Solo Therapist Billing New York: 5 Easy, Essential Checks
A solo therapist billing service in New York takes over the claims, calls and follow-up that pull you away from clients. This guide to solo therapist billing New York covers five checks tied to where you practice: Medicare, Medicaid, private insurance, state rules and what a billing service actually handles. New York pairs Medicaid billing rules for several license types with state network adequacy rules.
MCM South serves psychotherapists and psychiatrists in New York. This guide is for solo practices, and it links to our deeper New York posts. For the national picture, see what a billing service does for a therapy practice.
Check 1: Medicare in New York
Rules in this section are Medicare rules, which are separate from Medicaid and private insurance. National Government Services (NGS) is the Part A and Part B contractor for Jurisdiction K, which includes New York, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.
Our guide to New York Medicare Part B for therapists and psychiatrists walks through enrollment and billing. The CMS page Who are the MACs shows each contractor and jurisdiction.
Check 2: New York Medicaid
Medicaid rules are set by the state, and they differ from Medicare and from private plans. New York Medicaid has its own rules for the licenses that can bill. Read New York Medicaid billing for LCSWs, LMHCs and LMFTs before you bill a Medicaid client.
Check 3: Private insurance in New York
Private payers write their own rules, and Blue Cross Blue Shield plans are independent companies, so never assume one plan’s rules apply to another. Anthem and other Blue plans are common in New York, and each plan sets its own claim rules. See Anthem BCBS New York behavioral health billing.
If you are not yet in network, read credentialing for new therapists and our credentialing service.
Check 4: New York rules that affect your claims
State law is a third category, separate from payer contracts and federal rules. New York has state rules on how large a plan’s behavioral health network must be. Our guide to New York behavioral health network adequacy rules explains what that means for you. See also the Medicare.gov page on Medicare outpatient mental health care. Solo therapist billing New York is easier when you know which of these rules your payer follows.
Check 5: Solo therapist billing New York and what a service handles
A good service verifies benefits, files claims, works denials, posts payments and keeps you informed. Ask who will actually do each task, and how they will report to you. See our billing services, patient benefit verification and denied claim follow-up and appeals. To compare costs and options, read how therapists pay their billing service and whether to outsource therapy billing. A solo practice also benefits from an insurance billing expert who gives your time back. That is what solo therapist billing New York looks like when it runs well.
Frequently asked questions
What should a solo therapist billing service in New York know?
It should know the Medicare contractor, the state Medicaid program, your private payers and the state rules that affect claims, and keep each separate.
Does Medicare work the same in New York as in other states?
The Medicare rules are national, but the contractor that processes your claims depends on the state, so use the contractor for New York.
Can a billing service handle New York Medicaid claims?
Yes, if it knows the state program. Ask how it handles enrollment, authorizations and the state’s claim rules.
Does MCM South serve New York?
Yes. New York is one of MCM South’s ten currently served states, and we work with psychotherapists and psychiatrists.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
