The best medical billing software for home-based businesses should come tops for work from home medical billing professionals. According to the Bureau of Labor Statistics, the need for medical billing and coding experts is on the sharp increase. A rise of 15% from 2014 to 2024 clearly shows the relevance of health and medical technicians today.
Thus medical billing services have created vast opportunities for medical coding and billing professionals to work for healthcare firms from home. A medical records expert can earn on the average $35,000 to $45,000 per annum which is a relatively good pay.
Medical billing experts can also earn huge sums working for even insurance firms, independent physicians, pharmacies, government agencies, etc. It does not require so much educational training except for understanding how to use the best medical billing software for home-based businesses.
This article, therefore, looks at the top medical billing software for work from home jobs and how they can benefit you.
- What is the Best Medical Billing Software to Use?
- How do I Start my own Medical Billing Business?
- Can you Make Money doing Medical Billing from Home?
- What are 3 Different Types of Billing Systems?
- What Software do Medical Offices use?
- Is Medical Billing Profitable?
- How do Medical Billing Companies Work?
What is the Best Medical Billing Software to Use?
Kareo makes it easier and more rewarding for you to run an independent medical practice. We offer the only cloud-based, clinical and business management technology platform dedicated to serving the unique needs of independent practices. The software helps you find and engage with patients, run a smarter business, provide better care, and get paid faster.
From the front office to your back-end billing, Kareo Practice Management streamlines the way you work. It’s easy to use and proven powerful by the more than 50,000 providers that trust it for their small practices.
Unlike other companies that built their offering for large medical groups or hospitals, Kareo is purpose-built for the workflows and unique needs of the independent practice. The result is an affordably-priced platform without the bells and whistles that you don’t need.
With more than 65,000 members at 9,000 clinics, WebPT is the leading rehab therapy platform for enhancing patient care and fueling business growth. Ideal for outpatient organizations of all sizes, WebPT makes it easy for therapy professionals to transition from paper and outdated software to a user-friendly, cloud-based solution.
With WebPT, therapists, directors, owners, billers, and front office staff have access to patients’ medical records anywhere, anytime, from any web-enabled device. WebPT’s web-based application alleviates any large, upfront investments; costly IT support; or bulky, in-office servers. It provides an integrated method to manage patient documents and progress as well as clinic schedules, analytics reporting, and billing.
WebPT has an intuitive workflow, allowing therapists to efficiently create compliant and consistent documentation. In addition to documentation, WebPT offers a front office package that includes the tools necessary to run an organized clinic, including a multiuser scheduler with appointment reminders and the ability to upload external patient documents.
Through WebPT’s suite of reporting tools, therapists and staff can track productivity, cancellations, and no-shows as well as referrals. Therapists can also benchmark and track patient progress through WebPT’s outcomes tracking product. Lastly, WebPT’s billing options—including the WebPT Billing Service and integrations with several certified billing partners—ensure clinics receive reliable, accurate claims submission and processing as well as speedy, maximized reimbursements.
With WebPT, rehab therapists have a modern, intuitive platform that’s well-suited to their needs, empowering them to be better in business—and more importantly, enabling them to spend less time on documentation and more time with their patients.
TherapyNotes™ is the most trusted online practice management and EHR software for behavioral health practices of all sizes. With over 60,000 users, we’re considered the largest platform for mental health professionals, offering the most intuitive software and best customer support in the industry.
The streamlined scheduling, notes, billing, and a custom client portal — plus unlimited support and superior security — can help optimize how you manage your practice, letting you focus less on administrative tasks and more on your clients’ needs.
They offer • Streamlined scheduling and a personal to-do list that automatically generates tasks based on past activity • Powerful form-based notes, designed specifically for behavioral health • Electronic insurance claims, ERA payment posting, and credit card processing • HIPAA compliancy, keeping your data encrypted, secured, and backed up regularly To learn more about TherapyNotes™, visit TherapyNotes.com, and receive your first month completely free.
