systems to keep documents and supplies organized and easily accessible.
• Comfort: Create a comfortable and ergonomic work environment to promote employee satisfaction and well-being, ultimately enhancing productivity and performance.
• Considerations for the Setup of Your Office
• Considerations for Your Company Sign.

18. Creating a Website

Importance of a Website for Your Medical Billing Business:

A website serves as the primary platform for your medical billing business, offering vital information about your services, products, and promotions. Unlike social media accounts, a website provides full control and ownership when you host and register a domain name.

Key Functions of a Website:

• Contact Point: Acts as the main point of contact for potential clients, providing essential information about your business.
• Marketing Tool: Utilize your website for marketing purposes, including blogging about industry insights and tips to establish credibility and expertise.
• Customer Engagement: Engage with customers by offering valuable content tailored to their needs, fostering trust and loyalty.

In summary, a website is indispensable for your medical billing business, offering control, credibility, and a platform for effective customer engagement and marketing strategies.

For more, see How to Build a Website for Your Business .

19. Hiring Employees

Running a Medical Billing Business: Considerations for Growth

Solo Operation vs. Hiring Employees:

• Running your medical billing business alone initially can help control costs, especially during the early stages.
• Payroll expenses are significant, particularly at the outset, making solo operation an attractive option.

Transitioning to Hiring Employees:

• As your business expands, managing it alone may become overwhelming, necessitating the hiring of employees.
• Hiring qualified personnel with strong work ethics is crucial for maintaining business efficiency and reputation.

Job Positions or Outsourced Services for a Growing Medical Billing Business:

• Billing Specialist: Handles claim submissions, payment processing, and insurance verification.
• Coding Specialist: Ensures accurate medical coding for claims submission and compliance with industry standards.
• Accounts Receivable Specialist: Manages outstanding invoices, follows up on unpaid claims, and reconciles accounts.
• Customer Service Representative: Provides assistance to clients, resolves billing inquiries, and maintains positive client relationships.
• IT Support: Manages technical infrastructure, troubleshoots software issues, and ensures data security.
• Marketing Specialist: Develops marketing strategies, manages online presence, and generates leads to attract new clients.
• Compliance Officer: Ensures adherence to healthcare regulations, conducts audits, and implements compliance measures.
• Outsourced Services: Consider outsourcing tasks such as bookkeeping, payroll processing, or legal compliance to specialized firms to streamline operations and focus on core business functions.

By considering these job positions or outsourced services, you can effectively scale your medical billing business while maintaining operational efficiency and quality service delivery.

For more, see How and When to Hire a New Employee.

20. Getting Customers Through the Door

When you have reached this step, your business is set up and ready to go, with one more final step, which is important: getting customers through the door.

There are numerous ways to do this, like advertising, having a grand opening , word of mouth, etc.

The following sections will give you a few ideas to spark your creativity and draw attention to your new medical billing business.

In this step, we’ll cover the following sections:

a.) Marketing Considerations b.) The Market Can Guide You c.) Sample Ad Ideas d.) Joint Venture Ideas

Let’s dig a little deeper into the following sections.

a.) Marketing Considerations

Attracting Customers to Your Medical Billing Business:

Establishing a customer base is essential for the success of your medical billing business.

Initially, attracting customers may pose challenges as awareness of your services is limited. However, with time and a solid reputation, customer acquisition becomes more manageable, aided by accumulated marketing experience.

Ongoing Marketing Efforts:

Continuous marketing efforts are vital for sustained growth. Investing in effective marketing techniques yields higher revenue potential over time.

While hiring a marketing agency or expert is an option, it’s not always necessary, especially for smaller businesses.

Simple Methods to Promote Your Business:

• Networking : Attend industry events, conferences, and local business gatherings to network with healthcare professionals and potential clients. Establishing personal connections can lead to referrals and new business opportunities.
• Online Presence : Create a professional website showcasing your services, expertise, and client testimonials. Utilize social media platforms like LinkedIn and Facebook to engage with your target audience and share relevant content.
• Email Marketing : Develop an email list of prospects and existing clients to send regular updates, newsletters, and promotional offers. Email marketing is a cost-effective way to stay connected and nurture client relationships.
• Referral Program : Implement a referral program offering incentives to existing clients or business partners for referring new clients to your medical billing services. Word-of-mouth referrals can be a powerful driver of business growth.
• Local Advertising : Utilize local advertising channels such as community newspapers, radio ads, or flyers distributed in healthcare facilities to reach potential clients in your area.

By leveraging these simple methods, you can effectively raise awareness of your medical billing business and attract the right customers to support its growth and success.

See How To Get Customers Through the Door and our marketing section for ideas on promoting your business.

b.) The Market Can Guide You

Staying Attuned to Customer Demand in Your Medical Billing Business:

In business, it’s crucial to remain attentive to customer needs and market trends. While you may have a clear vision for your medical billing business, it’s essential to recognize potential shifts in demand.

If market indicators consistently point to a variation or additional service that customers desire, consider the opportunity carefully. Ignoring these signs could mean missing out on a chance to expand and thrive in the competitive landscape.

Ultimately, the decision rests with you as the business owner, but staying open to market feedback can lead to long-term success and sustained growth for your business.

c.) Sample Ad Ideas

1. Headline: “Maximize Your Revenue with Expert Medical Billing Services!” Are unpaid claims impacting your practice’s profitability? Our specialized medical billing team ensures accurate coding, prompt claim submission, and diligent follow-up to optimize your revenue cycle. Let us handle the complexities of billing while you focus on patient care. Contact us today for a consultation!

2. Headline: “Streamline Your Billing Process with Our Professional Services!” Struggling with inefficient billing processes? Our experienced medical billing experts offer tailored solutions to streamline your revenue cycle, minimize claim denials, and improve cash flow . Take the hassle out of billing and enhance your practice’s financial performance. Reach out to us now!

3. Headline: “Unlock Your Practice’s Financial Potential with Our Billing Solutions!” Ready to unlock your practice’s full financial potential? Our comprehensive medical billing services leverage advanced technology and industry expertise to maximize your reimbursements and reduce billing errors. Partner with us to achieve financial success and practice growth. Inquire today!

4. Headline: “Say Goodbye to Billing Headaches with Our Proven Solutions!” Tired of dealing with billing headaches? Let our dedicated team handle your medical billing needs with precision and efficiency. From claim submission to payment posting, we ensure seamless operations and optimized revenue. Experience peace of mind with our reliable billing solutions. Contact us now!

