Skilled Nursing Facility Billing Services in New York
New York's skilled nursing facility practices face unique billing challenges shaped by Empire BlueCross BlueShield's commercial rules, NY Medicaid Managed Care requirements, and Novitas Solutions Medicare policies. Our AAPC-certified coders specialize in both NY payer rules and skilled nursing facility coding complexity.
Why New York Skilled Nursing Facility Practices Need Specialized Billing
New York's healthcare market includes 90,000+ physicians, and skilled nursing facility practices here face a payer market dominated by Empire BlueCross BlueShield on the commercial side and NY Medicaid Managed Care on the public payer side. Medicare claims are processed through Novitas Solutions, which applies its own Local Coverage Determinations that directly affect skilled nursing facility procedure coverage and medical necessity requirements. Generic billing teams without NY specific knowledge leave revenue on the table.
Skilled Nursing Facility billing itself is complex. SNF billing under PDPM uses the Minimum Data Set (MDS) assessment to classify patients across five payment components: PT, OT, SLP, nursing, and non-therapy ancillary (NTA). Each component has its own case-mix group and reimbursement rate. Consolidated billing rules require the SNF to bill for virtually all services during a Part A stay, and the 100-day benefit period creates coverage-window management challenges. When you combine this coding complexity with New York's specific payer rules, authorization requirements, and 6 NY Medicaid Managed Care managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving skilled nursing facility practices from New York City to Albany and across New York.
Top CPT Codes for Skilled Nursing Facility in New York
Our NY coders handle these skilled nursing facility codes daily, applying Novitas Solutions Medicare rules and Empire BlueCross BlueShield commercial policies to each claim.
New York Payer Challenges for Skilled Nursing Facility
Every NY payer has specific rules for skilled nursing facility claims. Here's how we navigate them.
Empire BlueCross BlueShield Skilled Nursing Facility Claims
Empire BlueCross BlueShield processes the largest share of New York commercial skilled nursing facility claims. We know their NY specific fee schedules, prior authorization requirements for skilled nursing facility procedures, and their appeal timelines when claims are denied. Five separate payment components each driven by different MDS items — errors in any component reduce that portion of reimbursement.
NY Medicaid Managed Care Skilled Nursing Facility Billing
NY Medicaid Managed Care routes skilled nursing facility patients through 6 managed care plans: Fidelis Care, Healthfirst, MetroPlus, and 3 more. Each MCO has its own skilled nursing facility authorization and billing rules that we manage.
Medicare (Novitas Solutions) Skilled Nursing Facility Coverage
Novitas Solutions processes Medicare skilled nursing facility claims in New York with its own Local Coverage Determinations. We navigate Novitas Solutions's policies around consolidated billing compliance to prevent medical necessity denials.
Denial Prevention for New York Skilled Nursing Facility
Common skilled nursing facility denials in New York include five separate payment components each driven by different mds items — errors in any component reduce that portion of reimbursement and snfs must bill for nearly all services during a part a stay, including outside therapies, labs, and radiology. Our team catches these issues before submission and appeals aggressively with NY payer-specific documentation when denials occur.
Get Expert Skilled Nursing Facility Billing in New York
Free billing assessment for your NY skilled nursing facility practice. See where revenue is leaking.
What We Handle for New York Skilled Nursing Facility Practices
New York Skilled Nursing Facility Billing Cost Comparison
Hiring an in-house biller with skilled nursing facility expertise in New York costs $45K-$62K annually in salary alone. Add benefits, software, clearinghouse fees, and office space, and the true cost is even higher. At 2.49% of collections, Go Medical Billing provides an entire team of AAPC-certified skilled nursing facility coders and NY payer specialists for a fraction of that cost.
$45K-$62K
In-House Biller Salary
+ benefits, software, space
2.49%
Go Medical Billing Rate
Full team, all services included
60-80%
Typical Cost Reduction
With better results
Related Pages
Explore our New York and skilled nursing facility billing resources.
Frequently Asked Questions
Fix Your New York Skilled Nursing Facility Billing
Call 888-701-6090 for a free billing assessment specific to your NY skilled nursing facility practice. We'll show you where revenue is leaking and how to fix it.