How to get a US medical billing project for a startup?
According to Deloitte Center for Health Solutions (2024), 71% of U.S. executives expect improved profitability in 2025, suggesting an optimistic outlook for healthcare providers and medical billing companies.
Starting a medical billing company can be highly rewarding, however the reality of getting clients is the biggest challenge. The medical billing industry is highly competitive with heavy regulations, and constantly evolving payer rules and compliance requirements. For startups to standing out in this requires strategic planning, networking, and proven value propositions that healthcare providers can trust besides the basic knowledge of medical billing and coding.
We at Shoreline Healthcare Technologies being an established and experienced medical billing company in US like to help new entrants to navigate this process successfully with this blog by using real-world strategies that work.
Why is it challenging for startups to secure a US medical billing project?
The process of medical billing is complex and keeps changing. Any small mistake in this will lead to claim denials, delay in payments and patient dissatisfaction affecting the sustainability of the entire practice. Hence providers will always look for an experienced medical billing company who can handle this process efficiently and accurately, following all the compliances and get them a quicker reimbursement from insurance companies. So, for a startup with no proven track record, it will be challenging to convince healthcare professionals to sign a contract.
What does a successful medical billing startup need before approaching clients?
Healthcare Providers look for billing partners who can streamline their workflow and get them a quicker reimbursement without any costly denials. Hence startups must have a clear business plan, team of certified professionals to handle billing and coding with a reliable medical billing software, and a strong understanding of revenue cycle management to handle the complex payer requirements and deliver measurable results.
Below are the step-by-step strategies we recommend to startups entering the US Healthcare market.
1. Build a Solid Foundation in the Medical Billing Industry
Before approaching a potential client, it is necessary to master the essentials of medical billing services. Understand every stage of the billing process, learn how medical coding integrates with claims submission, how can we proactively manage denials and how payers assess claims. A strong foundation includes:
- Learning Revenue Cycle Management (RCM) starting with patient scheduling, insurance verification, getting prior authorization, coding, charge capture, denial management, payment posting, AR follow, patient statements and follow up.
- Gaining expertise in Medical Billing Software and leading Practice Management for accurate data entry and claim processing.
- Maintaining compliance with HIPAA standards to secure patient data.
- Keeping on Track with payer-specific rules, CMS guidelines and American Medical Billing Association (AMBA) resources.
- Investing in training Keeping on Track with AMBA or AAPC for medical billers and coders.
2. Identify Your Target Market and Build a Business Plan
Not all providers have the same needs. Developing a clear business plan helps to craft tailored offers to resonate with the chosen audience. Start by defining,
Whom to serve?
- Small clinics without dedicated billing staff.
- Independent physicians needing end-to-end RCM support.
- Specialty practices like dermatology, podiatry, or cardiology.
Geographic focus
- Local practices
- Nationwide remote billing
Scope of services
- Full Revenue cycle management
- Coding
- claims submission
- AR Follow up
A focused approach signals professionalism and makes it easier to demonstrate the value to potential clients.
3. Build Credibility and Showcase Expertise
Startups often struggle with the experience gap. Build Credibility as a new Medical Billing Company.
- Highlight professional coders’ certifications like CPC, CPB, etc.
- Share case studies or reports showing improvement in revenue cycle.
- Maintaining compliance with HIPAA standards to secure patient data.
- Demonstrating knowledge of compliance and medical billing software through live demos.
- Provide testimonials or references.
Trust is everything in the healthcare industry; by demonstrating reliability and compliance, we can get providers to work with us even without a long client list.
4. Network and Form Strategic Partnerships
The medical billing world is relationship-drive and thrives on connections. To reach potential clients:
- Join in events and online forums where physicians and practice managers meet which are conducted by ABMA.
- Partner with other medical billing companies as a subcontractor to build experience and gain references.
- Network with local healthcare associations, independent physician groups, and EHR vendors who may refer to potential clients.
- Join LinkedIn groups where providers discuss medical billing services.
Personal referrals remain one of the most effective ways to win your first medical billing project.
5. Offer Competitive and Flexible Pricing Models
Pricing is often a deciding factor for startups trying to win contracts. Avoid being the cheapest option; instead, structure the services to be attractive:
- Offer tiered pricing models based on claim volumes.
- Customize solutions for providers already using certain practice management systems.
- Provide trial periods or discounts for long-term contracts to build trust.
At Shoreline Healthcare Technologies, we found that by offering flexible payment structures we can attract clients who were hesitant to switch billing companies.
6. Build a Strong Digital Presence
Digital visibility can bring in leads from across the US especially from providers actively searching for revenue cycle management support. Ensure to have a
- A professional website that explains the services and compliance standards.
- SEO-optimized content targeting keywords like “start a medical billing company,” “outsourced billing process,” and “medical billing services for clinics.”
- Case studies, blogs, or educational posts showcasing the knowledge of the healthcare industry.
7. Highlight Compliance and Data Security
Healthcare providers are very cautious about outsourcing billing due to risks involved by data breaches and non-compliance. So startups must clearly mention about,
- Full HIPAA compliant.
- Use of secure, encrypted medical billing software.
- Transparent reporting and error-free claims submission processes.
8. Deliver Exceptional Customer Service
Winning the first project is only the beginning. It is essential to build long-term relationships by,
- Offering transparent reporting on claim status and collection rates.
- Responding promptly to provider queries and payer feedback.
- Optimize revenue cycle for quicker claim submission and faster reimbursements.
Satisfied clients become the biggest marketing tool, and will recommend the business to their peers.
Starting a medical billing business isn’t just about learning codes and claims, it is important to get trust, relationships, and a strong reputation in the healthcare industry. By offering value-driven solutions and maintaining compliances with the federal & state regulations startups can secure US medical billing projects successfully.
Continuous persistence, professionalism, with the right approach, can help startups to become a trusted partner.
FAQs
Q1. How can I as startup get my first US medical billing project quickly?
+By networking with physicians, joining AMBA, getting subcontracts and having a strong online presence you can attract potential clients.
Q2. Do I need certification to start my own medical billing company?
+No certification is not mandatory, but having a certificated professional coders and billers (CPC, CPB) adds credibility and increases trust among the providers.
Q3. Is it important to have medical billing software to start the business?
+Yes. A Reliable medical billing software is essential to get the codes right, speed up the process of claims submission, and to provide a better report for providers.
Q4. Is ShorelineMB the same as Shoreline Healthcare Technologies?
+Yes, ShorelineMB.com is the official website of Shoreline Healthcare Technologies, a leading provider of medical billing and RCM services.
Sharanya Rajmohan
Content Writer
Sharanya brings clarity to the complexities of medical billing and healthcare regulations. With a knack for turning industry shifts into straightforward, actionable insights, her blogs help readers stay informed without the jargon.
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