Medical billing services exist today to help with the management of medical practices. These services can be used to relieve doctors of the tedious details, but they are rarely able to maximize the practice’s bottom line. Physicians 1st Billing and Claims will not just free staff from more pressing tasks, but it will also maximize insurance carriers’ return.

National statistics show that only 70 percent of insurance claims submitted on paper are paid by the insurance companies. The percentage of claims paid can be increased to around 98 per cent by electronic submission through Physicians 1st Billing and Claims.

Further statistics show that it costs between $8.00 and $10.00 per claim for a medical practice to process insurance claims for patients. These costs can often be reduced by half with the help of Physicians 1st Billing and Claims.

Statistics show that turnaround times for paper insurance claims can be as long as 30-60 days. It can even take 90 days. This results in significant outstanding receivables. Physicians 1st Billing and Claims allows physicians to submit claims electronically and can usually have the money in their hands within 14-18 days. This greatly reduces outstanding receivables. It also significantly increases cash flow.

Statistics show that there is a 30% rejection rate or suspension for paper insurance claims. This does not mean that the claims will never be paid. What it does mean is medical staff must hassle with insurance carriers over payment. This percentage has been reduced to 2-3% by extensive editing of electronic claims before transmission to carriers. Claims are submitted with a 98 percent accuracy rate.

For many years physicians graduated from medical school under the premise that they were going to run a “practice.” “Businesses” were for other professionals. Numerous administrative procedures were ignored, such as:

• To ensure claims are paid promptly, it is important to keep up with current insurance specifications and regulations.
• Concentrate on collecting receivables or co-payments.
• It was important to ensure that fees were paid at the highest level allowed by insurance carriers.
• In order to ensure that claims weren’t rejected or suspended, the procedure codes were always current.

Outstanding receivables increased dramatically in many offices and it became a routine to write off bad-debts annually. But adequate profit margins allowed medical practices to ignore sound business procedures. The past is gone. Medical practice complacency towards industry change is a thing of the past. Four years ago, doctors began paying attention to public opinion about health care reform. With the onslaught of managed care organizations into the industry, physicians are finding profit margins shrinking. They recognize that to be able to continue to operate in the 21st century, physicians will need to have more efficient business practices. Physicians 1st Billing and Claims is ready to support local health providers in moving through the 20th and 21st centuries with sound business practices. This will help ensure that quality health care is provided for our families and the country.

Physicians 1st Billing and Claims contributes over $9,000 to the business. We are requesting to borrow another $5,000. This detailed business plan will be your focus. The Start up Summary section describes how these funds will be used.

1.1 Objectives

1. To open one account by the end month two.
2. 1500 claims per month 15
3. To be recognized locally as an expert in the field medical reimbursement.
4. We offer additional services beyond the initial electronic claim submission. These include:
   • Code optimization
   • Analysis of managed care contracts
   • Full practice management.
   • Customized reporting.
   • Medical transcription.
   • Fee analysis
   • Medicare financial impact analysis.

1.2 Mission

Physicians 1st Billing and Claims provides medical reimbursement consulting services that help medical practices reduce costs and improve efficiency. They can outsource their insurance processing and medical bill to an expert reimbursement company. By 1998, we will be able to offer complete one-stop shopping for all administrative functions of medical practices. We plan to make enough profit by 1998 to repay our business start-up loan, and to finance our continued growth and development through our quality service.

1.3 Keys for Success

The Federal Government has been encouraging electronic submissions of insurance claims since 1985. The industry can save millions annually by submitting claims electronically, as evidenced by statistics. Presently, 95 percent of all pharmaceutical claims and 70 percent of hospital claims are submitted electronically. Only 25-30% of the claims for dentists and physicians are electronically submitted.

The Federal Government is not happy about this situation and in 1990 Congress required that doctors file claims for all Medicare patients. Many doctors weren’t prepared for the avalanche of paperwork. Eight years later, doctors are still trying to escape from the burden of paperwork. In 1996, congress heard the calls for electronic submission of all Medicare claim. Although no mandate was given, the paperwork is growing and the baby boomers are approaching retirement age, the paper problem will only worsen. Those echoes will soon become screams. In the U.S., more than 1 trillion dollars worth medical charges will go out this year. This amounts to 9 billion medical claims. The mandates will be enforced on medical practices, which are already buried under mountains of paperwork and not equipped to deal with the change. It is sensible to outsource the process to professionals who are willing to save money, provide a faster return on insurance, and manage the claims with high accuracy. There aren’t many companies that can claim the Federal Government is there every step of the process.

Flexibility is another key ingredient to our success. Physicians 1st Billing and Claims realizes that each practice is unique. Even practices within the same specialty can have different staff and offer a variety of services. Physicians 1st Billing and Claims will evaluate the needs of each practice and offer solutions to help the practice become more efficient. While some might want all of our services, others may only need a select few. We will tailor our billing to meet the needs of each office.

Diversified services are another key. Physicians 1st Billing and Claims can be described as a one stop shop for medical administrative services.