Related: 6 Things I Wish Somebody Had Told Me When I Started My Small Business 2

2. A large and growing market opportunity

Investors look for startups which can address large markets, meaning those larger than a billion dollars and growing at double-digit rates. Small markets tend to change more rapidly with the economy,and may be more easily influenced by fads and competitors with recognized brand names.

Understanding Healthcare Start Up Issues

Health Care

Use this guide to help understand the laws and regulations that apply to health care businesses and the health care industry.

Click on one of the following links to jump to that section of the page:

• Antitrust
• Environmental Compliance
• Eye Care
• Facilities Management
• HIPAA
• Mammography Services
• Medical Device Reporting
• Medical Practitioners
• Medicare & Medicaid
• Taxes
• Workplace Health & Safety
• 

HOW A MEDICAL CLAIMS CLEARINGHOUSE WORKS

Here’s the nuts and bolts of how it works. The medical billing software on your desktop creates an electronic file (the claim) also known as the ANSI-X12,  837 file, which is then uploaded and sent to the medical billing clearinghouse chosen. The clearinghouse then scrubs the claim, which means it is checking it for errors : arguably the most important thing a clearinghouse does; is scrub: which means to check for errors of submitted claims information.  Then once the claim passes inspection, the clearinghouse securely transmits (also very important) the electronic claim to the specified payer with which it has already established a secure connection, that meets the strict standards laid down by regulations which called HIPAA Transactions’. 

   

Sole Proprietors Insurance Costs and Definitions

Being a sole proprietor is the easiest way to start a new business. The business entity consists solely of one individual, the owner. Insurance coverage is very important for any business especially for a sole proprietor. It provides a safety net for sole proprietors in case of any unforeseen risks that occur in running the business. This is important since a sole proprietor guarantees a business with his own money as well as money from the business.

Errors & Omissions Insurance

Every business, regardless of size, should consider errors and omissions insurance. This is particularly important for sole proprietors who bear the financial burden of the business alone. This insurance covers when a business makes a mistake and the mistake causes financial harm to another individual or entity. This insurance protects a sole proprietor from having to fund the entire cost of defending against an action that occurs during work. This insurance can also be referred to as malpractice insurance or professional liability insurance. The average cost of errors & omissions insurance can vary from $500 to $2500 a year for a sole proprietor, as of July 2011.

General Liability

Another type of insurance for sole proprietors to consider is general liability insurance. This basic insurance covers injury claims, property claims and advertising claims. Most sole proprietors carry this kind of insurance since it covers all kinds of employment. Insurance companies require sole proprietors to fill out questionnaires answering numerous questions before they give quotes. Costs for general liability insurance depend on the location of the business, yearly revenue and the past claims history of the sole proprietor. It could be as low as $500 to as high as $15,000 a year for a sole proprietor, as of July 2011.

Related Reading: Sole Proprietorship & Health Insurance

Factors in Cost

There are many factors that are considered in determining the cost of insurance for a sole proprietor. These factors include the type of business being insured, the state where the business is located, the annual revenue for the business, the number of professionals providing service and whether or not there have been any claims in the past. Sole proprietors are the only individuals that need to be insured for their business, a factor that usually reduces the cost of the insurance.

Other Insurance

Besides general liability insurance, sole proprietors need to consider the cost of health insurance. Health insurance premiums can be deducted from sole proprietor's income for tax purposes. The price of a health insurance plan depends on a number of factors including the age of the individual and whether the individual smokes or is overweight. These risk factors typically lead to higher premiums. Health insurance premiums under a sole proprietor can range from $508.76 for an individual and $1,294.31 for a family as of July 2010.

ClaimPay MD - Payment Options

Need to Pay Your Bill?

ClaimPay MD offers convenient online payment by credit card or checking account. All you need is your ClaimPay MD's account number and ZIP code.

