Your first 90 days

Ninety days does not produce a profitable billing service. The ramp is months, and the first client usually arrives in the back half of the first year, the six-to-twelve-month range operators describe in this r/CodingandBilling thread on finding clients. What ninety days produces is a complete, credible, operating business with a live pipeline, which is what the remaining months convert into income. Here is the calendar.

Days 1 to 30: build the thing

Week one is the money decision: write down your runway number from "The fit check," the month when money out exceeds money in and you stop. Every later decision answers to that number.

Then the stack, most of which you priced in "The honest money": form the LLC, get the EIN, open the bank account, bind E&O, buy the attorney-reviewed service agreement and BAA templates, set up the free software accounts, and register your domain with a simple three-page site (what you do, who for, how to reach you).

Weeks three and four are skill and list. If you are the career-changer from "Getting good enough to be trusted," schedule the CPB and start the free CMS materials daily. Build the list of fifty practices with the office manager's name for each, flag the trigger events, and identify five adjacent vendors worth knowing: the EHR consultant, the medical accountant, the chamber regular.

Days 31 to 60: work the graph

The warm list first: every person you know who knows a provider gets a specific, low-pressure ask. "Who do you know running a small practice that complains about insurance? I'd love an introduction." Then the five vendor relationships, one coffee each. Then local: one medical society or chamber event on the calendar.

Start the cold learning calls in week six: ten a week, tracked in the spreadsheet, every objection logged. Draft the ninety-day claims review offer and the one-page report template that backs it. If you are the apprenticeship type, send three subcontracting proposals to established local billing services this month.

Days 61 to 90: first revenue-shaped activity

By now something should be moving: a warm introduction has become a conversation, or a subcontracting proposal has become overflow work at a per-claim rate. Neither is the finish line. Both are revenue-shaped and count. Close one diagnostic review at a modest flat fee if you can. First money changes your psychology more than your bank balance.

If nothing has moved by day ninety, that is still inside the normal range, and the checkpoint is a decision, not a funeral:

• Extend with a niche change. Behavioral health instead of physical therapy. A different county. A sharper diagnostic offer. One variable, not all of them.
• Convert to apprenticeship mode. Spend the next ninety days landing subcontract work and come back to client acquisition with references and runway rebuilt.
• Stop cleanly. The skills you built, claim mechanics, Medicare rules, compliance discipline, are employable at practices and billing companies right now. The door to ownership reopens whenever the runway does.

That extend-convert-stop fork is a household-runway decision as much as a business one, and deciding whether to extend, convert, or stop is the guide that walks it.

One lesson remains: where this goes from here.