4. NextGen®️ Office
NextGen Healthcare’s private practice solution, NextGen®️ Office, helps practices simplify, automate, and unify clinical care—in person and virtually—so practices can save time and focus on what matters most: patient outcomes.
As a HIPAA compliant, cloud-based EHR, patient data is accessible from any device with an internet connection; virtual visits are embedded directly into clinical workflows; revenue cycle management tools facilitate optimal reimbursement; and a state-of-the-art patient portal helps keep patients engaged in their care, from anywhere.
Combining these capabilities into one seamless system frees practices from the confinements of onsite care delivery and opens the door to a virtual practice. With NextGen Office, providers can touch, talk, or type encounter notes directly into the clinical documentation.
NextGen Office includes MIPS reporting/dashboards; automates insurance eligibility; empowers patients to schedule appointments, request refills, and schedule telehealth visits; and connects the care team through direct messaging and referral exchange. The NextGen Office team is dedicated to helping practices achieve operational excellence, improve clinical outcomes, advance clinician and patient satisfaction, and foster healthier lives.
NextGen Office grew from a company founded in 1998 by two doctors with one goal—to make medical offices run more efficiently. Company founders designed a solution to accommodate physician and staff workflow with easy-to-use, affordable technology that adapts to the provider’s workflow and is accessible from anywhere.
athenahealth is providing cloud-based services for electronic health records (EHR), revenue cycle management and medical billing, patient engagement, care coordination, and population health management, as well as Epocrates and other point-of-care mobile apps. The suite of integrated, network-enabled services works to deliver measurable financial and clinical results for providers.
The billing module can be used in tandem with the EHR or on its own, and features a patented and continuously updated rules engine. Medical practice management tools include visibility into daily responsibilities, custom benchmarking, proactive trends analysis, and more.
How do I Start my own 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:
- 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.
How much will it cost you to start?
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+.
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
Can you Make Money doing Medical Billing from Home?
The first thing you should know about the work from home medical billing “opportunities” you might find online is that many of these are not actually work at home jobs, but rather someone trying to sell you information on how to start your own medical billing business.
Why is this misleading? It is because the advertisements make it sound as though you are going to work for someone, or for a company, rather than just paying for information that may or may not even help you.
With that said, you can get paid to do medical billing from home, but as mentioned above, it’s not nearly as easy to get started as many scammers would have you believe.
Medical billing involves billing insurance companies for healthcare services provided, billing patients, sending claims to insurance companies, and appealing claims denials, among other things.
To do the job, you’ll need to have an understanding of medical terminology, human anatomy, and the medical coding system.
You will need to know how to type. Customer service skills are also very important because chances are good you’ll be on the phone frequently with doctor’s offices, insurance companies, etc. once you start working.
According to Salary.com, most medical billers make around $38,000 per year.
What are 3 Different Types of Billing Systems?
A system is a set of procedures or protocols that work together as an interconnecting network. There are three basic types of systems: closed, open, and isolated. Medical billing is one large system part of the overarching healthcare network.
The healthcare network includes everything from medical billing to best practices for patient care, health institutions, and private practices. Medical billing systems are multifaceted and can be divided into 3 of the basic types of systems.
A closed system is a system that doesn’t allow transfers. In terms of medical billing systems, it means that this system focuses on one singular practice. The biggest example of a closed system is using EMRs, or electronic medical records in your practice. EMRs are basically the digital versions of old-school paper charts.
While this is still used in modern practices today, it is combined with other types of records. EMRs, are as the system implies, closed. They don’t allow for collaboration with other doctors and healthcare facilities (i.e. labs, urgent cares, etc.).
An open system is a system that allows for transfers across healthcare professionals, practices, facilities, etc. An example of using an open medical billing system is using EHRs, or electronic health record. Sometimes people in the medical interchange EMR and EHR, but in reality, EHRs are a highly collaborative record-keeping style, which enables everyone to be privy to the patient’s healthcare.