Account Billing Plan

ClaimPay MD's account billing plan* is similar to how credit card statements work. We bill you for individual insurance policies just as a credit card company bills you for purchases made at individual retail and service stores. Then we apply your payment on your monthly balance to your account, not to individual insurance policies—the same way a credit card company applies your payment to your monthly balance, not to individual purchases.

Flexible Payments
With the account billing plan, you may pay the minimum monthly amount due, the full account balance or any amount in between. If you pay more than the minimum due, we apply the difference as a credit to your account. You won’t receive another bill until the credit in your account is not enough to pay the minimum amount due..

Payment Schedule
We issue your statement at least 20 days before the payment is due. To continue your policies in force, you need to pay at least the minimum amount due. If we receive less than the minimum due, all the policies in your account could be canceled. If your policies are not canceled for the non-payment, the full account balance may be required on future billings.

View a sample personal insurance billing notice
View a sample business insurance billing notice

Electronic Funds Transfer

With electronic funds transfer, your payment is automatically deducted from your bank account each time your premium is due. No checks to write. No postage to pay. No need to worry about forgetting to make your payment.

Each payment appears on your bank statement for easy record keeping. When you use electronic funds transfer, you avoid transaction charges that are applied to monthly billings when you pay by check or credit card.

To sign up for electronic funds transfer:

• Download, print off, fill out and sign the Policyholder Authorization for Electronic Funds Transfer
• Attach a voided check or savings account slip
• Mail the Authorization Agreement and voided check or savings slip to your insurance agent

Be sure to pay the current amount due on your policy and any additional invoices you receive. This will ensure that your coverage is continued until your electronic fund payments begin.

Online Payment

If you are not set up for electronic funds transfer and need to make sure your insurance payment arrives on time, you can use your credit card (Visa®, MasterCard® or Discover®) or checking account to pay your bill online. All you need is your ClaimPay MD account number and the ZIP code shown on your billing statement. Enter your payment through our website:

Make Online Payment Now

Payment must be entered on the website by 6:45 p.m.Pacific Time, Monday-Friday (excluding holidays), to be credited to your account the same day.

The same transaction fees that apply to mailed payments are applied to each online payment. A payment entered on the website is applied to your credit card or taken from your checking account the following business day.

For website assistance, contact IT Support between 6 a.m. and 6 p.m. CT, Monday-Friday (excluding holidays).

Phone:
Toll Free:
Email: 

If you get voice mail, please leave a number where you can be reached.

If you have billing questions, contact your independent insurance agent.

Payment by Phone

To make a payment by phone, call (360)  and respond to the automated prompts. You can choose to pay by checking account, savings account or credit card.

Pay-by-phone is available to all direct-billed policyholders for standard invoices, as well as audits. Accounts currently registered for electronic funds transfer (automatic payments) are not eligible.

Payment by Mail

* Electronic funds transfer and online credit card and checking account payment are available to business insurance policyholders in the states where ClaimPay MD has business..

 

Things to Consideration starting a Medical Home Based Office

We offer a complete billing solution:

• Create, submit, follow-up and post reimbursement.
• Bill patients and handle patient inquiries
• Advise customers on strategies or procedures that can increase collections and compliance with government mandates.
• Manage all patient and other data in compliance with government mandates.
• Provide customized management reporting designed to improve financial performance and contract negotiation outcomes.
• Flexible statistical reporting
• Productivity tracking
• Coding reviews

Please review our performance-based services and together lets meet those ends.

