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JUN.16, 2022

Medical Billing Business Plan Template

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Medical Billing Business Plan Template

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    Medical billing business plan for starting your own business

    Do you want to start a medical billing business? Well, considering the rising costs of healthcare in the U.S. and the complexities involved in medical payments when there is 3rd party (insurance company) involved, the business can be immensely profitable.

    A medical billing business facilitates patients and medical practitioners as well as health insurance companies in dealing with complex medical transactions. For this, the medical billing specialist does a range of tasks such as filing the claim and keeping up the patient’s record and medical history.

    To start this business, the first step is to make a business plan for medical billing company. In case you don’t know the essentials, you can take help from here. Here we are providing a business plan for a medical billing startup, Medi Assist. If you will be raising a loan, you’ll also have to see business plan for a loan from a bank.

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    Executive Summary

    2.1 The Business

    Medi Assist will be based in San Diego. The business will provide expert medical billing specialists to physicians, dentists, surgeons, and others in the profession. After 5 years of the launch, the business will be expanded to one more location.

    2.2 Management of medical billing

    To make sure that you manage your medical billing startup well, it is essential to decide everything in a medical billing company business plan. Since the business requires expertise and specialization in the domain, you must manage the functions effectively. For each case, you’ll need to arrange for commute, legal assistance, and access to data for accurate record keeping. 

    To assist you we will provide the list of employees, management positions, and their spheres of authority in this medical billing business plan pdf. Though you can take help from this sample business plan for medical billing, it will be best practice to hire a business planning expert for making your business plan if you are new to the field.

    2.3 Customers of medical billing

    Before opening a medical billing company you must recognize groups of your target customers. The customers of Medi Assist are expected to be:

    • Medical Practitioners
    • Surgeons
    • Dentists
    • Others

    2.4 Business Target

    It is essential to set business targets even when you work on simple ideas like business plan for a medical laboratory or nursing business plan. It is to remain focused and directed throughout the operations of your business.

    Our targets to establish our name in the market will be given in the later sections. However, our financial targets are given as below:

    Medical Billing Business Plan - 3 Years Profit Forecast

    Company Summary

    3.1 Company Owner

    Medi Assist will be owned by Mariana Downey. She is an expert medical billing agent and has been working in the domain for more than 6 years.  

    3.2 Why the medical billing is being started

    Mariana decided to start medical billing business because of her interest and expertise in the field. Since the business requires specified knowledge and cannot be run by any layperson, Mariana found that there are more prospects of getting successful in this domain. 

    3.3 How the medical billing will be started

    If you are looking for what do I need to start a medical billing business, we’re providing a step-wise procedure here. 

    Step1: Research & Plan

    The first step is to carry out intensive research on how to start your own billing company. After that, you will have to pen down details in a business plan in a systematic manner. To assist you with this, we’re providing sample medical billing business plan in this blog.

    Step2: Fund & Recruit

    The next step is to incentivize your venture and manage financial resources. You’ll then need to invest your money to purchase the required equipment, rent a space, and employ the personnel.

    Step3: Manage & Systemize 

    After getting monetary and fiscal resources, you’ll have to devise a management structure to systemize all operations.

    Step4: Exist on the Web

    Next, you will have to make sure that you have a strong web presence. Today, clients are likely to search for medical billing services on the web and seek the services of only those whose websites come at the top. Thus, it is a must to ensure an online presence.

    Step5: Market

    Lastly, you will have to advertise your startup to reach your target audience. In this medical billing business plan example we will be listing the techniques adopted by Medi Assist to advertise their venture.

    Medical Billing Business Plan - Startup Cost

    Start-up Expenses  
    Legal $125,300
    Consultants $0
    Insurance $25,100
    Rent $32,500
    Research and Development $10,000
    Expensed Equipment $52,500
    Signs $3,400
    TOTAL START-UP EXPENSES $248,800
    Start-up Assets $225,400
    Cash Required $181,000
    Start-up Inventory $35,100
    Other Current Assets $225,000
    Long-term Assets $211,300
    TOTAL ASSETS $877,800
    Total Requirements $1,126,600
    START-UP FUNDING
    Start-up Expenses to Fund $248,800
    Start-up Assets to Fund $877,800
    TOTAL FUNDING REQUIRED $1,126,600
    Assets
    Non-cash Assets from Start-up $1,138,300
    Cash Requirements from Start-up $125,300
    Additional Cash Raised $50,000
    Cash Balance on Starting Date $31,300
    TOTAL ASSETS $1,344,900
    Liabilities and Capital
    Liabilities $15,200
    Current Borrowing $0
    Long-term Liabilities $0
    Accounts Payable (Outstanding Bills) $62,500
    Other Current Liabilities (interest-free) $0
    TOTAL LIABILITIES $77,700
    Capital
    Planned Investment $1,126,600
    Investor 1 $0
    Investor 2 $0
    Other $0
    Additional Investment Requirement $0
    TOTAL PLANNED INVESTMENT $1,126,600
    Loss at Start-up (Start-up Expenses) $140,600
    TOTAL CAPITAL $1,267,200
    TOTAL CAPITAL AND LIABILITIES $1,344,900
    Total Funding $1,126,600