Having an open system means the medical billing software (AdvacedMD, AllMeds, GE Centricity, McKesson, etc.) needs to be able to communicate and collaborate efficiently. Not all software allows for an open system because they want to keep it closed and have sole access to patient records. Also, some practitioners and healthcare facilities argue that because of HIPAA it’s important to be careful with open systems to protect the patient’s privacy.
An isolated system is one that is completely removed from healthcare facilities, physicians, and practices. PHRs, or personal health records, are used in isolated medical billings systems. The patients hold all their healthcare records and they’re designed and managed by them. These records are separate and shouldn’t replace EMRs or EHRs; it is simply to help the patient manage their health information.
Since PHRs can’t legally replace official healthcare records, isolated medical billing systems aren’t commonly used. Sometimes, if the patient uses appropriate software, their PHR can be used to fill out the medical practices’ official records. Again, this requires open communication between the software to ensure that everything gets transferred correctly.
Each system has its pros and cons in terms of medical billing systems. While the records aren’t the only aspect in the types of medical billing systems, it does play a major role in determining the type of system you want in your practice.
Once you’ve determined the system and the record-keeping you want, then you can move forward on either choosing software or keeping the one you currently have. Medical billing systems will help you determine the extent of outsourcing medical billing and coding.
What Software do Medical Offices use?
Medical offices are always a flurry of activity. Patients checking in, office staff on the phone with insurance companies, pharmaceutical sales reps trying to get past the reception desk to hawk their drugs. It can be a madhouse for the office manager.
Luckily, there is no shortage of medical office software to help you tame the savage beast of your practice. The question is, how do you choose the right software for your medical office?
Below, we’ll review the most commonly used medical office software tools and how to compare your choices. We know that there is no one-size-fits-all solution. But here is some ammo to help you make a decision that’s best for your practice.
1. Electronic Health Record (EHR) Software
Client record keeping is important for any business, but for medical offices, it’s an absolute necessity. Chances are if you manage a large practice with several doctors, you already have an Electronic Health Record system in place. For smaller offices that are outgrowing paper-based systems or are preparing for substantial growth, selecting an EHR tool that can grow with your business is a necessity.
Wondering how to select electronic health record software? InformationWeek outlined the six stages of EHR implementation, all packaged nicely in this handy EHR selection guide. It also provides an explanation of the Meaningful Use guidelines and reimbursement criteria, so that you can make sure your software selection is compliant.
Still need help? Don’t worry, that’s to be expected. The report also suggests that you consult with other practices of similar size for recommendations and warnings about EHR software.
2. Medical Billing and Collections Software
Part of running a successful business means getting paid for your work, and medical offices are no different. But add in the complexity of insurance companies and their accompanying co-pays, deductibles, plans, and group numbers, and suddenly it’s easier said than done. Without a robust software system in place, it’s virtually impossible to keep everything straight.
In addition to storing standard information like invoice numbers and payment information, there are five important medical billing features to consider when choosing your billing software:
- Appointment Setting
- Insurance Verification
- Prescription Safety
- Patient Records
- Security Protocols
By selecting a software tool that includes these essential features, you can ensure that your patients’ financial and medical information is safe and secure.
3. Patient Scheduling Software
There are a variety of Patient Scheduling Software tools on the market. Some are specifically for medical offices, while others are designed to be customizable for a variety of industries. Each has their strong points, but the main factor should be how well it fits with your practice’s needs.
When selecting appointment scheduling software for a medical office, be sure to choose a solution that is flexible, accessible from anywhere, and can integrate easily with other tools you are using. If you’re using an email marketing tool like MailChimp or Constant Contact, you want to be sure your appointment booking tool can play nicely with them.
And don’t be shy about getting the most bang for your buck – select a booking tool that has other valuable features like built-in reporting, time clock, and point-of-sale functionality. Check out whether the software has additional customizable options, like plugins and mobile apps.
