Physical Therapy Billing in New York

Yes. New York runs no-fault auto coverage, which changes who pays first for an injury claim — and that matters more in physical therapy than in most specialties. Medicaid runs as New York Medicaid, delivered largely through commercial managed care plans. So most New York Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.

National Government Services (JK). That contractor adjudicates Medicare claims for New York providers, publishes the local coverage determinations that bind you, and hears the first level of appeal. An argument that works with them works across every state they cover.

The specialty causes first: unit counts that do not match documented treatment time; visit caps reached without notice; provider did not re-certify the plan of care in time. On top of those, New York Medicaid runs through commercial plans, so filing windows and authorization rules vary by plan rather than by program.

New York is a no-fault state. For an auto injury the auto carrier is the payer of first resort, not the health plan. Billing the health plan first produces a denial that reads like a coverage problem but is a sequencing problem, and by the time it arrives the auto carrier's own window has been running.

New York does not permit billing companies to be compensated as a percentage of collections. Our pricing in New York is set accordingly, and it is confirmed in writing before any work begins. That describes what we charge; your own position is a question for your counsel rather than for us.

Yes. All coding is performed by certified coders credentialed through the AAPC or AHIMA, working from the documentation you provide. Timed treatment codes, where unit calculation is systematic rather than occasional — an error repeats on every visit.