     

    Services of medical billing

    Before you start medical billing company, it is essential to search for how to start a medical billing business and read at least one medical billing service business plan. After this, you will be able to know which services are being provided by your competitors. And thus decide the services that you want to provide as you start medical billing business. In this sample business plan for medical billing, we’re providing the services provided by Medi Assist.

    • Setup Patient Record

    Our medical billing experts will set up patients’ medical histories and records of all transactions related to healthcare.

    • Claim Filing

    We will help file medical claims both in manual and electronic forms. 

    • Negotiating Healthcare Contracts

    We’ll negotiate the medical and healthcare contracts by dealing with all three parties at a time. The three parties can be patients, medical assistance providers, and insurance companies. 

    • Upkeeping & Updating Record

    We will maintain the patient’s record and update it from time to time both manually and electronically.

    Marketing Analysis of medical billing

    If you’re looking for how to open a medical billing company, you are on the right page. In this medical billing business plan sample we have provided full guide on how to start medical billing business. After you have gone through the initial steps, you need to undergo a thorough market analysis. Unlike cannabis business plan or reiki business plan, market analysis for medical billing can give you a tough time. It is because the business is still unknown to many and does not involve just one-time interaction. The target customers would remain in contact for a long time and hence they would prefer to see how you are more reliable and efficient than your competitors. Therefore, you need to investigate the already operating medical billing businesses, market trends, inclinations of customers, and pricing policies that can help you get through. If you are starting medical billing business from home you’ll still need to do market analysis.

    5.1 Market Trends

    The growth prospects of medical billing startup are encouraging. According to IBISWorld, the market size of medical billing services stands at $5 billion in the U.S. even though only 1761 such businesses are operating there. If you want to enter this enterprise, you can also make a lot within a short time.

    5.2 Marketing Segmentation

    Before starting medical billing business it is also essential to do market segmentation. For this, you’ll have to divide the entire population into distinct groups. In this free medical billing business plan template on how to start your own medical billing company, we’re providing the market segmentation done by Medi Assist.

    Medical Billing Business Plan - Marketing Segmentation

    5.2.1 Medical Practitioners

    This category includes doctors and healthcare providers. They will need our services of filing claims, checking the credentials, and keeping a record of patients.

    5.2.2 Surgeons

    This segment will include the medics who perform minor or major surgeries.

    5.2.3 Dentists

    Dentists who provide teeth cleaning, healing, and maintenance services will also be our customers.

    5.2.4 Others

    This segment may include medics who aren’t covered in the above categories such as physiotherapists. Moreover, hospital groups and healthcare provider organizations are also included in it.

    Market Analysis
    Potential Customers Growth Year 1 Year 2 Year 3 Year 4 Year 5 CAGR
    Medical Practitioners 36% 52,500 63,000 75,600 90,720 108,864 10.00%
    Surgeons 30% 42,500 51,000 61,200 73,440 88,128 10.00%
    Dentists 18% 22,530 27,036 32,443 38,932 46,718 10.00%
    Others 16% 21,500 25,800 30,960 37,152 44,582 11.00%
    Total 100% 139,030 166,836 200,203 240,244 288,293 10%

     

    5.3 Business Target

    • Expand our service sector to at least one more locality by the end of the first 5 years
    • Maintain a CSAT score above 90% throughout the service years
    • Capture 15% of the market share within three years of operation

    5.4 Product Pricing

    Our prices are a little higher than others in the same profession. But due to our expertise, Mariana’s experience in the field, and our sales strategy we still expect to get more customers than them.

    Marketing Strategy of medical billing 

    Before starting a medical billing company you will have to devise ways by which you want to reach out to your target customers. In this medical billing company business plan on how to start a medical billing and coding business, we are providing the sales strategy of Medi Assist.

