Steps to Starting a New Billing Company and Expanding Your Client Base

Medical billing is a service in high demand, so setting up a new billing company is a smart business move. According to the U.S. Bureau of Labor Statistics, employment for medical records and health information technicians—under which medical billers are classified—is expected to grow 11 percent from 2018 to 2028. This rate is much faster than the national average for all occupations.

This projected outlook is partially explained by the healthcare billing system's growing complexity. Fifty-four percent of surveyed physicians reported that time spent on administrative tasks related to generating bills and collecting payments was a major problem for them.

Establishing a billing company may seem like a daunting undertaking, but with the appropriate tools and resources, you can start on the right track.

Starting a New Billing Company

Choose the right software

Software selection is one of the most important decisions you'll make when starting. Your software should be a central platform where virtually all your billing operations are executed and controlled. Choosing one with all the necessary capabilities (and more) will help you satisfy your clients and avoid problems down the line.
First, the software should manage billing operations— end-to-end claims management and the entire patient collections process— accurately, seamlessly, and with minimal effort from you. 

Next, many practice owners expect billing companies to handle more than bare-bones medical billing. They prefer billing companies that offer practice management services and handle processes like scheduling and insurance eligibility verification. And so, the right medical billing software should have fully integrated practice management features. Finally, you won't always have one, two, or three clients. The software you choose should let you scale up quickly and be easily functional for many practices.


Procure a license

Regardless of how small you intend to start out, you need to obtain a business license to run a medical billing company. It's also best to get this out of the way early on to avoid fines, fees, and regulatory challenges later down the line. However, before applying for a license, be sure to conduct thorough research on what business requirements the city/state you intend to operate is asking you to complete.

Utilize the best professional services

There are multiple back end processes involved in running a billing company that don't have anything to do with billing itself. You will need insurance policies and coverage, legal counsel to draft and review your contracts and policies, and accounting services just to name a few. An accounting service can help you choose your business structure, manage your company's books, and handle your taxes. Consequently, you should partner with trusted professionals or reputable companies that offer these services—preferably with experience in the medical billing industry.

It would help if you also considered forming relationships with solid collections agencies that you can refer to clients for collections that exceed 120 days.

Join beneficial associations

If you lack the right kind of support and access to information, it's easy to make avoidable mistakes. Established associations and organizations can help by providing you with sound guidance and access to valuable resources.  Some of the industry's top associations include Healthcare Billing & Management Association (HBMA –, American Medical Billing Association (AMBA –, and American Association of Professional Coders (AAPC – These associations also offer networking opportunities, and some host trainings. They all have varying membership fees/dues that aretypically charged annually.

Market, market, market

Client acquisition is crucial to the success of any new medical billing company. You may have locked down every other aspect of establishing the business, but you need at least one client to get things off the ground. The aim is to get potential clients (medical practices) aware of your company and its services. You will need to employ marketing strategies to achieve this, with the first being to build a professional website. You should then create social media pages on different platforms that you can leverage for engagement and popularity.

Click here for our free guide, 4 Steps to Building and Maintaining Your Billing Company’s Online Reputation. You should also create/publish marketing collateral like brochures, leaflets, and flyers to distribute to physicians and practices. The website, social media pages, and marketing materials should all contain open, up to date contact information through which interested clients can reach your company.

Once you land your first client, others will likely follow.

Prepare your client onboarding process

Make sure your client onboarding process and tools are ready before you take on any new clients. That way there's no delay between when potential clients show committed interest in using your services, and when they sign on the dotted line. You should have contract templates that cover terms and conditions, party responsibilities, and termination provisions, among other things. You also need forms to collect requisite and essential practice information from new clients. Finally, consider drafting an onboarding document that covers expected client questions, such as what your background is, if you belong to any associations, all the services you offer, and what client-biller communication structures you have in place.

Growing Your Practice

Once you've set up your billing company and are now operational, the next point of focus is growth and expansion. 

Manage your online reputation

Your company's online reputation significantly affects your client acquisition ability. Audit your reputation by looking for mentions and profiles of your company on the internet. Leverage positive reviews to get referrals and address negative reviews as quickly as possible. Click here for our free guide, 4 Steps to Building and Maintaining Your Billing Company’s Online Reputation. 

Increase your service offerings

Integrating services like practice management, marketing, and patient engagement into your core offerings allows you to present your company as a 'one-stop solution 'for practices. And the software you choose is integral to your ability to make these business growing additions. 


"I think of Kareo as more of an ecosystem than a platform because it has made us more creative in what we can do for our clients and lets us customize their individual experiences with us," says Bob Trotta, CEO, Medical Claims Billing, who was able to expand his company's service offerings by switching to Kareo. “As we continue to grow, we are able to offer even more services, like telehealth and other technology-centered ones."

 If you have an existing billing company, you can access our guide, 3 Keys to Growing Your Billing Service here. You can also visit for more information and related blogs on helping billing companies get started and expand their businesses.

About the Author

Tolu Ajiboye is a freelance health writer and lawyer. She helps healthcare brands and companies communicate effectively with their target audience, with case studies...

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