Accounts Receivable Management: • Coding • Billing • Claims Processing & Follow-up • Payment Processing • Lockbox Services • Secondary/Tertiary Claims Mgt. • Internal Controls • Electronic Claims Mgt. • Paper Claims Mgt. • Daily, Weekly, & Monthly Reports • Audits • Patient Statements • Software and Network Solutions NEW PRACTICE CHECK LIST Financial Considerations     1. Prepare and present pro-forma financial package & obtain financing (Mini Business Plan). 2. Decide on business format. 3. Secure tax identification number (s). 4. Contract for legal services. 5. Contract for accounting services. 6. Secure business checking account (s). 7. Formulate fee schedule. 8. Contract with selected third party payors. Facilities & Design     1. Determine space needs. 2. Locate available space. 3. Negotiate lease. 4. Attorney review lease. 5. Secure floor plan and or space plan. 6. Arrange telephone service 7. Arrange for utilities. Professional Consideration     1. Medical Society Membership. 2. Local specialty group memberships. 3. Secure hospital privileges. 4. Secure relief coverage. 5. Secure telephone directory listings. 6. Secure County Medical Society directory listing. 7. Have business card printed. 8. Visit referring physicians. 9. Design and printing of announcements. 10. Mail announcements. 11. Secure DEA registration. Insurance     1. Secure agent(s). 2. Malpractice insurance. 3. Casualty Insurance. 4. Accounts receivable. 5. Office liability. 6. Non-owned auto. 7. Fidelity bonding for employees. 8. Property. 9. Umbrella liability. 10. Workman’s Compensation. 11. Auto. 12. Personal property 13. Health. 14. Disability. 15. Life. Medical Equipment & Supplies     1. Develop list of medical equipment. 2. Submit list for bids 3. Order equipment. 4. Check plans for equipment and special requirements. 5. Develop list of medical supplies and drugs. 6. Schedule meetings with drug reps. and secure samples. 7. Order drugs and supplies. 8. Secure clinical patient education information. 9. Oversee installation of medical equipment. Office Equipment & Supplies     1. Develop list of office equipment and furnishings. 2. Submit list for bids. 3. Order equipment and furnishings. 4. Develop list of office supplies. 5. Price compare supply vendors. 6. Order supplies. 7. Secure service contracts on major equipment. 8. Necessary printed items: a) Letterhead & envelopes b) Prescription pads c) Patient registration forms d) Patient history forms e) Patient progress sheets f) Record of surgery g) Medication record h) Lab report forms i) Patient Information Brochures j) Medical records releases 9. Order medical records system: a) Filing cabinets b) Charts c) Color Coding supplies d) Purging system e) Outguides 10. Secure insurance claim forms. 11. Secure magazine subscriptions for waiting room. Personnel     1. Determine personnel needs. 2. Recruit applicants. 3. Screen applicants. 4. Interviews. 5. Check references. 6. Conduct background checks. 7. Prepare personnel policy manual. 8. Prepare job descriptions. 9. Decide pay levels. Implementation & Installation of Systems     1. Appointment scheduling 2. Billing System/Billing Service. 3. Internal controls. a) Petty cash fund b) Change fund 4. Formulate operations policies and procedures. 5. Advertising.

The Procedure: • Coding (CPT, ASA, ICD-9, HCPCS and Modifiers) • Start/Stop Time Verification • ASA Unit Assignments • Concurrency Assignments (Direction & Supervision) • Labor Epidurals • Acute, Chronic Pain Mgt. • Contract Reviews/Negotiations • Reimbursement Audits • Encounter Sheet Development/All Specialities • Billing Paperwork Exchange Management

Cash Flow Forecast

1. Divide your sales or revenues into logical categories that have similar characteristics and respond to similar variables. Hopefully your financial statements or other management reports are grouping your revenues this way.

2. Analyze these categories over the last three years if possible.

3. Do some research in trade and economic publications about factors concerning your industry, your customers or client groups, your product, your geographical region, etc. This will serve to broaden your "horizons" and give you a larger frame of reference within which to make decisions. You can go to your trade association, the research desk at a public library, the library at a local college or university or the Washington Small Business and Technology Development Center and talk to their information specialist to get leads.

4. List and analyze the specific variables that will affect each category of your sales or revenues for your forecast period. This will involve a very thorough process that will consider several variables. Some of them are:

Price

Customer Demographics

Product Availability or Production Capacity

Marketing Plans and Budgets

Geographical Market Changes