Medical Billing

New York Medical Billing, By People Who Actually Know New York

Garden City, Nassau County. AAPC-certified veteran billers with 5 to 15 years of experience each. 1.99% of collections, all-inclusive — billing, coding, and credentialing — with no monthly minimums and no flat fees.

Happy to visit your practice when it makes sense. We’re about 22 miles from midtown, roughly 35-40 minutes off-peak via the Belt/Southern State.

Support

0 /7

100%

Compliance

Let Us Handle Your Billing,
So You Can Handle Your Patients

With us, you get more time for patients and way less stress about billing, because we make it easier for you.

Stats Bar

First-pass clean claims rate

0 %+

Net collections rate

0 %+

Billing related denial rate

> 0 %

Years experience per biller

Efficient, Custom-Fit Billing Solutions

Why practices choose TMS

Billing doesn’t have to be complicated. Let us be the trusted team you rely on for smooth medical coding and billing.

Make billing, coding, and credentialing hassle-free with our streamlined solutions.

We don’t write off the hard claims

A 99%+ first-pass clean claims rate and 98%+ net collections rate mean we’re not just submitting the easy ones. When a claim gets denied, it gets worked — not added to an aging queue. If you have old AR sitting untouched, that’s recoverable too, and it’s part of the engagement.

You’ll know what’s happening with your money

You get a dedicated point of contact, not a rotation of people who don’t have context on your account. Reporting covers collections trends, aging AR, denial categories by payor, payor turnaround times, and write-offs. For group practices, we can break that down by provider — which matters if you’re tracking performance or calculating compensation.

We know how New York billing actually works

eMedNY. Healthfirst, MetroPlus, Fidelis, EmblemHealth, Empire. Novitas as your Medicare MAC.
The no-fault NF-3 workflow and the 45-day window. C-4 filings with the Workers’ Compensation Board. OMIG audit documentation. These are not features we’ve added to a list — they’re what the job requires in this state, and we do them daily.

We know how New York billing actually works

When we scrub a claim and something’s off, we tell you

If charge entry catches a modifier that’s consistently missing, a diagnosis code that doesn’t support the procedure, or a documentation pattern that’s causing downstream denials, you get a specific explanation — not a generic flag. That feedback loop is part of the service.

Value-based payment (VBP)

New York has been shifting Medicaid reimbursement away from straight fee-for-service toward
value-based payment models for several years. That shift affects how you get paid, how you report
quality data, and how your contracts are structured — and it affects different practices very
differently depending on your payor mix and specialty.

We bill across all three VBP levels and support hybrid practices running both VBP and fee-for-
service simultaneously. If your contracts include shared savings arrangements, capitation, or
bundled payments, we know how to work within those structures without disrupting your cash flow.

What’s included

A standard engagement covers all of this. Nothing below is an upsell or an add-on.

Credentialing

AR projects and old claim recovery

Provider enrollment

Medical coding

Patient statements and collections

Denial management and appeals

Payment reconciliation, including underpayment disputes with payors

Eligibility verification (VOB)

Charge entry and claim scrubbing

Prior authorization submission and follow-up

Credentialing shouldn’t hold you back. We fast-track the process to get you approved quicker, so you can see patients without the wait.

NY-Specific Section

We work in New York’s actual billing environment

Medicaid managed care

New York runs Medicaid almost entirely through managed care. The plans — Healthfirst, Fidelis Care, MetroPlus, Affinity, WellCare, EmblemHealth, Aetna Better Health of New York — each have their own portal, authorization workflow, and claim edit patterns. Fee-for-service Medicaid runs through eMedNY, which has its own edit library, pend codes, and documentation request process. We know the difference between a TP denial from a managed care plan and an eMedNY system edit, and we know how to fix both.

Medicare

New York’s Medicare Administrative Contractor is Novitas Solutions (Jurisdiction L). That matters for LCD compliance, ADR (Additional Documentation Request) responses, and submission requirements specific to this jurisdiction.

Personal injury / no-fault

We run the full NY no-fault workflow: NF-3 submissions, strict adherence to the 45-day filing window from date of service, managing PIP carrier denials from Allstate, GEICO, Travelers, State Farm, and Progressive, handling IME and peer review denials, and preparing AAA arbitration packets when payors push back. Miss the 45-day window and you’ve created an avoidable collection problem. Our team knows the timing and doesn’t miss it.

Workers’ compensation

New York workers’ comp billing goes through the Workers’ Compensation Board, with its own fee schedule and its own submission requirements. We handle C-4 and C-4.2 filings, CMS-1500 digital submissions through Board-approved channels, and we know the WCB Medical Fee Schedule — which varies by specialty and is entirely separate from your commercial contracts.