5. Headline: “Drive Revenue Growth with Our Trusted Medical Billing Services!” Seeking to drive revenue growth for your healthcare practice? Our trusted medical billing services are tailored to meet your unique needs, delivering accurate coding, timely claim submission, and effective denial management. Partner with us to achieve sustainable financial success. Connect with us today!

d.) Joint Venture Ideas

Approachable Businesses for Joint Ventures:

• Medical Practices : Partnering with medical practices allows for mutual referrals and collaboration on patient billing and revenue cycle management solutions.
• Healthcare Consulting Firms : Collaborating with healthcare consulting firms can offer complementary services, such as revenue optimization strategies and compliance assistance, benefiting both parties and their clients.
• Insurance Agencies : Joint ventures with insurance agencies can facilitate seamless claims processing and improve reimbursement rates for healthcare providers, enhancing client satisfaction and revenue outcomes.
• Healthcare IT Companies : Partnering with healthcare IT companies enables access to advanced billing software solutions and technical support, enhancing billing efficiency and accuracy for both businesses’ clients.
• Medical Equipment Suppliers : Joint ventures with medical equipment suppliers can provide bundled service offerings, combining medical billing services with equipment leasing or purchasing options for healthcare providers.
• Pharmacies and Medical Supply Companies : Collaborating with pharmacies and medical supply companies can offer integrated billing solutions for prescription medications and durable medical equipment, streamlining billing processes for healthcare providers.
• Legal Firms Specializing in Healthcare Law : Partnering with legal firms specializing in healthcare law can provide expertise in compliance, contract negotiation, and dispute resolution, ensuring regulatory compliance and risk mitigation for healthcare clients.
• Telemedicine Providers : Joint ventures with telemedicine providers can offer comprehensive virtual care solutions, including billing services for telehealth visits, expanding service offerings and client reach in the digital healthcare space.
• Medical Billing Software Companies : Collaborating with medical billing software companies allows for integration of billing platforms, offering seamless data exchange and enhanced functionality for mutual clients.
• Wellness Centers and Integrative Medicine Practices : Partnering with wellness centers and integrative medicine practices can offer holistic healthcare solutions, combining medical billing services with alternative therapies and wellness programs for comprehensive patient care.

Approaching these businesses for potential joint ventures can lead to mutually beneficial partnerships that expand service offerings, increase client satisfaction, and drive business growth for all parties involved.

Also see How To Create A Joint Venture

Points To Consider

Next, for your medical billing business, let’s review essential points to consider

We will cover sections, including tips to improve the setup of your medical billing business, equipment, alternatives to starting from scratch, and more.

After that, you’ll reach the “Knowledge Is Power” segment, where you can access resources containing valuable information.

Key Points to Succeed in a Medical Billing Business

Critical Points to Succeed in the Setup Phase of a Medical Billing Business:

• Market Research : Conduct thorough market research to understand the demand for medical billing services, identify target clients, and assess competition.
• Business Plan : Develop a comprehensive business plan outlining goals, target market, pricing strategy, and financial projections to guide business operations and secure funding.
• Legal and Regulatory Compliance : Ensure compliance with healthcare regulations, obtain necessary licenses and permits, and establish policies and procedures to protect patient privacy and billing integrity.
• Technology Infrastructure : Invest in reliable billing software, electronic health record (EHR) systems, and IT infrastructure to streamline operations, ensure data security, and facilitate efficient billing processes.
• Client Acquisition Strategy : Develop a marketing plan to attract clients, including healthcare providers, medical practices, and facilities, through targeted advertising, networking, and referrals.
• Staffing : Recruit and train skilled staff with expertise in medical billing, coding, and customer service to handle client inquiries, claims processing, and revenue cycle management effectively.

Critical Points to Succeed in the Operation Phase of a Medical Billing Business:

• Efficient Workflow Management : Implement efficient workflow processes to handle billing inquiries, claim submissions, and payment collections promptly and accurately.
• Quality Assurance : Establish quality assurance measures to ensure coding accuracy, claims completeness, and compliance with payer requirements, reducing the risk of claim denials and revenue loss.
• Client Communication : Maintain regular communication with clients to provide updates on billing progress, address concerns, and offer proactive solutions to optimize revenue performance.
• Staff Training and Development : Provide ongoing training and professional development opportunities for staff to stay updated on industry changes, enhance skills, and improve job performance.
• Employee Turnover Management : Implement strategies to reduce employee turnover , such as competitive compensation, performance incentives, and a positive work culture, to maintain continuity and consistency in operations.
• Client Retention Strategies : Develop client retention strategies, including personalized service, value-added offerings, and responsiveness to client needs, to foster long-term relationships and loyalty.
• Continuous Improvement : Regularly assess business performance , solicit client feedback, and identify areas for improvement to adapt to changing industry trends and maintain competitiveness in the market.

Ideas to Make a Medical Billing Business Stand Out:

• Specialized Services : Offer specialized services tailored to specific medical specialties or niche markets, such as pediatric billing or mental health billing, to attract clients seeking expertise in their field.
• Advanced Technology : Utilize cutting-edge billing software and electronic health record (EHR) systems to streamline processes, improve accuracy, and enhance client satisfaction.
• Transparency and Communication : Maintain open communication channels with clients, providing regular updates on billing progress, claims status, and industry developments to build trust and loyalty.
• Customized Solutions : Develop customized billing solutions to address the unique needs and challenges of individual healthcare providers or practices, offering personalized service and value-added benefits.
• Compliance Expertise : Position the business as a compliance expert by staying aware of changing healthcare regulations and ensuring clients’ billing practices align with legal requirements, reducing the risk of audits and penalties.
• Educational Resources : Provide educational resources and training sessions for clients on billing best practices, coding updates, and revenue cycle management strategies to empower them and improve overall billing efficiency.
• Value-Added Services : Offer additional services beyond basic medical billing, such as credentialing assistance, revenue cycle analysis, or denial management, to differentiate the business and meet evolving client needs.
• Outstanding Customer Service : Prioritize exceptional customer service by offering prompt responses to inquiries, resolving issues efficiently, and demonstrating a commitment to client satisfaction.
• Performance Metrics Reporting : Implement performance metrics reporting tools to provide clients with detailed insights into their billing performance, identifying areas for improvement and demonstrating value-added services.
• Industry Partnerships : Collaborate with other healthcare service providers, such as medical practices, billing consultants, or insurance companies, to expand service offerings, enhance credibility, and access new client networks.