    6.1 Competitive Analysis

    • Our employees are highly specialized and experts in their domains.
    • We are offering several discounts, in the beginning, to get known.
    • Customers are our topmost priority, we are willing to go to all lengths to facilitate them.

    6.2 Sales Strategy

    • We’ll offer a 50% discount to our first 50 customers.
    • We’ll offer a 20% discount on all our services in June and July.
    • We’ll advertise our startup on social media, in local newspapers, and in magazines. 

    6.3 Sales Monthly

    Medical Billing Business Plan - Sales Monthly

    6.4 Sales Yearly

    Medical Billing Business Plan - Sales Yearly

    6.5 Sales Forecast

    Medical Billing Business Plan - Unit Sales

    Sales Forecast      
    Unit Sales Year 1 Year 2 Year 3
    Setup Patient Record 1,350 1,431 1,517
    Claim Filing 1,425 1,511 1,601
    Healthcare Contracts 1,215 1,288 1,365
    Record Upkeep 1,155 1,224 1,298
    TOTAL UNIT SALES 5,145 5,454 5,781
    Unit Prices Year 1 Year 2 Year 3
    Setup Patient Record $400.00 $464.00 $538.24
    Claim Filing $350.00 $406.00 $470.96
    Healthcare Contracts $425.00 $493.00 $571.88
    Record Upkeep $525.00 $609.00 $706.44
    Sales
    Setup Patient Record $540,000.00 $663,984.00 $816,434.73
    Claim Filing $498,750.00 $613,263.00 $754,068.18
    Healthcare Contracts $516,375.00 $634,934.70 $780,715.71
    Record Upkeep $606,375.00 $745,598.70 $916,788.16
    TOTAL SALES $2,161,500.00 $2,657,780.40 $3,268,006.78
    Direct Unit Costs Year 1 Year 2 Year 3
    Setup Patient Record $100.00 $110.00 $115.50
    Claim Filing $110.00 $121.00 $127.05
    Healthcare Contracts $125.00 $137.50 $144.38
    Record Upkeep $110.00 $121.00 $127.05
    Direct Cost of Sales
    Setup Patient Record $135,000.00 $157,410.00 $175,197.33
    Claim Filing $156,750.00 $182,770.50 $203,423.57
    Healthcare Contracts $151,875.00 $177,086.25 $197,097.00
    Record Upkeep $127,050.00 $148,140.30 $164,880.15
    Subtotal Direct Cost of Sales $570,675.00 $665,407.05 $740,598.05

    Personnel plan of medical billing

    The staff of medical billing business cannot comprise anyone but highly experienced and qualified professionals. In this medical billing business plan example we’re providing the list of employees of Medi Assist along with their job descriptions and expected salaries. If you’re going to make business plan medical billing you should also do the same.

    7.1 Company Staff

    Mariana will hire personnel for the following positions:

    • 1 Co-Manager to oversee all operations
    • 1 Financial Manager
    • 5 Medical Billing Specialists
    • 2 Accountants
    • 1 Legal Expert
    • 2 Drivers
    • 1 Web Designer 

    7.2 Average Salary of Employees

     Personnel Plan      
    Year 1 Year 2 Year 3
    Co-Manager $32,550 $35,805 $39,386
    Financial Manager $32,550 $35,805 $39,386
    Billing Specialists $184,500 $202,950 $223,245
    Accountants $42,500 $46,750 $51,425
    Legal Expert $23,000 $25,300 $27,830
    Drivers $42,500 $46,750 $51,425
    Web Designer $23,000 $25,300 $27,830
    Total Salaries $380,600 $418,660 $460,526

    Financial Plan of medical billing

    If you are going to start medical coding and billing business you must be wary of how profitable is medical billing business. Well, the business is immensely profitable and the profit margin is expected to increase more in the upcoming years.

    To assess, how much you would be able to make as per your resources, investment and sales, you will be needing to create a financial plan for your business. For that, you can take help from the financial plan provided here as well as those listed in business plan for urgent care center and business plan for veterinary clinic.