Audits and compliance

We work with practices navigating OMIG (Office of the Medicaid Inspector General) audit exposure, RAC audits, and the NY surprise billing IDR process, which runs under different rules than the federal No Surprises Act.

Specialties we bill for

Improve your cash flow and reduce claim denials by partnering with our experienced medical billing professionals.

Mental and behavioral health

Prior auth management, HARP billing, and Medicaid managed care claim patterns specific to behavioral health.

Primary care and family medicine

Everyday visit billing alongside chronic care management, preventive services, and quality-measure reporting where applicable.

Physical therapy

Same no-fault and workers’ comp depth as chiropractic, plus functional limitation reporting, cap management, and PT-specific modifier rules.

Podiatry

Procedure and diagnosis coding specific to podiatric services, including surgical and wound care billing.

Assisted living

Long-term care billing including Medicaid managed long-term care (MLTC) plans.

Pain management

Procedure-specific coding, modifier use, and documentation requirements for interventional and non-interventional services.

Chiropractic

Standard chiropractic coding plus the full personal injury and workers’ compensation workflow — NF-3 submissions, WCB filings, and arbitration when payors dispute.

Home healthcare (HHA)

RAP and final claim submissions, OASIS coding, managed care authorization tracking, and EVV (Electronic Visit Verification) claims integration and corrections.

Pediatrics

Well-visit, immunization, and developmental screening billing alongside managed care plan requirements for pediatric populations.

Hospice

Hospice election billing, room and board payor coordination, and compliance with New York’s hospice claim requirements.

Testing labs

Accurate billing for diagnostic and laboratory services, including payor-specific coding requirements and medical necessity documentation.

Years of Experience

0 +

Billing Steps

We work in your system

Our team works directly inside your existing platform. No migration, no changes to your front desk workflow. If you don’t have a platform, or it belongs to your old billing vendor, we can provide one.

We’re regularly working in:

Hospital / enterprise: – Epic, Oracle Health (Cerner), athenahealth, MEDITECH, Altera Digital Health (Allscripts)
Multispecialty / primary care: – eClinicalWorks (ECW), NextGen, Greenway Health (Intergy), AdvancedMD, Kareo / Tebra, DrChrono, ModMed, Practice Fusion, CureMD, CareCloud, and others
Behavioral health: – TherapyNotes, SimplePractice, Valant, ICANotes, TheraNest, CentralReach
PT / chiropractic: – WebPT, ChiroTouch, Prompt EMR, Raintree, Genesis, Eclipse, Practice Perfect
Home health / hospice: – HCHB, MatrixCare, WellSky, Axxess, PointClickCare, KanTime, Brightree, and others.oTouch, Prompt EMR, Raintree, Genesis, Eclipse, Practice Perfect

Clearinghouses

Clearinghouses are the intermediaries that validate and route your claims to payors before
reimbursement. We work across all major clearinghouse networks, including Change Healthcare, Availity, Waystar, Office Ally, TriZetto, Ability Network, Experian Health, and all standard EDI submission channels.

If you’re on a platform not listed above, that’s not a problem. We have experience with less common systems and regularly onboard into new environments.

FAQs

Frequently Asked Questions

Do you have questions about our medical billing and coding company? Let’s help you out.

Do you only work with New York practices?

New York is the core focus. We also support surrounding states when a group has locations that cross state lines, for example New Jersey and Connecticut. The approach stays the same. Regional payor rules, portals, and workflows, not generic billing.

Do you handle New York Medicaid, both fee for service and managed care?

Yes. We handle New York Medicaid fee for service workflows tied to eMedNY, plus Medicaid managed care plan billing. That includes eligibility checks, claim status follow up, denials, resubmissions, and appeals.

What is eMedNY, and why does it matter?

eMedNY is New York’s Medicaid system for provider billing operations, reference material, and tools like claim status inquiry. If a billing team does not know how to work eMedNY correctly, you usually see it in slow claim fixes and aging A R.

We already have a workflow. What changes when we switch?

We merge into your existing workflow. If you want, we take specific steps off your staff’s plate while you keep control of the rest. If you want a full transition, we take the workflow over from the prior billers and keep it moving with minimal disruption.

Will you work inside our current EMR, PM, and clearinghouse?

Yes. Most practices want continuity. We work in your existing system and document the workflow so your team knows what is happening and where to look.

If you do not have a platform, or your current platform is controlled by a billing vendor and you cannot keep it, TMS can provide a platform so you are not boxed in.

If your practice prefers paper and superbills, we can run the workflow that way too.