Ideas for Add-ons for a Medical Billing Business:

• Credentialing Services : Offer assistance with provider credentialing and enrollment in insurance networks, streamlining the onboarding process for new healthcare providers.
• Telemedicine Billing : Provide specialized billing services for telemedicine visits, including coding, claim submission, and reimbursement optimization, to support the growing demand for virtual care.
• Patient Payment Solutions : Integrate patient payment solutions, such as online payment portals or payment plans, to facilitate timely collections and improve revenue cycle management for healthcare practices.
• Revenue Cycle Analysis : Offer comprehensive revenue cycle analysis services to identify inefficiencies, optimize revenue streams, and maximize profitability for healthcare providers.
• Compliance Auditing : Conduct compliance audits to assess billing practices, coding accuracy, and regulatory compliance for healthcare practices, mitigating risks and ensuring adherence to industry standards.
• Financial Consulting : Provide financial consulting services to healthcare practices, offering guidance on budgeting, cash flow management, and financial planning to support long-term financial stability and growth.

Hours of Operation:

Operating hours typically align with standard business hours, such as Monday to Friday, 9:00 AM to 5:00 PM, to accommodate client inquiries and communication with healthcare providers.

Tasks Requiring After-Hours Attention:

Tasks like data entry, reconciling accounts, and updating records may be best completed after hours to minimize disruptions during peak client interaction times.

Equipment and Supplies

A List of Equipment and Supplies to Consider for a Medical Billing Business:

• Computer : Essential for accessing billing software, managing databases, and communicating with clients and healthcare providers.
• High-Speed Internet Connection : Reliable internet access is necessary for electronic billing, communication, and research.
• Printer : Used for printing invoices, reports, and other documentation required for billing purposes.
• Scanner : Enables the digitization of paper documents, such as patient records and insurance forms, for electronic storage and processing.
• Fax Machine or Online Fax Service : Some healthcare providers and insurance companies still rely on fax for document transmission.
• Telephone System : Allows communication with clients, healthcare providers, and insurance companies for inquiries and follow-ups.
• Headset : Useful for hands-free communication during phone calls, especially for extended periods.
• Office Furniture : Includes desks, chairs, filing cabinets, and shelves for organizing paperwork and maintaining an efficient workspace.
• Backup Power Supply : Prevents data loss and downtime during power outages, ensuring uninterrupted operations.
• Security Software : Protects sensitive patient information and billing data from cyber threats, including antivirus, firewall, and encryption tools.
• Document Management Software : Facilitates the organization, storage, and retrieval of electronic documents, such as patient records and insurance forms.
• Accounting Software : Manages financial transactions, invoicing, and expense tracking for accurate bookkeeping.
• Postal Scale and Postage Meter : Required for accurately weighing and affixing postage to outgoing mail, such as invoices and claims.
• Shredder : Safely disposes of sensitive documents and protects patient privacy by securely disposing of outdated records and billing information.
• Office Supplies : Includes paper, pens, folders, envelopes, and other supplies necessary for daily administrative tasks.

Ensure to assess specific business needs and regulations to determine any additional equipment or software required for efficient medical billing operations.

See the latest search results for medical billing equipment.

Focusing on your skill set is crucial before starting a medical billing business.

Evaluate whether you possess the necessary skills, such as attention to detail, organizational skills, knowledge of medical terminology, and proficiency in billing software.

If lacking, consider learning or hiring someone with the required expertise. This ensures efficient operations and maximizes business success .

Essential Skills for a Medical Billing Business Owner:

• Attention to Detail : Accuracy is vital in medical billing to avoid errors and ensure proper reimbursement.
• Organizational Skills : Managing multiple tasks, schedules, and deadlines efficiently is essential for smooth operations.
• Medical Terminology Knowledge : Understanding medical terminology facilitates accurate coding and billing processes.
• Technical Proficiency : Competence in using billing software and electronic health records (EHR) systems is crucial for efficient workflow.
• Communication Skills : Clear communication with healthcare providers, insurance companies, and patients is necessary for resolving billing issues and inquiries.
• Problem-Solving Abilities : Addressing billing discrepancies and resolving payment issues requires effective problem-solving skills.
• Compliance Knowledge : Understanding healthcare regulations and compliance standards ensures adherence to legal requirements.
• Financial Management : Managing accounts receivable, tracking payments, and budgeting are essential for financial sustainability.
• Customer Service : Providing excellent customer service to patients and clients fosters trust and loyalty.
• Adaptability : The ability to adapt to changes in healthcare regulations, technology, and industry trends is crucial for long-term success.

For more, see The Essential Skills To Run a Business

Considering a Medical Billing Business For Sale

Benefits of Buying an Established Medical Billing Business:

• Immediate Revenue : Acquiring an existing business allows you to start earning revenue from day one, bypassing the lengthy startup phase.
• Skip Startup Challenges : Avoid the challenges and uncertainties associated with starting a business from scratch, such as establishing processes and acquiring initial clients.
• Assessment of Viability : By reviewing the business’s financial records and performance history, you can assess its profitability and viability before making an investment.
• Known Financials : Access to detailed financial records provides insights into revenue, profit margins, and expenses, aiding in informed decision-making.
• Established Customer Base : Acquiring an existing business means inheriting its customer base, providing immediate access to clients and potential revenue streams.
• Reputation : An established business typically has built a reputation within the industry and community, potentially reducing marketing efforts and accelerating growth.

Drawbacks of Buying an Established Medical Billing Business:

• Higher Initial Cost : The purchase price of an existing business is often higher due to factors like goodwill, which reflects the value of the established customer base and reputation.
• Resistance to Change : Implementing significant changes to the business’s operations or services may risk alienating existing customers, leading to potential revenue loss.
• Inherited Reputation : Acquiring a business means inheriting its reputation, whether positive or negative, which can impact customer perception and retention.

Considering these factors can help you make an informed decision when evaluating the purchase of an established medical billing business.

The latest search results for a medical billing business for sale and others in the same category.

See our article on performing due diligence for buying a business if you find something promising.

Franchise Opportunities Related to a Medical Billing Business

Pros of Owning a Franchise:

• Proven Business Model : Franchises provide a structured plan established by the corporate office, reducing the need for extensive market research and planning.
• Brand Reputation and Marketing : Leveraging an established brand’s reputation and marketing efforts can accelerate business growth and customer acquisition.
• Comprehensive Training : Franchise owners receive thorough training and support from the corporate office, ensuring they understand all aspects of the business.
• Corporate Support : Ongoing support from the corporate office includes assistance with operations, marketing, and troubleshooting.

