Medical Billing Outsourcing - Business Opportunities

The advantages of being a medical billing outsourcing agent, and how to break into the billing/coding market...

Due to the increasing complexity and administrative work needed to code and bill insurance claims, more and more medical providers are choosing to outsource their medical billing needs.

Great news for you, the medical biller and coder! Especially if you're looking into outsourcing your medical billing and coding talents by opening up your own medical billing business.

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Medical Billing Business
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When you hear the word "outsourcing" you may think this means that coding work is being sent overseas, much as in the same way cars and electronics are made outside of the United States.

While this does sometimes happen in medical coding and billing, it's rarely the case. Almost all medical billing and coding is outsourced by highly trained, specialized teams of medical billers and coders within the United States.

Most providers actually prefer their coding and billing to be done by an agency within their own locale.

Is medical billing outsourcing an option for you?

There are lots of benefits to being a medical billing outsourcing agent

You may be wondering if outsourcing is an option for your own business.

If you're already billing or coding using your own tax identification number, working from your home or your own office, you're already an outsourcing agent!

But if you're currently still employed as a medical biller or coder within a doctor's office, clinic, or hospital, outsourcing may an option worth investigating.

There are many pros to being an outsourcing agent. The most obvious would be the fact that you are your own boss, you can set your own operating schedule, and you can decide on how much you want to work or not.

There is also a large market for medical billing and outsourcing agents, especially highly-trained specialists in specific medical fields. As medical billing guidelines and coding becomes more and more complex, it's only more likely that more providers will turn to outsourcing.

What are the provider benefits of outsourcing?

Outsourcing their medical billing and coding helps providers by:

  • Improving accuracy of coding
  • Getting paid faster
  • Enhancing efficiency
  • Reducing the amount of denials
  • Increasing claim payment

Choosing your specialty

After you've decided to become your own medical billing outsourcing agent, you'll have to decide what kind of billing you'll do. Will you specialize in family practice, hospital, laboratory, or specialty coding?

Choosing your specialty is one of the most important decisions you can make. To consider which specialty you want to enter, you need to decide:

  • Do you have any special interests or talents regarding the medical industry?
  • Do you have certification in any specific areas?
  • Is there a market for your specialty?
  • Will you do the coding, billing, or coding plus billing?
  • How large do you want your company to be?
  • Will you have employees or will you work by yourself?
  • How will you market your business?
  • What type of rate will you charge?

This is only a short list of the many important decisions you'll need to make.

Answering these questions will help you narrow down the size, market, and demand for your business. This in turn helps you decide which specialty is right for you.

Choosing your specialty will be one of the most important decisions. It determines what type of claims you will deal with every hour of every work day.


If you hate the tediousness of HCPCS billing and claims management, then a DME billing company (durable medical equipment billing) is out of the question for you.

But if you prefer the fast pace and intrigue of emergency care, then perhaps emergent billing may the best choice for you.

What services will you provide?

You'll have to decide which services to offer

The next most important choice you'll make depends on what kind of services you plan on providing.

You can choose to be responsible for only the minimum amount of billing duties, or you may decide that you can handle all of the medical billing and coding responsibilities of a certain practice.

Ask yourself the following...

  • Will you verify patient insurance eligibility?
  • Will you scan patient records and code patient visits?
  • Will you enter patient charges?
  • Will you send claims?
  • Will you follow up on claims?
  • Will you enter insurance and patient payments?
  • Will you handle the insurance and patient accounts receivable?
  • Will you handle practice report maintenance?

Determining how many of these duties you want to perform depends on how much you choose to charge (see: medical billing rates), as well as how much time and effort you plan on spending on a certain practice.

Breaking into the market

Your last big hurdle in becoming a medical billing outsourcing agent is breaking into the medical billing market in your specialty.

Do your market research, and find out how many medical providers are in your area in your specialty. If you decide on marketing your skills online, check available online avenues to see how many opportunities there are for your business.

At first, you may have to charge very competitive rates to lure new customers to your business.

But don't go too low. If you're doing the work, it needs to be worth the money. Furthermore, if your rates are too low it will decrease the esteem held for billers throughout your specialty. Billing and coding is hard work, and you deserve to be paid a decent amount.

Many other options exist for marketing your new medical billing and coding business, including going door to door, and marketing your self online.

For more information, see our article on marketing a small business.

No matter which specialty you choose and how much responsibility you take, a medical billing outsourcing company is a lucrative and viable option for your own medical billing business.

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