Medical Billing New York – Medicaid, Medicare & No-Fault Services
At TMS Billings, we understand medical billing New York. Whether you’re dealing with Medicaid, Medicare, No-Fault claims, or Workers’ Compensation, we take care of the details for you. Our medical billing experts in New York ensure everything is processed accurately and on time, so you don’t have to worry about the paperwork.
MetroPlus, EmblemHealth, eMedNY)
What is Medicaid Managed Care?
Medicaid Managed Care is when private insurance companies handle Medicaid benefits for individuals. We work with a range of NYS Medicaid Managed Care plans, including:
Healthfirst Medicaid Managed Care
A well-known plan offering comprehensive benefits with a focus on preventive care.
Fidelis Medicaid Managed Care
Provides a wide range of healthcare services and is available across New York State.
MetroPlus Medicaid Managed Care
A plan serving the New York City area, offering affordable healthcare options for low-income residents.
EmblemHealth
A trusted plan offering a variety of healthcare services with an emphasis on patient care.
eMedNY
New York State's Medicaid program for managed care services, used for billing and managing Medicaid claims.
We make sure your claims are filled out correctly and submitted on time for all these Medicaid plans, so you don’t have to worry about errors or delays.
Medical Billing
Medicare & Novitas (Jurisdiction L, LCD, ADR)
Medicare billing requires precision, and we’ve got you covered. We help with:
- Handling claims for Novitas in Jurisdiction L.
- Following Local Coverage Determinations (LCD) to make sure everything is in line.
- Responding to Additional Documentation Requests (ADR) to avoid rejections.
We stay up-to-date with all the Medicare rules and make sure your claims are processed properly.
No-Fault Billing in New York
When dealing with No Fault medical billing for auto accident claims, timing is everything. Here’s how the process works:
Timely Claim Submission
File No Fault claims quickly and accurately to ensure proper processing.
Accurate Medical Coding
Ensure medical codes are correct to avoid rejections and delays.
Efficient Follow-Ups
Follow up with auto insurers to track claims and ensure timely payment.
Let the paperwork be handled, ensuring No Fault claims are approved smoothly and without issues.
Workers' Compensation in New York
Billing for Workers’ Compensation in New York can be complex, especially with the WCB (Workers’ Compensation Board) fee schedule. At TMS Billings, we manage the entire process to make sure your claims are filed correctly and promptly. Here’s how we help:
Accurate Claim Submission
Ensure Workers’ Compensation claims are submitted in line with New York’s strict rules and regulations.
Correct Medical Coding
Use the right medical codes based on the WCB fee schedule to avoid errors and ensure that claims are processed smoothly.
Dispute Resolution
Handle communications with insurance companies to resolve claim denials or discrepancies swiftly.
Compliant Documentation
Make sure all required documentation is completed correctly and submitted on time to avoid issues with reimbursement.
We take care of all the details of Workers’ Compensation billing, so you don’t have to worry about the paperwork or delays.
Value-Based Payment / VBP (Levels 1–3, Shared Savings, Bundled Payments)
As Value-Based Payment (VBP) models become more common, it’s important to stay on top of the changes. Here’s how we assist with the VBP process:
Handling VBP Levels 1–3
Ensure compliance with all VBP Levels 1–3, making sure your practice meets the requirements for each level.
Managing Shared Savings
Assist in managing shared savings programs, ensuring that your practice is reimbursed for providing high-quality care.
Dealing with Bundled Payments
Help with bundled payments, ensuring all services provided under a single payment are billed correctly.
Navigating VBP Claims
Guide you through the complexities of VBP, ensuring your claims are handled properly and in compliance with the latest regulations.
OMIG & Audit Compliance
Audit season doesn’t have to be complicated. At TMS Billings, we help with:
- Getting your practice ready for OMIG audits with all the right paperwork in place.
- Ensuring your claims meet OMIG and RAC audit standards.
- Handling the NY surprise billing IDR process and making sure everything’s compliant with the federal No Surprises Act.
We’ll keep your practice in good shape for any audits and help prevent issues from popping up.
Looking for Assistance with Your Billing?
If you’re looking for reliable medical billing New York services, TMS Billings is here for you. Our medical billing experts in New York will take care of your claims so you can focus on providing the best care to your patients.
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.