Cons of Owning a Franchise:

• High Initial Investment : Franchise ownership often requires a substantial initial investment, including franchise fees, startup costs, and ongoing royalties.
• Limited Autonomy : Franchisees must adhere to corporate guidelines and policies, limiting the flexibility to make independent business decisions.
• Restrictions on Products and Services : Franchise agreements typically dictate which products or services can be offered, limiting diversification opportunities.
• Operational Constraints : Franchisees are bound by the terms of the franchise agreement, restricting the ability to innovate or customize business operations.
• Ongoing Fees : Franchisees are required to pay ongoing royalties and fees to the franchisor, affecting profitability.

Exploring franchise opportunities in related industries may uncover options suitable for a medical billing business. Utilize the provided link to explore potential franchise options within the healthcare or service sectors.

See the latest search results for franchise opportunities related to this industry.

Knowledge Is Power if You Use It!

There are many sources of information that you may not have considered to increase your knowledge for starting and running a medical billing business.

The good news is that the sections below cover a lot of material, and I have made it easy for you by providing links to search results.

You don’t have to focus on what to look for; instead, click the links that interest you and explore the search results.

You can explore now or bookmark this page to return another time.

Terminology

Being familiar with the terminology in your industry is a must. You can pick it up as you gain more experience.

For now, you can see the list below to get you started.

• CPT Codes: Current Procedural Terminology codes used to describe medical procedures and services provided by healthcare providers.
• ICD Codes: International Classification of Diseases codes used to classify and code diagnoses, symptoms, and medical conditions.
• HCPCS Codes: Healthcare Common Procedure Coding System codes used to identify medical services, supplies, and equipment.
• Superbill: A document completed by healthcare providers listing services rendered to a patient during a visit, used for billing purposes.
• EOB: Explanation of Benefits provided by insurance companies detailing the services covered, amounts paid, and patient responsibility.
• CMS-1500 Form: Standard claim form used by healthcare providers to bill Medicare and Medicaid for services rendered.
• UB-04 Form: Standard claim form used by hospitals and other facilities to bill for inpatient and outpatient services.
• Clearinghouse: A third-party service that processes and submits medical claims electronically to insurance companies.
• Accounts Receivable (AR): Amounts owed to a medical billing business for services rendered but not yet collected.
• Denial Management: Process of investigating and appealing denied claims to ensure proper reimbursement.
• Revenue Cycle Management (RCM): Process of managing the financial aspects of patient care, including billing, payments, and collections.
• Credentialing: Process of verifying the qualifications and credentials of healthcare providers to participate in insurance networks.
• Compliance: Adherence to laws, regulations, and ethical standards in medical billing practices.
• Charge Capture: Process of accurately recording services provided to patients for billing purposes.
• Electronic Health Record (EHR): Digital record of patient health information, including medical history, diagnoses, and treatments.
• Coordination of Benefits (COB): Process of determining primary and secondary insurance coverage for a patient with multiple insurance policies.
• Fee Schedule: List of predetermined fees for medical services and procedures established by insurance companies or healthcare providers.
• Copayment: Fixed amount paid by the patient for covered medical services at the time of the visit.
• Deductible: Amount that the patient must pay out of pocket for covered medical expenses before insurance coverage begins.
• Claim Adjudication: Process of reviewing and processing medical claims to determine payment or denial by insurance companies.

Trends and Statistics

Monitoring industry trends and statistics offers insights into market dynamics, helping medical billing businesses adapt strategies.

Understanding trends aids in decision-making, staying competitive, and identifying opportunities for growth.

Statistical analysis provides data-driven approaches for efficiency and informed decision-making in the medical billing sector.

See the latest search results for trends and statistics related to the medical billing industry.

Associations

Trade associations provide benefits such as industry news updates and networking opportunities for members.

Staying informed about industry trends and regulations enhances business acumen, while networking fosters professional connections beneficial for growth and collaboration within the sector.

See the search results for associations for a medical billing business and the benefits of Joining the Chamber of Commerce.

The Top Medical Billing Companies

Analyzing an established medical billing business can inspire new ideas and reveal industry gaps for competitive advantage.

Identify overlooked services or areas where you can differentiate yourself. This analysis aids in refining strategies and positioning your business effectively in the market.

See the latest search results for the top medical billing companies.

Customer Expectations

Analyzing search results for customer expectations in medical billing provides valuable insights to meet and exceed their needs.

Understanding their perspectives helps in addressing potential issues and ensuring comprehensive service delivery. Take the time to review and adapt strategies to align with customer expectations for better satisfaction.

See the search results related to customer expectations for medical billing.

Tips For Medical Billing

Reviewing medical billing tips benefits both experts and novices.

Experts may discover new approaches or perspectives, while novices gain valuable insights for skill enhancement and knowledge improvement.

Utilize tips to refine your skill set and broaden your understanding of medical billing practices.

See the latest search results for medical billing to gain tips and insights.

Tips for Running a Medical Billing Business

Exploring tips and insights for managing a medical billing business enhances knowledge and offers ideas for improvement.

Additionally, learning how to avoid common issues is valuable for maintaining efficiency and success in the industry.

See the latest search results about insights into running a medical billing business.

What To Avoid When Running a Medical Billing Business

Reviewing others’ mistakes in medical billing business can help avoid similar pitfalls. Utilize resources to learn from others’ experiences and refine your approach for success.

Explore the provided link for valuable insights into what to avoid in managing your medical billing business.

See the latest search results about mistakes to avoid in your medical billing business.

Interviews With Medical Billing Business Owners

Interviews with experienced individuals in medical billing provide valuable insights and tips for industry knowledge.

Learning from their experiences offers practical advice on effective strategies and pitfalls to avoid.

These insights are invaluable for expanding your understanding and refining your approach to running a successful medical billing business.

See the latest search results for interviews with medical billing business owners.

Publications offer tips and insights on medical billing, providing valuable information for practitioners.

Journals, magazines, and online articles cover industry trends, regulatory updates, and best practices. Stay informed through reputable publications to enhance your expertise in medical billing.

See the search results for medical billing books.

Discussion Forums

Engage in medical billing discussion forums to network and gain insights from industry peers.

Understanding customer perspectives through dialogues helps in enhancing your business strategies and services.

See the latest search results related to medical billing discussion forums.

Enroll in online or local courses to enhance skills and knowledge for operating a medical billing business effectively.

These courses offer structured learning opportunities to improve proficiency and stay updated with industry practices.

See the latest courses that could benefit a medical billing business owner . Also, see our management articles for tips and insights for managing your business.

Subscribing to leading medical billing blogs provides industry insights and updates. Regularly review and unsubscribe from inactive or low-value blogs to curate a valuable collection.

This ensures a steady stream of relevant information for staying informed.

Look at the latest search results for top medical billing blogs to follow.

Service Based Business Tips

Analyzing data in the service sector aids in managing and optimizing a medical billing business for long-term success.

