Physicians 1st Billing and Claims

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Medical Billing Business Plan

Strategy and Implementation Summary

Studies show that the No. 1 issue with consumers today is "personal service." They are tired of robotic salespeople, hollow sales promises, and mediocre support from unresponsive technical staff. They want to know that someone really cares about their concerns and wants to resolve their problems. They want thoroughly thought out solutions that reap benefits. And they want it when they want it. Physicians 1st Billing and Claims understands this because we have been in their position.

Physicians 1st Billing and Claims also understands that they want a reasonable price for services. That is why Physicians 1st Billing and Claims takes the time to evaluate the needs of each medical office and then we customize our service and our charges, based on needs. We need to make sure we are not overcharging or undercharging. If we're overcharging, then the client will not be happy. If we're undercharging, then we won't be happy and we probably won't do a good job. What we're looking for is win-win, long-term relationships with our clients. Zig Ziglar, noted sales trainer, asks the question, "Would you buy from you? Are you the type of business that you would like to do business with?" Physicians 1st Billing and Claims feels we are the type of company that anyone would be happy to do business with.

5.1 Competitive Edge

Physicians 1st Billing and Claims can provide the following benefits:

  1. Free State-Of-The-Art Practice Software.
  2. Two-way Computer Communications.
  3. Next Day Patient Record Updating.
  4. Complete Practice Analysis.
  5. Full Service Medical Claims Management.
  6. Superior Service.
  7. Experience.

No one else in the local market can offer this service package.

5.2 Marketing Strategy

There is a marked increase in results when multiple items are used in concert to attain your goal, a contract for services between you and a health care practice.

The basic plan is divided into five segments:

  1. Contacting the medical practice for the first time.
    • By phone.
    • Cold call.
  2. Identifying the gatekeeper and making contact with them.
  3. Mailing or dropping off information
    • Three-panel brochure.
    • Self mailer.
    • Promotional letter.
  4. Scheduling an appointment for a presentation.
  5. The presentation.

Contacts to implement this marketing strategy will be from a prior developed database of physicians who currently do not file medical claims electronically. This information is obtained from public records.

5.2.1 Promotion Strategy

We believe it is much smarter for a medical practice to out-source the detail work of insurance processing to an expert medical reimbursement service instead of trying to make the transition to in-house processing themselves. For years medical practices have been relying on the expert advice of accounting services for tax issues and financial planning. These areas have become very complicated and expertise is needed to ensure judicious decisions. Insurance processing has become very complicated as well, and physicians need to begin relying on expert services to maximize their reimbursement from insurance carriers.

Most medical offices are computerized to the degree that they own a computer and software with capabilities to set appointments, bill patients, and print paper insurance claims. Most do not have capabilities to transmit claims electronically or scientifically evaluate managed care contracts, and the transition is expensive.

Their current software and system have been very stable, and for years may not have even required a software update. Electronic claims submission is a very volatile and different industry requiring frequent software modifications to stay abreast of industry changes. Expertise and time is required over and above what the normal medical office can afford.

For most offices the transition would begin with buying new hardware (or updating the old), claims software, modems, communications software, etc. Very likely the current medical staff will not have the expertise to handle upgrades, install programs, test modems, understand baud rates, conduct initial testing, and other essential skills. This means the office has to hire someone with these skills or retain an expensive support service. With the high turnover of personnel that most medical offices currently experience, retaining another type of employee adds a completely new dimension.

The logical solution to meeting Federal mandates and to process all claims electronically, is to contract with an expert electronic medical billing and reimbursement service. This allows current office staff to resume the tasks they were trained to do, such as assist patients and doctors.

5.2.2 Marketing Programs

With a service-oriented business such as this, clients must be brought on one at a time. The full practice analysis will be conducted with each need being identified. Charges will be negotiated based on these needs. When we have successfully met the needs of each practice, the practice will be more inclined to promote our business to other medical practices that would benefit from our service. Studies have shown that the most common way to expand a medical reimbursement business is through referrals from current clients.

In addition to the on-going program discussed above, Physicians 1st Billing and Claims will incorporate numerous other strategies simultaneously.