4. Practice Management Software
Practice Management software is the multitasker of medical offices. Many practice management software tools handle both billing and insurance claims, and some even dabble in EHR management and scheduling. The benefit to selecting an all-in-one system is that you only have one tool to purchase. The risk is that if you don’t select the right tool, your entire practice could be held hostage by a system that is too complicated or not robust enough.
It may be to your advantage to select the practice management software that excels in the areas where other software doesn’t. For example, some practices find that the right blend of technology is using practice management software for billing and insurance and patient scheduling software for online appointment booking. Think of it like a Swiss Army knife. You really depend on it for the cutting tools, but you’d rather find a better go-to wine bottle opener.
The American Medical Association has a really useful practice management vendor toolkit, complete with scoring sheets and vendor survey templates, to help medical offices select a Practice Management system.
5. Clinical Documentation Software
Particularly for physical therapists, chiropractors, or other medical professionals who prescribe treatment plans, keeping accurate notes on patient progress is essential. Clinic documentation or clinical notes software is invaluable for tracking session history.
The good news is that this software can be relatively inexpensive to purchase as a stand-alone system, so the decision to purchase really depends on the volume of notes you need to store. If your note-taking tends to lean toward basic annotations per visit rather than extensive observations in progress, you would do well to find an EHR or appointment booking system that includes notes as part of patient data storage.
Is Medical Billing Profitable?
Startup Costs: $2,000 – $10,000
Home Based: Can be operated from home.
Part Time: Can be operated part-time.
Franchises Available? No
Online Operation? No
The medical billing industry is extremely competitive. However, for the determined entrepreneur there is still a good opportunity to earn $40,000 per year or more operating a home based medical billing service. All medical billing is processed electronically and sent directly to Medicare clearinghouses, so computer equipment will be required as well as medical billing software to operate the service.
Additionally, you’ll have to familiarize yourself with the diagnostic and procedure coding systems used by doctors and health-care professionals on medical claim forms to indicate the type of service being billed. Currently, medical billing services are charging clients in the range of $2 to $3 per claim processed, and the overall profit potential for the service is good, providing you can process medical claims on a volume basis.
There’s a steep learning curve for operating a medical billing service and careful planning and research techniques will have to be practiced.
How do Medical Billing Companies Work?
Medical billing is a payment practice within the United States health system. The process involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures.
The same process is used for most insurance companies, whether they are private companies or government-sponsored programs: Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly. Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS Exam, RHIA Exam, CPB Exam, and others.
Certification schools are intended to provide a theoretical grounding for students entering the medical billing field. Some community colleges in the United States offer certificates, or even associate degrees, in the field. Those seeking advancement may be cross-trained in medical coding or transcription or auditing and may earn a bachelor’s or graduate degree in medical information science and technology.
In many cases, particularly as a practice grows, providers outsource their medical billing to a third party known as medical billing companies who provide medical billing services. One goal of these entities is to reduce the amount of paperwork for medical staff and to increase efficiency, providing the practice with the ability to grow.
Read Also: Business Performance Management Software
The billing services that can be outsourced include regular invoicing, insurance verification, collections assistance, referral coordination, and reimbursement tracking. Healthcare billing outsourcing has gained popularity because it has shown a potential to reduce costs and to allow physicians to address all of the challenges they face daily without having to deal with the daily administrative tasks that consume time.
Medical billing regulations are complex and often change. Keeping your staff up to date with the latest billing rules can be difficult and time-consuming, which often leads to errors. Another main objective for a medical billing service is to use its expertise and coding knowledge to maximize insurance payments.
It is the responsibility of the medical billing service you choose to ensure that the billing process is completed in a way that will maximize payments and reduce denials Payment posting an important part of medical billing.
The use of the best medical billing software for home based businesses will both enhance performance and give a competitive advantage.
Each one of the above top medical billing and coding software offers excellent solutions for medical billing experts. However, not all would be applicable to each user’s needs. Users can also take advantage of online courses to learn about medical billing before delving into practice.