Continuous improvement strategies based on sector insights enhance operational efficiency and sustainability.

Look at the latest search results for service tips and insights to follow.

The news serves as a valuable source for staying informed about medical billing topics covered by the media.

Regular updates and in-depth coverage provide insights into industry trends, policy changes, and emerging issues. Stay tuned to reputable news sources to stay up to date of developments in this field.

See the latest results for medical billing news.

YouTube is a valuable resource for visual learners interested in medical billing. With daily updates and related video suggestions, it offers a wide range of informative content. Explore various channels to deepen your understanding of this topic.

YouTube videos related to medical billing.

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Start a Medical Billing Business

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MEDICAL BILLING BUSINESS

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How to Write a Business Plan for an Outpatient Medical Practice

Noah Parsons

16 min. read

Updated February 7, 2024

Free Download:  Sample Medical Practice Business Plan Template

So you’re thinking about starting your own outpatient medical practice.

You probably have many good reasons to open a private practice. Private practices can be lucrative, although it requires you to spend time building relationships with patients while also attending to all business processes that are part of running your practice .

Maybe you want more autonomy over your practice and your workflow. Or maybe you hope to expand your services to underserved areas or specific populations based on your expertise.

If you’re thinking about starting an outpatient medical practice, one of the first things you should do is write a business plan. Even if you’re able to self-fund your practice and don’t need outside investment, your business plan is a great tool for thinking through all the different aspects of building a profitable and sustainable practice.

You should go into this thinking about your business plan as a living document, not something you do once and then file away forever. Use it as a tool, especially around your financials. Revisit and update it regularly by comparing your forecasts to your actuals and adjusting as necessary.

To help you get started, you can download our free business plan template . If you’ve never written a business plan before, Bplans also offers a library of sample medical business plans that you can review or even download to use as a model.

• Executive summary

The first section that will appear in your business plan is the executive summary . But before you dive right in, it’s the section of your plan that you should actually write last. It’s a summary and an overview of your outpatient medical practice and your plans, so it will be easy to put together after you’ve written the rest of your plan.  

Executive summaries are short—keep it to one to two pages. Keep in mind that if you’re using your plan to get funding, investors and banks tend to read your executive summary to get a sense of whether to read on and consider your request. Do not neglect it; just write it last.

Your executive summary will include the following sections:

• Who you are: Your business name, location, and contact information.  
• What you offer and the problem your business solves: What does your practice offer and why is it needed? This is your value proposition .
• Target market: Who is your ideal patient? Do they self-pay or use insurance? Be specific.
• Competition: Who else is offering similar services?
• Team: Who is on your management team?
• Financial summary: Explain your business model, startup costs, revenues, and liabilities to the company. Mention your funding needs.
• Milestones and traction: How have you validated that there’s a need for your practice in your location?

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Now that you’re familiar with what’s included in your executive summary, tuck that information away, and get to work on the rest of your plan.

Think of the next few sections of your plan as the overarching description of your practice’s business opportunity. You’ll cover the problem you’ve identified and the solution that your practice offers. Then you’ll think through your ideal customer , your competition , and your opportunities for growth . This section area should describe the services you provide and how they benefit your patients.

• Problem and solution

First, describe the problem that you’ve identified and how your practice solves that problem. Here’s a brief example:

The problem : There is a lack of affordable pediatric and gynecological care available in coastal areas of Lane County, Oregon. Many patients have to travel miles to the closest practice.  

The solution : Dr. Gardner plans to open Ocean Lane Outpatient Care to serve smaller Oregon coastal communities scattered outside of major towns with major hospitals. Due to her focus on pediatric and gynecological care, Dr. Gardner’s particular services are especially valuable in this location due to the lack of available service providers in the area. Dr. Gardner’s practice will accept private insurance and Medicaid, as well as a sliding scale for patients in a certain income bracket.   

The services section identifies what kind of medical practice you are opening. Restate who your practice serves and what kind of services you specialize in. Talk about how your practice approaches treatment and what goals you have in addition to providing quality care. Here’s an example from a sample business plan for a medical practice.

Include a breakdown of all services furnished by the clinic, being as granular as possible. For example:

Gynecology:

• Annual women’s wellness exam

Pediatrics:

• Immunizations
• Youth eating disorder treatment
• Target market

Next, talk about your ideal patients. If you’re in the earliest stages, you’ll want to do some research that verifies your hypotheses.

For example, Dr. Gardner would have needed to verify her assumption that people in coastal towns in Oregon are in need of pediatric and gynecological services—a need that isn’t currently satisfied by available resources.

A formal market analysis can help verify that there’s a need for your particular practice in your intended location.  

Your target market section should include:

• TAM, SAM, and SOM: Total Available Market (TAM), Segment of the Available Market (SAM), Share of the Market (SOM). Here, you are looking at the difference between targeting everyone: TAM (all people who need medical care—so all humans in your area), versus your ideal clients: SAM (maybe this is those with certain insurance or ability to self-pay), versus the number of new patients you think you can realistically reach: SOM, especially within your first few years. The idea is that not everyone will be an ideal patient. It matters because you can waste a lot of money with marketing outreach to everyone, instead of targeting a specific population that is more likely to be looking for your services.
• Buyer persona : Imagine there’s one specific patient who represents your ideal patient. Be specific. Maybe she’s 34 years old, has private insurance, is relatively healthy, but needs more regular medical care and advice.  
• Competition and competition matrix : List competitors and analyze what makes them competitive. For instance, your competitors might be large hospitals because of the wide range of services they offer. You might also be competing with local chiropractors or other alternative medicine practices that already have a foothold in local communities.
• Future products and services : Name the products/services you will offer as your practice grows and earns more money and as your patients develop new needs. Maybe you will want to open a second location when you gain enough patients. Or maybe you will want to extend your practice’s hours of operation.

Ideal patient profile

Your ideal patient profile identifies the type of patient whom you hope to attract and retain. To clarify, this does not mean you only serve your ideal patient type. Rather, focusing your outreach efforts on attracting your ideal patient will allow you to grow your practice more effectively than targeting a large number of patients who may or may not be in the market for your practice’s specialty.

When developing your ideal patient profile, consider:

• Who you enjoy working with
• Who needs the services you provide
• Who can and will pay your pricing (or have an insurance plan that you want to accept)

For instance, because Dr. Gardner specializes in preventive and curative care, a patient seeking palliative treatment for terminal cancer is not the ideal patient. This patient would not receive the best care for their needs from Dr. Gardner’s services.

