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Medical Billing Business | Projections
Manual Billing Electronic Billing Services You Can Offer Income Projections Business Plan
WHAT INCOME DO I EXPECT FROM A BILLING SERVICE?

Various federal and state laws forbid all business opportunity companies from specifying a level of income entrepreneurs can earn from the business they are selling. The rationale for these laws is simple: as with everything in life, there are no guarantees. Your potential success depends on many factors that we cannot predict nor control. Your income depends on factors like your level of effort, your prior business background and skills, the time you dedicate to starting your company, and your willingness to market your services aggressively. ClaimTek supports these regulations and we urge you, in fact, to be careful about blindly accepting unrealistic income projections from other medical billing business opportunities.

However, not knowing your income potential makes planning difficult when you are considering starting any new business. To alleviate this problem, we are providing here some tools you can use to make your own income projections.

Below are two calculators, as follows:

  • Quick Income Projection - This tool lets you do a fast calculation of your potential gross income. It does not take into account business expenses.
  • Detailed Income Projection - This tool lets you do a very detailed calculation of your potential income over time. It takes your estimated monthly projections over four quarters (1 year) plus an estimate of your ultimate goal. It then calculates your gross quarterly and annual income, expenses, net income and cash flows.
Quick Income Projection

To Use:
  • Choose the method of pricing you will use in your business: per claim fees or percentage.
  • Then move the sliders or type a number in each box representing your monthly estimates.
  • The results will appear showing your projected monthly and annual income.
Service pricing method [choose one]:  
         
Number of doctors:
Average monthly claims per doctor:

 

Number of doctors:
Medical billing companies starting out may be able to service from 1 and 7 doctors or health care providers depending on size and volume. Some grow to have tens, even hundreds of providers. You might calculate once with just 1 or 2 providers to represent a start-up period of time; then do it again to simulate having a more mature business with more clients.

How many claims per month:
The average number of claims varies per specialty. Chiropractors, internal medicine providers, pediatricians, and dermatologists may see several hundred patients per month while surgeons may see about 100. Move the slider here using your best estimate of the average number of claims you might handle per month.

Percentage collected:
Move the slider to indicate your average percentage fee. For most billers, this can range from 4% to 12% depending on specialty and other factors. It can even go higher if you are collecting on old unpaid claims.

Average claim value:
Claim values will vary, depending on medical specialty, number of services performed, approved insurance rate, and other factors. In general, you might use an average of $50 to $300 you will collect per claim from the insurer and the patient. Some claims can reach as high as $1000 or $5000 if you are billing for specialists. Use an average here.

Service pricing method:
Medical billers usually choose one method of pricing their services: a percentage of all fees collected (most common method) or a flat fee. The flat fee may be $2.00-$10.00 per claim (mostly around $3 or $4) and $2.00 - $3.00 per patient statement. The percentage method may range from 3% to 12% of all fees collected, with an average of 7% or 8%.

Service pricing method:
Medical billers usually choose one method of pricing their services: a percentage of all fees collected or a flat fee. The flat fee may be $2.00-$10.00 per claim and $2.00 - $3.00 per patient statement. The percentage method may range from 3% to 12% of all fees collected, with an average of 7% or 8%.

Number of doctors:
Many billing services have between 1 and 7 doctors, but some grow to manage larger operations with many providers. We recommend that you remain conservative in your estimates. You might project 0 or 1 provider in Q1 & Q2, then increase your clients in Q3 and Q4; then do a projection for your ultimate goal.

Average monthly claims per doctor:
Chiropractors and many specialists (e.g., internal medicine, pediatric, dermatology) may see several hundred patients per month while surgeons may see around 100. Use an average for each quarter. Tip: this is an average per doctor per month, so it will not fluctuate greatly per quarter (except if you intend to steer your business toward lower or higher volume specialists).

Percentage collected:
This can range from 3% for high value claims to 12% for standard claims, with an average of 7-8%. It can go higher if you are collecting on old unpaid claims. Tip: Your percentage can increase as you build your business and offer more services.

Average dollar amount for each claim :
Claim values will vary, depending on medical specialty, number of services performed, approved insurance rates, and other factors. Commonly, you may collect an average of $50 to $300 per claim from the insurer and patient. Some claims can reach as high as $1000 or $5000 if you are billing for specialists. Use an average here. Tip: Your average dollar amount might increase as you build your business or bill for higher claim value providers.

Gross Monthly Income:
This is your estimated average gross monthly income for each month in that quarter. For your Goal, it represents the average monthly income over one year.

Monthly Marketing Expense:
This will fluctuate over time. In the early phases of your business, you might estimate higher amounts ($250 - $500 or more) per month for postage, promotional items, ads, meals, etc. As your business grows, your marketing costs should stabilize or decrease. Remember that ClaimTek provides you with many marketing and advertising items, reducing your marketing expenses.

Administrative Expense:
This includes your business and cell phones, office supplies, answering service if you use one, and other general office expenses. These expenses might increase proportionately over time as you get more clients. If you grow your business, you’ll need to account for employee payroll, business insurance, more computers…etc.

Clearinghouse Expense:
Your monthly clearinghouse fees are either fixed or proportional to the number of claims filed. Enter $50-$75 per provider if you intend to use a fixed monthly fee, or use 35 cents per claim.

Total Monthly Expenses
This is your estimated average monthly expense for each month in that quarter. For your Goal, it represents the average monthly expense over one year.

Projected Net Monthly Income:
This total shows your net monthly income, which is equal to your Gross Monthly Income minus your monthly expenses.

Projected Cash Flow:
This total shows you accumulated cash flow on a quarterly basis. Your cash flow is the sum of your net monthly incomes added together. The last amount is the same as your projected annual income in Year 1.

Projected Yearly Income:
This total projects your estimated annual income in Year 1 and also your estimated annual income for your Goal.

Detailed Income Projection
(Show Details...)

To Use:
  • Choose the method of pricing you will use in your business: flat fee or percentage.
  • Then for both Projected Revenues and Expenses, fill in the quarterly grid using estimated monthly average for Q1, Q2, Q3, and Q4. In the fifth box in each row, fill in your estimated monthly average reflecting your Goals. (Use the Tab key to move quickly through the fields.)
  • Upon completion, you will see the following estimated totals:
    • Projected monthly income in each quarter
    • Accumulated cash flow over 4 quarters (1 year)
    • Projected annual income over 4 quarters (1 year)
    • Projected annual income based on your goal.
Service pricing method [choose one]:  
                 
Years to reach your goal:                 
Q1 Q2 Q3 Q4 Goal Help
Projected Revenue
Number of doctors:
Average monthly claims per doctor:
Projected Monthly Gross Income:
Projected Expenses
Marketing expense per month:
Administrative expense per month:
Clearinghouse expense per month: