First customers in Medicare billing
The buyer is the office manager or physician-owner of a one-to-five-provider practice; the friendly specialties are behavioral health, physical and occupational therapy, speech therapy, small primary care, and chiropractic. The first client usually arrives warm, six to twelve months in (one operator: eight months, and the client was a relative of someone their spouse knew). Hunt trigger events: a biller's departure, an EHR migration, visible aging receivables. The offer that converts is a diagnostic, not a marriage: a ninety-day claims review ending in a one-page report of what denials are costing. The call script keeps one shape: who you help, a specific pain, a small reversible yes. Scripts in first clients, arithmetic in the first-ten module.
Pricing in Medicare billing
Percentage of net collections, 4 to 9 percent, is the default, higher for small or complex practices. Per-claim runs $3 to $12, commonly $4 to $10; monthly flat fees of $500 to more than $2,500 are rare at the start because they need volume data. The unit economics: a practice collecting $40,000 a month at 6 percent pays you $2,400 a month; two clients covers a modest take-home while you grow. Percentage means percentage of what gets collected, not billed; if their collections sag, your fee sags with them. The honest money owns the tables; the pricing method owns the floor.
Rules in Medicare billing
You are a business associate under HIPAA, with obligations enforceable against you directly. The BAA is signed before a single patient record moves; no test batches, no papering it later. One encrypted work computer, no PHI in personal email or texts, cross-cut shredding, six-year retention. Know the fraud vocabulary cold (upcoding, unbundling, routine copay waivers) and the refusal sentence: "I can't submit a claim the documentation doesn't support," in writing, every time. E&O averages about $88 a month; no state licenses medical billers. Taught in HIPAA at your kitchen table, the fraud lines, and setting up shop, inside the legal setup framework.
Money in Medicare billing
The lag is the shape of the business. You invoice after the practice gets paid, so plan on two months from first claim to first fee: Medicare cannot pay a clean electronic claim before day 14, and prompt-pay windows give carriers about thirty days, which they tend to use. The software stack starts free (Office Ally clearinghouse and Practice Mate at $0, paper claims $0.75 each), the CPB exam at $425 ($400 student) is a later decision funded by client revenue, and a quarterly self-audit of twenty claims per client keeps you clean. The honest money has the ledger and the launch-cost table, on the money system.
First hire in Medicare billing
The course ends at the first contracted biller: firm-building, hiring, and office space are where a solo operator's decisions stop being universal, so the hiring decision routes to the first-hire module.
The whole revenue cycle, superbill to check: the full course.