    8.1 Important Assumptions

     General Assumptions      
    Year 1 Year 2 Year 3
    Plan Month 1 2 3
    Current Interest Rate 8.12% 8.20% 8.26%
    Long-term Interest Rate 8.40% 8.44% 8.47%
    Tax Rate 24.03% 24.21% 24.60%
    Other 0 0 0

    8.2 Break-even Analysis

    Medical Billing Business Plan - Break-even Analysis

     Break-Even Analysis  
    Monthly Units Break-even 5340
    Monthly Revenue Break-even $132,500
    Assumptions:
    Average Per-Unit Revenue $231.00
    Average Per-Unit Variable Cost $0.62
    Estimated Monthly Fixed Cost $163,800

    8.3 Projected Profit and Loss 

     Pro Forma Profit And Loss    
    Year 1 Year 2 Year 3
    Sales $2,161,500 $2,657,780 $3,268,007
    Direct Cost of Sales $570,675 $665,407 $740,598
    Other $0 $0 $0
    TOTAL COST OF SALES $570,675 $665,407 $740,598
    Gross Margin $1,590,825 $1,992,373 $2,527,409
    Gross Margin % 73.60% 74.96% 77.34%
    Expenses
    Payroll $380,600 $418,660 $460,526
    Sales and Marketing and Other Expenses $145,000 $148,000 $156,000
    Depreciation $2,300 $2,350 $2,500
    Leased Equipment $0 $0 $0
    Utilities $2,900 $3,000 $3,100
    Insurance $2,100 $2,100 $2,100
    Rent $2,900 $3,000 $3,200
    Payroll Taxes $24,000 $25,000 $27,000
    Other $0 $0 $0
    Total Operating Expenses $559,800 $602,110 $654,426
    Profit Before Interest and Taxes $1,031,025 $1,390,263 $1,872,983
    EBITDA $1,031,025 $1,390,263 $1,872,983
    Interest Expense $0 $0 $0
    Taxes Incurred $206,205 $278,053 $374,597
    Net Profit $824,820 $1,112,211 $1,498,386
    Net Profit/Sales 38.16% 41.85% 45.85%

    8.3.1 Profit Monthly

    Medical Billing Business Plan - Profit Monthly

    8.3.2 Profit Yearly

    Medical Billing Business Plan - Profit Yearly

    8.3.3 Gross Margin Monthly

    Medical Billing Business Plan - Gross Margin Monthly

    8.3.4 Gross Margin Yearly

    Medical Billing Business Plan - Gross Margin Yearly

    8.4 Projected Cash Flow

    Medical Billing Business Plan - Projected Cash Flow

     Pro Forma Cash Flow      
    Cash Received Year 1 Year 2 Year 3
    Cash from Operations
    Cash Sales $51,000 $55,080 $59,486
    Cash from Receivables $22,000 $23,760 $25,661
    SUBTOTAL CASH FROM OPERATIONS $73,000 $79,570 $85,936
    Additional Cash Received
    Sales Tax, VAT, HST/GST Received $0 $0 $0
    New Current Borrowing $0 $0 $0
    New Other Liabilities (interest-free) $0 $0 $0
    New Long-term Liabilities $0 $0 $0
    Sales of Other Current Assets $0 $0 $0
    Sales of Long-term Assets $0 $0 $0
    New Investment Received $0 $0 $0
    SUBTOTAL CASH RECEIVED $74,000 $79,000 $85,000
    Expenditures Year 1 Year 2 Year 3
    Expenditures from Operations
    Cash Spending $42,000 $42,000 $45,000
    Bill Payments $27,000 $28,000 $31,000
    SUBTOTAL SPENT ON OPERATIONS $69,000 $70,000 $76,000
    Additional Cash Spent
    Sales Tax, VAT, HST/GST Paid Out $0 $0 $0
    Principal Repayment of Current Borrowing $0 $0 $0
    Other Liabilities Principal Repayment $0 $0 $0
    Long-term Liabilities Principal Repayment $0 $0 $0
    Purchase Other Current Assets $0 $0 $0
    Purchase Long-term Assets $0 $0 $0
    Dividends $0 $0 $0
    SUBTOTAL CASH SPENT $69,000 $74,520 $80,482
    Net Cash Flow $21,000 $23,000 $25,000
    Cash Balance $27,000 $30,000 $33,000