Acquiring a new patient is six to seven times more expensive than retaining a current patient. In order to support and retain current patients, develop a strategy to proactively meet their needs and set benchmarks to measure the success of your strategy.

• Execution: How your practice will respond to the opportunity

First, your business plan laid out the opportunity at hand. Now, the rest of your plan will focus on how to take advantage of that opportunity. Now is the time to lay out what you’ll do to attract patients and set up a viable business model with healthy financials.

Components of this section include:

• Your marketing and sales plan
• Strategic partnerships or alliances
• Your operations plan
• Your team and company information
• Financial plan
• Milestones and metrics that you’ll need to hit to be viable
• Your key assumptions and risks
• Your funding ask and exit strategy, if applicable
• Marketing and sales plan

The marketing and sales component of your plan should include how you plan to reach the patients in your target market, how you’ll bill for your services, and what you need to do to bring in the right number and type of patients.

• Positioning : Describe how you will present your company to your customers with your positioning statement . Think about answering these questions: What are you offering your patients that they can’t get elsewhere? Why should they pick you instead of another practice? Where do you see yourself in the competitive landscape? Use this model to help:

“For [target market description] who [target market need], [how our business offering meets the need]. Unlike [key competition], it [most distinguishing feature].”

For [coastal community members] who [require gynecological care], Ocean Lane Outpatient Care [provides both pediatric and women’s health services]. Unlike [other area medical practices], Ocean Lane Outpatient Care is [conveniently located near the communities it serves and can fill the gap between pure pediatric care and full-blown adult care for young women].

• Pricing and billing : Medical pricing is complex, especially if you plan to work with insurance companies. Practice Builders says that “a 10 percent increase in pricing can result in a much better return than a 10 percent reduction in costs—or even a 10 percent increase in patient volume.”

Make sure you price your services at what they are worth and explain your pricing to your patients. Consider the demographics your practice serves when you choose your pricing. Research other practices in the area and learn more   about how you can choose the best prices for your patients and your practice.Also, consider how you will get patients to keep coming back to your practice. Sometimes you can increase sales by upselling and cross-selling , or offering complementary services.

If you accept insurance, the contracts you set up with insurance companies for reimbursement will probably dictate your pricing, so this is a good place to talk about your negotiation strategy as well.

• Update your website and social media frequently and ensure your website is mobile-friendly and share-friendly with credible links added.
• Make sure all communications with and about patients are HIPAA-compliant . Download a HIPAA Compliance Guide to ensure you are following regulations.
• Maintain a positive online reputation for your practice as a key management technique. You can do this by claiming your profile on any third-party sites that list it. Encourage your patients to review you online, too.
• Strategic alliances : List any people or organizations with whom you are working. You will most likely need to partner with a regional lab for medical testing. Opening an on-site lab can be costly for a smaller practice. You will most likely need to partner with a nearby hospital as part of a referral system or to share select services and equipment.

The operations section of your business plan covers how your business works, from the logistics to the technology.

• Technology: Describe how your technology works, but do not go into too much detail. Investors can ask for more information if they want to. Will you rent or buy equipment ? The technology you need ranges from simple items like thermometers to more complex items like centrifuges.
• Billing and information storage: Provide a brief overview of how you will manage information technology and patient records to promote safety, efficiency, and compliance with HIPPA  regulations and industry standards. Explain your usage of Electronic Medical Record (EMR) software in this section.
• Payment types you accept: Consider payment types such as private pay, private insurance, Medicaid/Medicare, etc. What kind of referrals can you offer to the uninsured or those who cannot afford your services?
• Milestones and metrics

In this part of your plan, you set measurable, achievable milestones, such as the number of new patients added per month in the first year of operations. Milestones can be about any aspect of your medical practice as long as they emphasize growth. For metrics , decide which numbers to check regularly to track your company’s health. This area should also include information about traction (past successes) and risks:

• Traction: Look back at major milestones you have achieved. Hopefully, they demonstrate that your business model works and that you are filling a need for your market. If you’re looking to attract private funders, this section is important since it shows your initial success .
• Key assumptions and risks : Acknowledge the assumptions you are basing your business on. Set out to prove them right if you can. Also, discuss risks so that investors know you have considered what could go wrong and that you have a plan for dealing with challenges. Malpractice suits and changing healthcare regulations are risks specific to the healthcare field. Malpractice insurance is a must for addressing the former. Changing healthcare regulations can affect the volume of patients who are able to afford your services.

Your team can be more important than your product or service. Describe your team here, even if it is just you and a receptionist who answers the phone in your office building.

• Management team and qualifications: Address who works for you, what do they do, and how much you pay them. Compile the details of their relevant experience and education.
• Hiring plans : Outline who, if anyone, you need to hire to fill skills gaps in your management team and how much you plan to pay them.
• Company overview

The company overview tells about who you and your staff are and appeals to potential investors. Keep it short—it should be the shortest chapter of your business plan but is still very important.

It needs to include these elements:

• Mission statement : Your mission statement articulates your goals for what your company does for its customers, employees, and owners. It will read something like this: “Our mission is to provide X (services) for Y (customers) by Z (methods).” For instance, Ocean Lane Outpatient Care is dedicated to providing quality care for all the inhabitants of coastal Lane County by providing affordable and versatile services.”
• Intellectual property : List any patents you have or have pending, and mention any core technology you are licensing from another company.
• Legal structure and ownership : Explain your business structure and who owns how much of it. More on considerations for physicians and legal structure here.
• Business location : Describe the company’s location and any facilities it owns.
• Company history if it’s an existing company

Having a solid financial plan is critical, whether you’re seeking funding or not.  A typical financial plan includes projections by month for the first year and annual projection for the next three to five.

Include these key elements:

• Profit and loss statement : this explains how your business made a profit or incurred a loss in a given amount of time (typically three months) by listing all revenue and expenses, then documenting the total amount of net profit or loss.
• Cash flow statement: documentation of how much cash the business brought in, how much it paid out, and the amount of its ending cash balance (on a monthly basis).
• Balance sheet : snapshots how your company is performing at a given moment by including how much money you have in the bank, how much your customers owe you, and how much you owe your vendors.
• Sales forecast : projections of what you think you will sell in a given timeframe (one to three years).
• Business ratios : Comparisons of your company’s financials with numbers from the industry profile.
• Keep it brief. For example, Dr. Gardner will employ administrative aides and nurses.
• Use of funds : Needed if you’re seeking investment or a loan. This section explains how you will use investors’ money.
• Exit strategy : You only need this if you’re seeking outside investment. An exit strategy is a method by which entrepreneurs and investors, especially those that have invested large sums of money, transfer ownership of their business to a third party to recoup money invested in the business. Common exit strategies include being acquired by another company, the sale of equity, or a management or employee buyout.

