The Medical Billing handles medical billing and coding for practices in Rochester, NY — from solo physicians and specialty groups to independent labs and clinics across Monroe County. We take the full revenue cycle off your desk so your staff can focus on patients.
Medical Billing for Rochester's Healthcare Market
Rochester practices work alongside large systems such as University of Rochester Medical Center (Strong Memorial Hospital) and Rochester Regional Health. That brings a steady flow of referrals and shared patients, but also more payer edits on referrals, authorizations and place of service. Our coders check those details before the claim goes out.
New York Payer Rules We Handle for Rochester Practices
- Medicare: Part B claims go to National Government Services (NGS); Medicare Advantage claims go to the patient's private plan with its own authorization rules.
- Medicaid: New York Medicaid is run by the New York State Department of Health through eMedNY, and most members are in Medicaid managed care plans such as Fidelis Care, Healthfirst and MetroPlusHealth.
- Commercial plans: we bill Anthem Blue Cross Blue Shield (formerly Empire), Excellus BlueCross BlueShield, EmblemHealth and MVP Health Care and the employer plans common in Monroe County.
- Local detail: Most New York Medicaid members are in managed care plans, and since 2023 Medicaid pharmacy benefits run through NYRx — so we confirm which plan covers which service before billing.
What's Included for Rochester Practices
- Insurance eligibility and benefits verification before each visit
- Medical coding (CPT, ICD-10-CM, HCPCS and modifiers) by certified coders
- Charge entry and claim scrubbing to catch errors before submission
- Electronic claim submission to Medicare, New York Medicaid plans and commercial payers
- Denial management and appeals with root-cause tracking
- A/R follow-up on aging claims, worked daily
- Payment posting from ERAs and EOBs, including underpayment checks
- Credentialing and payer enrollment, including eMedNY provider enrollment
- Monthly reporting on collections, denials and days in A/R
Why Rochester Practices Outsource Billing to Us
Most revenue is lost in small gaps: an eligibility check that was skipped, a denial nobody had time to appeal, a payment that was posted short. We close those gaps for Rochester practices with a structured process and transparent reporting, and we start with a free audit so you can see the numbers first.
We also support practices in Greece, Irondequoit, Henrietta and Brighton, and across the rest of the state — see our New York medical billing services or nearby pages for New York City and Buffalo. Specialty groups can read more about our hematology billing and physician billing services.
Specialties We Bill For in Rochester
Frequently Asked Questions
Do you provide medical billing services in Rochester, NY?
Yes. We work remotely with physician practices, clinics, specialty groups and labs in Rochester and across Monroe County. We handle coding, claims, denials and A/R follow-up for Medicare, New York Medicaid and commercial payers.
Which insurance payers do you bill for Rochester practices?
Medicare Part B through National Government Services (NGS), Medicare Advantage plans, New York Medicaid and its managed care plans, and commercial payers such as Anthem Blue Cross Blue Shield (formerly Empire), Excellus BlueCross BlueShield and EmblemHealth.
Do you work with practices near Rochester?
Yes — including Greece, Irondequoit, Henrietta and Brighton. Billing is done remotely, so practices anywhere in New York can work with us.
How much does medical billing cost for a Rochester practice?
Most billing companies charge a percentage of monthly collections, commonly between 4% and 10% depending on specialty and claim volume. We give you a fixed quote after a free audit of your claims and A/R.
How long does it take to switch to your billing service?
It depends on how quickly payer and EHR access can be set up. We plan the transition so that existing A/R keeps being worked while new claims move to our team, and we share a timeline after the free audit.