    8.5 Projected Balance Sheet

     Pro Forma Balance Sheet    
    Assets Year 1 Year 2 Year 3
    Current Assets
    Cash $275,000 $308,000 $338,800
    Accounts Receivable $24,000 $26,880 $30,213
    Inventory $4,300 $4,816 $4,900
    Other Current Assets $1,000 $1,000 $1,000
    TOTAL CURRENT ASSETS $282,000 $315,840 $355,004
    Long-term Assets
    Long-term Assets $10,000 $10,000 $10,000
    Accumulated Depreciation $19,400 $21,728 $24,444
    TOTAL LONG-TERM ASSETS $24,400 $27,328 $30,744
    TOTAL ASSETS $294,000 $329,280 $370,440
    Liabilities and Capital Year 4 Year 5 Year 6
    Current Liabilities
    Accounts Payable $18,700 $20,944 $23,541
    Current Borrowing $0 $0 $0
    Other Current Liabilities $0 $0 $0
    SUBTOTAL CURRENT LIABILITIES $19,000 $21,280 $23,919
    Long-term Liabilities $0 $0 $0
    TOTAL LIABILITIES $15,000 $16,800 $18,883
    Paid-in Capital $30,000 $30,000 $31,000
    Retained Earnings $53,000 $57,770 $63,547
    Earnings $193,400 $210,806 $231,887
    TOTAL CAPITAL $285,000 $310,650 $341,715
    TOTAL LIABILITIES AND CAPITAL $300,000 $329,280 $370,440
    Net Worth $293,400 $319,806 $351,787

    8.6 Business Ratios

     Ratio Analysis        
    Year 1 Year 2 Year 3 INDUSTRY PROFILE
    Sales Growth 7.25% 8.03% 8.90% 3.00%
    Percent of Total Assets
    Accounts Receivable 9.21% 10.20% 11.31% 9.80%
    Inventory 5.39% 5.97% 6.62% 9.90%
    Other Current Assets 2.11% 2.34% 2.59% 2.40%
    Total Current Assets 149.80% 151.00% 152.00% 158.00%
    Long-term Assets 11.55% 11.60% 11.64% 12.00%
    TOTAL ASSETS 100.00% 100.00% 100.00% 100.00%
    Current Liabilities 4.90% 4.94% 4.98% 4.34%
    Long-term Liabilities 0.00% 0.00% 0.00% 0.00%
    Total Liabilities 7.59% 7.65% 7.72% 7.38%
    NET WORTH 100.45% 101.25% 102.19% 110.00%
    Percent of Sales
    Sales 100.00% 100.00% 100.00% 100.00%
    Gross Margin 94.60% 97.15% 99.87% 99.00%
    Selling, General & Administrative Expenses 93.56% 96.09% 98.78% 97.80%
    Advertising Expenses 1.52% 1.56% 1.60% 1.40%
    Profit Before Interest and Taxes 41.50% 42.62% 43.81% 33.90%
    Main Ratios
    Current 34 35 36 32
    Quick 33 33.8 34.645 33
    Total Debt to Total Assets 0.18% 0.18% 0.17% 0.40%
    Pre-tax Return on Net Worth 74.08% 74.89% 75.00% 75.00%
    Pre-tax Return on Assets 96.30% 101.12% 106.17% 111.30%
    Additional Ratios Year 1 Year 2 Year 3
    Net Profit Margin 33.56% 34.60% 35.67% N.A.
    Return on Equity 55.80% 57.53% 59.31% N.A.
    Activity Ratios
    Accounts Receivable Turnover 7.7 7.8 7.8 N.A.
    Collection Days 100 100 100 N.A.
    Inventory Turnover 32.4 34.02 35 N.A.
    Accounts Payable Turnover 15.6 16 16.3 N.A.
    Payment Days 27 27 27 N.A.
    Total Asset Turnover 2.5 2.5 2.6 N.A.
    Debt Ratios
    Debt to Net Worth -0.04 -0.03 -0.04 N.A.
    Current Liab. to Liab. 1 1 1 N.A.
    Liquidity Ratios
    Net Working Capital $244,000 $257,664 $272,093 N.A.
    Interest Coverage 0 0 0 N.A.
    Additional Ratios
    Assets to Sales 0.85 0.87 0.89 N.A.
    Current Debt/Total Assets 1% 0% 0% N.A.
    Acid Test 29 29.12 29.16 N.A.
    Sales/Net Worth 2.1 2.2 2.2 N.A.
    Dividend Payout 0 0 0 N.A.

    FAQ

    • Is the medical billing business profitable?

    Yes, the business is profitable. You can see it from the profit generated by Medi Assist in the first 3 years of their launch as given in this sample medical billing business plan.

    • How do I start a medical billing business?

    As a first step, you need to make medical billing business plan and then the later steps include executing the business plan medical billing in letter and spirit.

    • How do medical billing companies make money?

    Medical billing companies make money by offering several services such as filing claims for patients, upkeeping and updating medical records, etc.

    • How do I get medical billing clients?

    To get medical billing clients, you’ll need to advertise your services on social, electronic, and print media. You can explore more techniques by visiting the sales strategy section of this medical billing business plan example.

    Download Medical Billing Business Plan Sample in pdf

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