When writing your financial plan, make sure to consider startup costs . For a medical practice, average startup costs can include initial fees, malpractice insurance, cost of renting or leasing office space, and the cost of any legal or tax advisors.

Consider submitting your plan to at least five to 10 banks if you need help financing your startup costs. Many banks have divisions designated to providing loans to new dental and medical practices , so submit your plan to that division if you can. Startup costs can be high in the medical field, so make sure not to underestimate them.

Finally, your appendix is the holder for any supporting information such as charts, images, graphs, and more. If you need to include large sets of data or pages of information, put it here. That way, it is available but does not distract from the plan’s most important pieces.

For instance, you can expand on your personnel plan with charts of each employee’s annual insurance costs. You can also include versions of your profit and loss statements and other financials that extend further into the future.

Don’t forget to go back to your executive summary! Remember to keep it brief and write it based on what you have written already.

When you’re ready to write your business plan, there are an array of resources available to you. Download our free business startup checklist to think about the next steps. Also, check out our free business plan template . Reviewing sample business plans in the medical field can help you get a better sense of the process and information you’ll provide. Downloading this plan for a family medicine clinic will probably be most helpful if you’re setting up a primary care practice.

Remember that this plan is a living document. Schedule a regular business plan review meeting. You should review your trajectory and compare your financial projections to your actuals frequently to keep your practice on track.

See why 1.2 million entrepreneurs have written their business plans with LivePlan

Noah is the COO at Palo Alto Software, makers of the online business plan app LivePlan. He started his career at Yahoo! and then helped start the user review site Epinions.com. From there he started a software distribution business in the UK before coming to Palo Alto Software to run the marketing and product teams.

Table of Contents

• Position your practice’s business opportunity

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Medical Billing Business Plan Template

JUN.16, 2022

Medical billing business plan for starting your own business

Do you want to start a medical billing business? Well, considering the rising costs of healthcare in the U.S. and the complexities involved in medical payments when there is 3 rd party (insurance company) involved, the business can be immensely profitable.

A medical billing business facilitates patients and medical practitioners as well as health insurance companies in dealing with complex medical transactions. For this, the medical billing specialist does a range of tasks such as filing the claim and keeping up the patient’s record and medical history.

To start this business, the first step is to make a business plan for medical billing company. In case you don’t know the essentials, you can take help from here. Here we are providing a business plan for a medical billing startup, Medi Assist. If you will be raising a loan, you’ll also have to see business plan for a loan from a bank.

Executive Summary

2.1 the business.

Medi Assist will be based in San Diego. The business will provide expert medical billing specialists to physicians, dentists, surgeons, and others in the profession. After 5 years of the launch, the business will be expanded to one more location.

2.2 Management of medical billing

To make sure that you manage your medical billing startup well, it is essential to decide everything in a medical billing company business plan. Since the business requires expertise and specialization in the domain, you must manage the functions effectively. For each case, you’ll need to arrange for commute, legal assistance, and access to data for accurate record keeping. 

To assist you we will provide the list of employees, management positions, and their spheres of authority in this medical billing business plan pdf. Though you can take help from this sample business plan for medical billing, it will be best practice to hire a business planning expert for making your business plan if you are new to the field.

2.3 Customers of medical billing

Before opening a medical billing company you must recognize groups of your target customers. The customers of Medi Assist are expected to be:

• Medical Practitioners

2.4 Business Target

It is essential to set business targets even when you work on simple ideas like business plan for a medical laboratory or nursing business plan . It is to remain focused and directed throughout the operations of your business.

Our targets to establish our name in the market will be given in the later sections. However, our financial targets are given as below:

Company Summary

3.1 company owner.

Medi Assist will be owned by Mariana Downey. She is an expert medical billing agent and has been working in the domain for more than 6 years.  

3.2 Why the medical billing is being started

Mariana decided to start medical billing business because of her interest and expertise in the field. Since the business requires specified knowledge and cannot be run by any layperson, Mariana found that there are more prospects of getting successful in this domain. 

3.3 How the medical billing will be started

If you are looking for what do I need to start a medical billing business, we’re providing a step-wise procedure here. 

Step1: Research & Plan

The first step is to carry out intensive research on how to start your own billing company . After that, you will have to pen down details in a business plan in a systematic manner. To assist you with this, we’re providing sample medical billing business plan in this blog.

Step2: Fund & Recruit

The next step is to incentivize your venture and manage financial resources. You’ll then need to invest your money to purchase the required equipment, rent a space, and employ the personnel.

Step3: Manage & Systemize 

After getting monetary and fiscal resources, you’ll have to devise a management structure to systemize all operations.

Step4: Exist on the Web

Next, you will have to make sure that you have a strong web presence. Today, clients are likely to search for medical billing services on the web and seek the services of only those whose websites come at the top. Thus, it is a must to ensure an online presence.

Step5: Market

Lastly, you will have to advertise your startup to reach your target audience. In this medical billing business plan example we will be listing the techniques adopted by Medi Assist to advertise their venture.

Services of medical billing

Before you start medical billing company, it is essential to search for how to start a medical billing business and read at least one medical billing service business plan. After this, you will be able to know which services are being provided by your competitors. And thus decide the services that you want to provide as you start medical billing business. In this sample business plan for medical billing, we’re providing the services provided by Medi Assist.

• Setup Patient Record

Our medical billing experts will set up patients’ medical histories and records of all transactions related to healthcare.

• Claim Filing

We will help file medical claims both in manual and electronic forms. 

• Negotiating Healthcare Contracts

We’ll negotiate the medical and healthcare contracts by dealing with all three parties at a time. The three parties can be patients, medical assistance providers, and insurance companies. 

• Upkeeping & Updating Record

We will maintain the patient’s record and update it from time to time both manually and electronically.

Marketing Analysis of medical billing

If you’re looking for how to open a medical billing company, you are on the right page. In this medical billing business plan sample we have provided full guide on how to start medical billing business. After you have gone through the initial steps, you need to undergo a thorough market analysis. Unlike cannabis business plan or reiki business plan , market analysis for medical billing can give you a tough time. It is because the business is still unknown to many and does not involve just one-time interaction. The target customers would remain in contact for a long time and hence they would prefer to see how you are more reliable and efficient than your competitors. Therefore, you need to investigate the already operating medical billing businesses, market trends, inclinations of customers, and pricing policies that can help you get through. If you are starting medical billing business from home you’ll still need to do market analysis.

