Start a Medicare Billing Business

Money Worksheet

Companion to the lessons "The honest money" and "Your first 90 days"

1. Runway and Stop Date

Runway number (the month money out exceeds money in): $ per month × months available: Stop date: . Every later decision answers to this number.

2. Per-Client Unit Economics (collections × fee % = monthly gross)

Worked example from the course, stated assumptions: a solo primary care or specialty practice collecting on the order of $30,000–$50,000 a month, at 6 percent of collections. Percentage is of what gets collected, not what gets billed.

ClientMonthly collectionsYour fee %Your monthly gross
Worked: solo practice$40,0006%$2,400
Worked: three clients like that$120,0006%$7,200
Client A
Client B
Client C

Pricing models from the course's sourced rows: percent of net collections 4%–9% (the default; higher for small or complex practices); per claim $3–$12, commonly $4–$10; monthly flat fee $500 to more than $2,500 (rare at the start). Two clients covers a modest take-home while you grow; one client is a part-time income. Unit economics, not a promise.

3. Launch Budget (can stay under $1,000 if you start lean)

ItemReference cost (from the course's sourced rows)Your actual quote
Clearinghouse + practice management (Office Ally Service Center + Practice Mate)$0
Print-and-mail claims when a payer requires paper$0.75 per claim
Full EHR + billing platform (when a client needs one)Reported around $99–$399 per provider per month, billed to the engagement
Errors and omissions insuranceSmall-business average $88/month; 46% of one carrier's customers pay under $75
LLC filingRoughly $35–$500 depending on state
Optional: CPB exam + AAPC membership$425 one attempt ($400 student) plus $229/year membership ($164 student)
Service agreement + BAA templates, attorney-reviewedbuy once

You can defer the credential and the paid platform. You cannot sensibly defer insurance and a signed contract.

4. Cash-Lag Planner

You are paid when the payer pays the practice, then when the practice pays you on the following month's invoice. Plan on two months from first claim to first fee. Clean electronic Medicare claims cannot be paid before day 14 after receipt (day 29 for paper); commercial and Medicare Advantage commonly take thirty to forty-five days; state prompt-pay laws typically allow thirty days for a clean electronic claim, forty-five for paper.

MilestoneDateNote
First claim submitted
Payer pays the practiceDay 14 earliest (electronic); 30–45 days common
First invoice to practiceRoughly a month after first month of service
First fee receivedPractice's payment cycle after invoice

Stack the sales cycle in front of it: operators describe six to twelve months to a first client. The lag is the reason the runway number comes first on this sheet.