EMP Claims Solutions in Chicago gained five clients in its first year -- including two large practices. Just the start for Piyush Kedia and his wife Smigdha in their goal to build a national company. After convincing one doctor just starting his practice to try the Kedias, four more soon followed.

"We were willing to work hard and it came through to him," Smigdha Kedia said. "We did all the paperwork to get his practice started because we wanted to have a business on our own."

Said Piyush Kedia: "We didn't come to this country to mess around."

The Kedias came to Chicago in 2001 so Piyush could gain his masters degree in public finance before becoming a financial analyst for a bank in the heart of one of America's leading economic centers. Many people would have been satisfied with such a good job, but like Piyush said, he didn't come to this country to mess around. He was ready for another challenge.

Medical insurance impressed the Kedias. It's not readily available in India. They saw medical billing as a recession proof business against the coming economic downturn.

"People won't stop going to doctors and doctors won't stop billing," Smigdha Kedia said.

With the same business skills used to analyze markets for his bank, Piyush Kedia researched medical billing software companies. He narrowed the online search to two firms with strong presence. Interviews with both companies left him with only one that proved satisfactory.

ClaimTek Systems.

"I was very cautious," Piyush Kedia said. "[ClaimTek president] Kyle Farhat seemed more personable -- someone I could relate to. Their software is a good product that makes life a lot easier. Kyle's guidance has made a big difference."

That the Kedias had no medical billing experience wasn't an obstacle.

"Medical billing is learning coding," he said. "It excited me a little bit. I felt I could do it without new skills to do it or a high investment."

That the Kedias didn't know anyone in the medical community wasn't an obstacle, either. He went to trade shows, called offices and networked until finding a doctor willing to be the Kedias' first client. They also have a website to attract clients.

"A good billing company works as an extension," Piyush Kedia said. "We make a stronger effort to build trust with a doctor. My financial background is a big help. We help them with their financial planning to give a full financial picture. That has given us the edge."

So what's it like having a spouse as a business partner?

"I would definitely recommend if they want to have a strong relationship, they should find each other's strengths and weaknesses and work together," Smigdha Kedia said. "We work well together."