5.1 Market Trends

The growth prospects of medical billing startup are encouraging. According to IBISWorld, the market size of medical billing services stands at $5 billion in the U.S. even though only 1761 such businesses are operating there. If you want to enter this enterprise, you can also make a lot within a short time.

5.2 Marketing Segmentation

Before starting medical billing business it is also essential to do market segmentation. For this, you’ll have to divide the entire population into distinct groups. In this free medical billing business plan template on how to start your own medical billing company, we’re providing the market segmentation done by Medi Assist.

5.2.1 Medical Practitioners

This category includes doctors and healthcare providers. They will need our services of filing claims, checking the credentials, and keeping a record of patients.

5.2.2 Surgeons

This segment will include the medics who perform minor or major surgeries.

5.2.3 Dentists

Dentists who provide teeth cleaning, healing, and maintenance services will also be our customers.

5.2.4 Others

This segment may include medics who aren’t covered in the above categories such as physiotherapists. Moreover, hospital groups and healthcare provider organizations are also included in it.

5.3 Business Target

• Expand our service sector to at least one more locality by the end of the first 5 years
• Maintain a CSAT score above 90% throughout the service years
• Capture 15% of the market share within three years of operation

5.4 Product Pricing

Our prices are a little higher than others in the same profession. But due to our expertise, Mariana’s experience in the field, and our sales strategy we still expect to get more customers than them.

Marketing Strategy of medical billing 

Before starting a medical billing company you will have to devise ways by which you want to reach out to your target customers. In this medical billing company business plan on how to start a medical billing and coding business, we are providing the sales strategy of Medi Assist.

6.1 Competitive Analysis

• Our employees are highly specialized and experts in their domains.
• We are offering several discounts, in the beginning, to get known.
• Customers are our topmost priority, we are willing to go to all lengths to facilitate them.

6.2 Sales Strategy

• We’ll offer a 50% discount to our first 50 customers.
• We’ll offer a 20% discount on all our services in June and July.
• We’ll advertise our startup on social media, in local newspapers, and in magazines. 

6.3 Sales Monthly

6.4 Sales Yearly

6.5 Sales Forecast

Personnel plan of medical billing

The staff of medical billing business cannot comprise anyone but highly experienced and qualified professionals. In this medical billing business plan example we’re providing the list of employees of Medi Assist along with their job descriptions and expected salaries. If you’re going to make business plan medical billing you should also do the same.

7.1 Company Staff

Mariana will hire personnel for the following positions:

• 1 Co-Manager to oversee all operations
• 1 Financial Manager
• 5 Medical Billing Specialists
• 2 Accountants
• 1 Legal Expert
• 1 Web Designer 

7.2 Average Salary of Employees

Financial plan of medical billing.

If you are going to start medical coding and billing business you must be wary of how profitable is medical billing business. Well, the business is immensely profitable and the profit margin is expected to increase more in the upcoming years.

To assess, how much you would be able to make as per your resources, investment and sales, you will be needing to create a financial plan for your business. For that, you can take help from the financial plan provided here as well as those listed in business plan for urgent care center and business plan for veterinary clinic .

8.1 Important Assumptions

8.2 break-even analysis.

8.3 Projected Profit and Loss 

8.3.1 profit monthly.

8.3.2 Profit Yearly

8.3.3 Gross Margin Monthly

8.3.4 Gross Margin Yearly

8.4 Projected Cash Flow

8.5 Projected Balance Sheet

8.6 business ratios.

• Is the medical billing business profitable?

Yes, the business is profitable. You can see it from the profit generated by Medi Assist in the first 3 years of their launch as given in this sample medical billing business plan.

• How do I start a medical billing business?

As a first step, you need to make medical billing business plan and then the later steps include executing the business plan medical billing in letter and spirit.

• How do medical billing companies make money?

Medical billing companies make money by offering several services such as filing claims for patients, upkeeping and updating medical records, etc.

• How do I get medical billing clients?

To get medical billing clients, you’ll need to advertise your services on social, electronic, and print media. You can explore more techniques by visiting the sales strategy section of this medical billing business plan example.

Download Medical Billing Business Plan Sample in pdf

OGSCapital’s team has assisted thousands of entrepreneurs with top-rate business plan development, consultancy and analysis. They’ve helped thousands of SME owners secure more than $1.5 billion in funding, and they can do the same for you.

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Zelenskiy calls for operational changes to Ukraine military after sacking commander

President demands ‘new level of medical support for soldiers’ as questions mount over speed of counteroffensive against Russia

Volodymyr Zelenskiy has demanded rapid changes in the operations of Ukraine’s military and announced the dismissal of the commander of its medical forces.

The Ukrainian president’s move was announced on Sunday as he met defence minister, Rustem Umerov, and coincided with debate over the conduct of the 20-month-old war against Russia , with questions over how quickly a counteroffensive in the east and south is proceeding.

“In today’s meeting with defence minister Umerov, priorities were set,” Zelenskiy said in his nightly video address. “There is little time left to wait for results. Quick action is needed for forthcoming changes.”

Zelenskiy said he had replaced Maj Gen Tetiana Ostashchenko as commander of the medical forces.

“The task is clear, as has been repeatedly stressed in society, particularly among combat medics, we need a fundamentally new level of medical support for our soldiers,” he said.

This, he said, included a range of issues – better tourniquets, digitalisation and better communication.

Umerov acknowledged the change on the Telegram messaging app and set as top priorities digitalisation, “tactical medicine” and rotation of service personnel.

Ukraine’s military reports on what it describes as advances in recapturing occupied areas in the east and south and last week acknowledged that troops had taken control of areas on the eastern bank of the Dnipro River in southern Kherson region.

Ukrainian commander in chief, Gen Valery Zaluzhny, in an essay published this month, said the war was entering a new stage of attrition and Ukraine needed more sophisticated technology to counter the Russian military.

While repeatedly saying advances will take time, Zelenskiy has denied the war is headed into a stalemate and has called on Kyiv’s western partners, mainly the United States, to maintain levels of military support.

Ostashchenko was replaced by Maj Gen Anatoliy Kazmirchuk, head of a military clinic in Kyiv.

Her dismissal came a week after a Ukrainian news outlet suggested her removal, as well as that of others, was imminent after consultations with paramedics and other officials responsible for providing support to the military.

Meanwhile on Sunday, air defence units in Moscow intercepted a drone targeting the city, mayor Sergei Sobyanin said.

Sobyanin, writing on the Telegram messaging app, said units in the Elektrostal district in the capital’s east had intercepted the drone.

According to preliminary information, falling debris resulting from the operation had caused no casualties or damage, Sobyanin said.

• Volodymyr Zelenskiy

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