Follow-up to Starting Your Own Coding Business
I've gotten several requests for more information since posting the original info about operating a coding-only business, so this is an update with more details. Some things have changed too, such as my approach to marketing.
I recently lost my most important client, so I've taken part-time remote employment to fill the gap while I look for more business. I think that finding business for a coding-only operation can be a challenge, which is helped a lot if you're a "get out there and talk to people" type person. Medical practices seem to hire for services based mostly on word-of-mouth recommendations. Marketing online is probably not going to be very successful, yet I think having an online presence is just about required. It is quite useful because you can refer potential clients to your website, etc. So I would recommend focusing on local networking, visiting practices in person, having kick-ass local online listings. Taking clients from outside your local area is not a problem, but I think word-of-mouth in your local area is the best way to build a thriving coding business. Focus on the benefits of your service to the client, which are many fewer denials, leading to faster reimbursement and reduced A/R. Compliance issues are also important. Some doctors and office managers are not interested in becoming more compliant, while for others compliance is an important issue.
I don't use any medical management software - I keep it really simple. The client scans their reports and uploads them in pdf format to my secure Sookasa folder within my Dropbox. This costs me $10/month, and all the client has to do is click a link to upload their files. When the coding is completed, I send them a link to download the files. If there are a large number of files, they can manage this by setting up their own Sookasa folder and sharing it with me. Files and PHI cannot be shared via unsecured email, because of HITECH and HIPAA regulations. If you're doing billing too, check out OfficeAlly for a free, cloud-based billing application. It's all-inclusive.
I type the codes directly onto the document using Acrobat Reader's annotation tools. Acrobat Reader is free. The client's biller then uses your codes to create the claim. If the client has an EMR, you can usually gain remote access to it to see all the reports, input codes, etc. It can often be done using Windows apps, or Logmein.com. If that doesn't work, you'll have to hire an IT person to make it work, and you can charge the client for this.
To code correctly and efficiently, you'll need to subscribe to an encoder service. My favorite is Supercoder. It's several hundred dollars per year.
Excellent E/M coding is required. Even surgeons have pre-op visits, follow-up, etc. To master E/M coding, I recommend the AAPC E/M Auditing webinars and workshops. I have seen powerpoints from past E/M Auditing presentations for free online. Here are a couple of online resources that are very helpful:
Billing your clients can be done by the chart or with a flat monthly fee. I think per chart is preferable. The fee can be negotiated with the client. I charge $5-8 per chart, mostly depending on how long I think the coding is going to take. I think you should shoot for $30-40/hour of actual coding work, to cover your business expenses. To keep track of the number of charts coded, etc., I keep a simple spreadsheet with a tab for each client. I include other services in the fee: provider education, documentation improvement, and HIPAA advising. You'll also want to negotiate your turnaround time. If all your clients want their coding in 48 hours, you could be in trouble. If you can have a variety of different times, it's easier to manage. If you have more work than you can handle, you can sub-contractor with other coders to help. You might have coder friends who you know are skilled and reliable who could do this. I send out invoices by email on the last day of the month, due in 10 days.
Make sure to create a contract between you and the client that lays out what you've agreed on and your terms for things like a 30-day notice for terminating services, etc. You also have to get a signed Business Associate Agreement between the client and you before you look at any of their PHI, per HIPAA requirements. Also get a business license/certificate for your city, and make sure to pay your local taxes.
There are few start-up expenses per se, but as you go along you will have to pay for new
coding books every year, CEUs, professional membership dues, coding software subscriptions, website hosting, domain and work email, high-speed internet, top of the line PC and two monitors, a comfortable chair, business cards for networking, and toll-free number for national business (Grasshopper is cheap and allows you to have a toll-free number on your cell phone). Track all income and expenses for your schedule C at tax time. If you are making over a certain amount, you have to pay self-employment taxes.
Coding-only does not have any of the headaches and stress of a billing service, but it is not as profitable. If you can develop the business to the point where you have a few clients, while continuing your full-time job, the transition can be easier. Splitting your time 50/50 between your clients and a remote coding job can be a next step toward becoming fully independent.