ER medical Billing company

[emergentmd]

I am looking into different non clinical endeavors and considering dipping my toes into starting an ER billing company b/c current options kind of suck. Does anyone know if entry is difficult? I have the time, the $$$, medical/financial knowledge, technical skills, and FSERs that would let me do their billing. My college degree was in computer engineering, long history of management, understand financials, and long history of revenue management with our SDG/FSER.

Where should I start learning about this business model? I see ACEP and other societies having billing conferences but not sure if this is the best way to start. Once I can figure out all the CPT coding, insurance/billing interfaces then I feel comfortable doing the physical set up.

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[Tiger26]

I am looking into different non clinical endeavors and considering dipping my toes into starting an ER billing company b/c current options kind of suck. Does anyone know if entry is difficult? I have the time, the $$$, medical/financial knowledge, technical skills, and FSERs that would let me do their billing. My college degree was in computer engineering, long history of management, understand financials, and long history of revenue management with our SDG/FSER.

Where should I start learning about this business model? I see ACEP and other societies having billing conferences but not sure if this is the best way to start. Once I can figure out all the CPT coding, insurance/billing interfaces then I feel comfortable doing the physical set up.

I think the needle movers in billing is going to be AI and text analytics if you can figure out the infrastructure for that

 

[Rekt]

I think the needle movers in billing is going to be AI and text analytics if you can figure out the infrastructure for that

Yep. I would guess the margins are very small. I think it was something like single digit dollars per chart for the billing company. Removing overhead and automating text analytics as much as possible with AI would be the only way.

You have to have something great to offer groups to bother going through a shift because it’s a very painful experience after a billing group gets to know your group and how they document. And also vice versa with how the group expects billing to bill if you’re RVU based.

 

[emergentmd]

Yep. I would guess the margins are very small. I think it was something like single digit dollars per chart for the billing company. Removing overhead and automating text analytics as much as possible with AI would be the only way.

You have to have something great to offer groups to bother going through a shift because it’s a very painful experience after a billing group gets to know your group and how they document. And also vice versa with how the group expects billing to bill if you’re RVU based.

My goal is not to pick up contracts as I have connections who would jump at the offer b/c most billers are terrible. Goal more so is maximize transparency and collections for groups I am involved in. I mean, if I can make it work, then getting more contracts would not be difficult.

 

[JacobMcCandles]

I would think that doing your own SDG/FSER billing would be a good start on dipping your toes into the water.

 

[Arcan57]

I think the needle movers in billing is going to be AI and text analytics if you can figure out the infrastructure for that

The problem with that is depending on who you're billing the penalty for screwing up can be severe. My dad did healthcare law back in the day and represented quite a few docs that lost their practices after the billing company they hired had system glitches that resulted in fraudulent Medicare bills. Regardless of how removed the doc is from the bill that's actually generated, the federal government stills assigns responsibility to that individual provider. And being sanctioned by Medicare can make you unemployable.

If you were in the FSED market and never billed Medicare, could be worth it as the stakes would be much lower.

 

[EctopicFetus]

Let me start with the obvious. Much of it is easy. Coding isn’t hard. Many billing companies off shore it already. Coding a chart is cheap and dare I say right now with the new rules it is simpler than ever before. There are AI solutions out there now. Fathom is one of them.
the challenge is in the back and forth with insurance and reconciliation and providing good reports to your clients.
i also think it’s not a cheap endeavor as you need decent man power for it to work. Insurers will pend claims and reject claims etc. you have to sort all that out. Then you have to work thru the nsa arbitration process for folks. Again not rocket science but seems difficult if you are starting from scratch.
keep in mind many hospitals are terrible at registering patients and getting accurate info. So then u have to deal with that. Lastly, you have to deal with collections agencies and sorting out patient deductibles and collecting them from patients. Again not impossible but a fair bit of work. avg charge for a billing company is 7-8 bucks a chart.