Our Medical Billing & RCM Services in USA

We handle the full billing cycle for healthcare practices in New York—from eligibility verification before the first claim goes out to following up on aging AR. With AAPC-certified billers and 5 to 15 years of experience per biller, your practice gets an experienced team, not entry-level staff.
Everything on this page is included in a standard engagement at 1.99% of collections—no flat fees, no monthly minimums, and no unexpected charges.

First-pass clean claims rate

0 %+

Net collections rate

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Billing related denial rate

> 0 %

Years experience per biller

What We Offer

We offer a comprehensive suite of services designed to optimize your practice’s billing and revenue cycle. With deep experience in New York-specific payors and healthcare regulations, TMS Billings ensures your billing processes are efficient and compliant.

Billing

Eligibility Verification (VOB)

We confirm active coverage, plan details, and applicable deductibles or co-pays before a claim goes out. Catching eligibility issues at the front end prevents a category of denials that are entirely avoidable.

Charge Entry and Claim Scrubbing

We enter charges and run every claim through a scrub before submission — checking for modifier errors, diagnosis-to-procedure mismatches, missing documentation flags, and payor-specific edit patterns. When scrubbing catches something that’s consistently slowing down your claims or leaving revenue uncaptured, you get a specific explanation, not a generic alert.

Prior Authorization

We submit prior auth requests and track them through till their approval. When an auth is denied, we handle the appeal. When one is expiring and a renewal is needed, we flag it before it becomes a claims problem.

Claim Cubmission and Tracking

Claims go out clean, on time, and to the right payor through the right channel. We track status from submission through adjudication and follow up on anything sitting without a response.

ERA / EOB posting

We post payments from electronic remittance advice and explanation of benefits documents, reconcile against expected reimbursements, and flag discrepancies for follow-up.

Payment Reconciliation and Underpayment Disputes

When a payor pays less than the contracted rate, we don’t write it off. We identify the variance, document it, and go back to the payor. Underpayment recovery is part of the standard engagement.

Denial Management and Appeals

Denials get worked, not aged. We identify the denial reason, determine whether it’s a correctable error or a payor dispute, and route it accordingly — resubmission, appeal, or escalation. Our billing- related denial rate is under 1%.

Patient Statements and Collections

We generate and send patient-facing statements and manage the follow-up on outstanding patient balances, keeping the process professional and consistent.

AR Projects and Old Claim Recovery

If you have aging AR that’s been sitting untouched — from a prior billing company, a transition, or claims that fell through the cracks — we can work it. Old claim recovery is included in the standard engagement, not priced separately.

Coding

Our coding team is AAPC-certified and works across all the specialties we bill for. Coding is included in the rate of engagement and is also available as a standalone service if that’s all a practice needs.

Accurate CPT and ICD-10 coding specific to your specialty and payor mix.
Modifier application — including the modifier patterns that trip up claims with specific payors.
Documentation review and feedback when coding gaps are creating downstream denial patterns.
Compliance with New York Medicaid, Medicare (Novitas/JL), and commercial payor coding requirements.
Coding for no-fault, workers’ comp, HARP, MLTC, VBP, and other NY-specific billing contexts.

Credentialing

We handle the full lifecycle:

New provider enrollments with Medicaid managed care plans, Medicare, and commercial payors.
Recredentialing and maintenance as contracts come up for renewal.
In-network approval management with New York’s Medicaid Managed Care organizations.
Regular fee schedule increase requests submitted to payors on your behalf, tied to your current contracts and payor mix.
Provider enrollment tracking so nothing lapses without notice.

What We Offer

Our Core Services

Medical Billing

Simplifying billing from claims to follow-ups for quicker payments and fewer denials.

Medical Coding

Accurate coding, fewer errors, and increased revenue, handled by our certified team.

Credentialing

We ensure fast credentialing and in-network approvals, getting you back to patient care.

Revenue Cycle Management

We handle your revenue cycle, maximizing collections and cutting down on write-offs.

AR Recovery

Quick follow-ups on unpaid claims for faster payments and fewer outstanding balances.

Personal injury and workers’ compensation

We run the full NY no-fault and workers’ comp workflow. This is not a checkbox — it’s a daily operation for our team.

No-fault / personal injury

NF-3 form submission — NY’s no-fault specific claim form.
Strict tracking of the 45-day filing window from date of service — missing it creates an avoidable collection problem.
PIP carrier denial management: Allstate, GEICO, Travelers, State Farm, Progressive.
–IME (Independent Medical Examination) and peer review denial responses.
–AAA (American Arbitration Association) arbitration packet preparation when payors dispute claims.

Workers’ compensation

C-4 and C-4.2 filings with the NY Workers’ Compensation Board (WCB).
CMS-1500 digital submissions through Board-approved channels.
PAR (Prior Authorization Request) management for WCB cases.
NY WCB Medical Fee Schedule compliance — which varies by specialty and is separate from commercial contracts.
Carrier dispute follow-up and attorney lien coordination where applicable.

Reporting

Reporting is standard, not an add-on. We focus it on what practice owners and administrators actually use:

AR aging by payor and age bucket (30/60/90/120+ days).
Collections summary — gross charges, allowed amounts, collected, adjustments, write-offs.
Denial report by payor, denial reason code, and worked/appealed status.
First-pass clean claims rate by payor and billing period.
Claim submission log with current status.
Payment posting summary with underpayment variance flagging.
Prior authorization tracking — pending, approved, denied, expiring.
Provider-specific production and collections reporting for group practices —useful for performance tracking and compensation calculations.

Pricing

1.99% of collections. All-inclusive.

Billing, coding, and credentialing are all in that number. No flat monthly fees. No minimums. No separate charges for denial work, AR recovery, or reporting. If it’s a slow month, your bill reflects it — we only collect when you do.

Other pricing structures are available when the standard model isn’t the right fit:

Ask us what makes sense for your practice.

Why Practices Choose TMS?

We Don’t Write off the Hard Claims

A 99%+ first-pass clean claims rate means we’re getting clean claims out the door. A 98%+ net collections rate and under 1% billing-related denial rate means we’re not just submitting the easy ones and leaving the rest. When a claim gets denied, it gets worked. When AR is aging, it gets addressed — old claim recovery is part of the engagement.

You’ll Know What’s Happening with Your Money

You get a dedicated point of contact who has context on your account — not a support queue. Reporting is standard and covers what you actually need to run the practice: collections trends, AR movement, denial categories by payor, payor turnaround, write-offs. For multi-provider groups, that breaks down by provider for performance tracking and compensation calculations.

We Know How New York Billing Actually Works

eMedNY. Healthfirst, MetroPlus, Fidelis, EmblemHealth, Empire. Novitas Solutions as your Medicare MAC. NF-3 submissions and the 45-day window. C-4 filings with the Workers’ Compensation Board. OMIG audit documentation. These aren’t features we’ve added to a list — they’re what the job requires in this state, and we do them every day.

When Scrubbing Catches Something, We Tell You Specifically What It Is.

If a modifier is consistently missing, a diagnosis code isn’t supporting the procedure being billed, or a documentation pattern is creating downstream denials — you get a clear explanation of what’s happening and what needs to change. Not a flag. Not a monthly summary with no action items.

Years of Experience

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Billing Steps

We Work in Your System

Our team works directly inside your existing platform — no migration, no disruption to your front desk workflow. If you don’t have a platform, or your current one is controlled by a prior billing vendor and you can’t keep it, we can provide one.

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.