In general they are:

  • A listing in the local Yellow Pages. We realize the importance of stability and professionalism; anyone who has been in business any length of time can be located in the Yellow Pages. We will only be utilizing a one-line listing for we feel this will not be the main source of clients contacting us, but will provide the professional appearance we need.
  • Networking as members of the Chamber of Commerce, local civic organizations, county medical associations.
  • Attending and volunteering services for medical fundraisers and health fairs, maintaining an information booth at local medical trade shows.
  • Attending Medicare, Medicaid, Blue Shield and Worker's Compensation activities.
  • Networking with other professionals, such as medical and professional consultants, attorneys, and accountants whose clientele is predominately medical, pharmaceutical representatives, and medical equipment salespeople.
  • Affiliation with local and national peer organizations, including those available on the Internet.
  • Advertising in local/hospital newsletters.
  • Membership in the Better Business Bureau.
  • Accepting an invitation to appear on a local radio talk show.
  • Submitting several press releases annually to local newspapers.
  • Writing articles for several health publications in the area.

5.2.3 Pricing Strategy

Physicians 1st Billing and Claims's pricing strategy is a two part program:

Part 1:
The first question that must be asked in the negotiation process is, "Does this practice want complete claims management?" If the answer is yes, Physicians 1st Billing and Claims will negotiate services based on a percentage. Usually the percentage will be from 6 to 10 percent based on the size of the practice.

Part 2:
If the practice simply wants claims filing, the pay-for-services rendered will be based on a sliding scale with ranges between $3.50 and $5.00. This scale is divided as follows:

# PatientsPrice Per Claim

A one time setup charge between $150.00 and $500.00 based on patient load will be assessed and will be due at contract signing.

5.3 Sales Strategy

The following graph and chart reflect the realistic goals we have set.

Sales Forecast
Year 1 Year 2 Year 3
Unit Sales
Service 1 33,000 48,000 52,000
Service 2 28,800 0 0
Total Unit Sales 61,800 48,000 52,000
Unit Prices Year 1 Year 2 Year 3
Service 1 $3.50 $3.50 $3.50
Service 2 $1.50 $1.50 $3.50
Service 1 $115,500 $168,000 $182,000
Service 2 $43,200 $0 $0
Total Sales $158,700 $168,000 $182,000
Direct Unit Costs Year 1 Year 2 Year 3
Service 1 $0.00 $0.00 $0.00
Service 2 $0.00 $0.00 $0.00
Direct Cost of Sales
Service 1 $0 $0 $0
Service 2 $0 $0 $0
Subtotal Direct Cost of Sales $0 $0 $0

5.4 Strategic Alliances

Physicians 1st Billing and Claims is a franchise affiliated with the nationally known Medical billing franchise. This affiliation allows us to take advantage of the prestige and experience associated with the national company. Included with affiliation is:

  • Full-accounting, state-of-the-art medical billing software (Windows based) that includes patient billing, specialized reports, superbill generation, electronic claims, open-item accounting, patient recall, mailing labels, patient scheduling, and graphics capabilities.
  • One year, toll-free telephone support for software, claims processing and marketing strategies.
  • One year software updates, rewrites, and new manuals.
  • A library of current medical insurance carriers.
  • A library of current CPT (procedure) codes.
  • A library of current ICD-9-CM (diagnosis) codes.
  • Flash Code for Windows (software that handles extensive validity checking on procedure and diagnosis codes).
  • Clearinghouse registration for claims processing centers and first medical practices.
  • Dental electronic claims software.
  • Marketing manuals, audio tapes, and supplemental marketing materials.
  • Computer software to help in designing innovative marketing brochures.
  • Personalized help in designing marketing materials.
  • Updates to keep us informed concerning changes in the health care industry.
  • Computer software to calculate what it currently costs a medical practice to provide insurance processing for patients and to help calculate customized charges for medical practices.
  • Invoicing software.
  • Contact management software.

5.5 Milestones

See Milestone table.

Milestone Start Date End Date Budget Manager Department
First Client 10/1/1998 10/30/1998 $1,200 John & Mary Biller S&M
Second Client 10/30/1998 11/30/1998 $1,200 John & Mary Biller S&M
Third Client 11/30/1998 12/30/1998 $1,200 John & Mary Biller S&M
Fourth Client 12/30/1998 1/30/1998 $1,200 John & Mary Biller S&M
Fifth Client 1/1/1999 2/1/1999 $1,200 John & Mary Biller S&M
Totals $6,000