Pulmonology Billing Services in New York Built for NYSDOH Compliance
New York has one of the highest asthma and COPD burdens in the country, and its billing rules are just as demanding. Here’s how we handle it for your pulmonary practice:
- Managing claims across New York Medicaid managed care, which covers around 6 million enrollees statewide
- Fixing the modifier 25 and bundling errors behind most same-day PFT and office visit denials
- Filing clean claims that start New York’s 45-day prompt pay clock instead of forfeiting it
- Avoiding the unspecified codes that can cost $1,040+ per patient in lost annual revenue under HCC risk adjustment
Trusted by
500+ Physicians
Catering to
40+ Specialties
1100+ Certified
Medical Billers & Coders
End-to-End
RPA Billing Solutions
Up to 98% First Pass
Clean Claim Rate
Our Success in Numbers
Which Billing Problems Cost New York Pulmonology Practices the Most?
New York’s Medicaid managed care structure and prompt-pay rules create billing pressure that most practices never fully account for. The costliest problems include:
NY Medicaid Managed Care Maze
Fidelis, Healthfirst, and MetroPlus each run their own prior auth rules, so the same service can be approved by one plan and denied by another. Practices that don't track these plan-specific differences lose claims.
Oxygen Recertification Deadlines
Medicare requires an oxygen test between days 61 and 90. Missing that window results in coverage lapse for equipment still in use. The patient still needs the oxygen, but the claim no longer qualifies for payment.
New York Prompt Pay Loophole
New York's prompt pay law gives insurers only 45 days to pay a claim, but the clock starts only once the claim is completely clean. One coding error resets the deadline and hands the payer a free extension.
Biologic Therapy Reauthorization
Severe asthma drugs like Xolair and Nucala require detailed prior authorization and are reauthorized every 12 months against strict clinical criteria. Missing one criterion denies a high-cost biologic claim outright.
How Does Transcure Help Pulmonology Practices With Billing in New York?
New York pulmonary practices lose revenue in the gap between what the chart supports and what the payer actually pays. As a medical billing company, we close that gap through the following services.
NY Medicaid Plan Verification
We confirm coverage and identify the assigned plan, Fidelis, Healthfirst, or MetroPlus, before the visit, so the claim routes correctly from the start.
Biologic and Sleep Prior Auth
PRIA manages prior authorization for CPAP, home oxygen, and severe asthma biologics like Xolair, tracking each plan’s annual reauthorization criteria.
Pulmonary CPT and ICD-10 Coding
Our coders apply precise codes for PFTs and bronchoscopy, checking modifier 25 and bundling rules before claims reach New York payers.
Prompt Pay Compliant Submission
Transcure files clean claims that meet New York’s 45-day prompt-pay standard and track oxygen recertification deadlines so coverage never lapses.
NY Payer Contract Analysis
We review contracted rates against payments from Fidelis, Healthfirst, and commercial plans to catch systematic underpayments before they compound.
Denial and Dispute Resolution
DEXA identifies the issue behind each denial, and ARIA tracks the claim through resubmission or New York’s own dispute process until paid.
In Which New York Cities Does Transcure Provide Pulmonology Billing Services?
New York City
Buffalo
Rochester
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Yonkers
Syracuse
Albany
New Rochelle
Mount Vernon
Schenectady
How Does Transcure Speed Up Payment for New York Pulmonology Claims?
New York gives insurers only 45 days to pay a clean claim, but a PFT with a modifier error or a sleep study missing prior auth never starts that clock. Instead of 7 to 14 days, that claim drags to 60, 90, even 120 days. For a practice that bills dozens of these each month, one slip becomes a recurring cash flow problem.
Transcure closes this gap before it even happens. Our certified coders and CODIN, an AI agent, catch modifier 25 and bundling errors before the claim leaves the building. We also use PRIA to clear prior auth on sleep studies, home oxygen, and biologics before the visit. More of your New York pulmonology claims move through the fast lane and are paid within days.
Where in New York State Does Transcure Provide County-Level Coverage?
Kings County (Brooklyn)
Queens County
New York County (Manhattan)
Suffolk County
Bronx County
Nassau County
Westchester County
Erie County
Monroe County
Pulmonology Billing Services Across States in the US
Transcure’s pulmonology billing services extend beyond New York to practices nationwide. We bring the same specialized medical billing and coding expertise to pulmonary practices nationwide.
Which Procedures Does Transcure’s Pulmonology Billing Services Handle in New York?
Our AAPC-certified coders handle the full range of diagnostic, therapeutic, and critical care pulmonary procedures New York practices perform, applying the specific CPT selection and documentation each one requires.
Bronchoscopy Billing
Lavage, brushing, and biopsy can all happen in a single bronchoscopy session, and billing them out of sequence is a common denial trigger. Our coders sequence and bundle each one correctly before the claim is submitted.
Polysomnography (Sleep Study) Billing
In-lab and home sleep testing are billed under different codes, and New York payers expect documentation justifying which one was used. That justification gets built into the claim before it ever leaves your office.
Critical Care Billing
Pulmonary critical care pays on documented time, not just the diagnosis alone. We cross-check the recorded minutes against every separately billed procedure, so the time-based code holds up if a payer ever questions it.
Spirometry and PFT Billing
Spirometry paired with a same-day office visit is the single most denied PFT combination in all of pulmonology today. Our review catches the missing modifier before submission, well before any denial ever arrives.
EBUS Billing
An EBUS claim lives or dies on the lymph node station count documented in the record. We confirm those stations match the billed codes before submission, since a mismatch here is the fastest way to lose the claim.
Bronchial Thermoplasty Billing
We stage and code this severe asthma procedure by lobe, using 31660 for the first and 31661 for each additional one. Fidelis Care and other New York plans only cover it when strict clinical criteria are documented.
What Does Transcure Offer New York Pulmonology Practices That In-House Billing Can't?
Running pulmonology billing in-house means absorbing every New York payer rule, denial, and staffing gap alone. Here’s what a dedicated partner like Transcure adds:
One Flat Monthly Fee of 5%
A New York medical biller earns an average of $52,569 a year before benefits, training, and turnover costs. Transcure charges a flat 5% of collections instead, replacing that entire salary with a full billing team.
Dedicated NY Account Manager
You get one dedicated billing lead who knows your pulmonology practice and claim history inside out. When a PFT gets bundled wrong or a sleep study authorization stalls, they know exactly where to look.
HCC-Protective Coding
Our coders apply the specific COPD, asthma, and respiratory failure code your documentation actually supports every time. That precision protects the full risk-adjusted revenue your practice has rightfully earned.
Double-Checked Complex Coding
Bronchoscopy and other claims get reviewed by our AI coding agent CODIN, then checked again by a certified coder before submission. That two-layer review catches bundling errors before they cost an appeal.
Is Your Practice Ready for New York's Out-of-Network Billing Rules?
Pulmonology practices routinely refer patients out-of-network to an EBUS specialist, an interventional pulmonologist, or a thermoplasty center. Each of those referrals falls under New York’s own dispute process, governed by Insurance Law Article 6. If you accidentally route the claim through the wrong process, it gets denied.
This is where Transcure becomes your strategic partner. Our 99% first-pass clean claim rate means most of your out-of-network claims never need to be disputed in the first place. For those that do, we prepare the documentation the state requires and file it before the window closes. In fact, practices that work with us see up to a 20% increase in revenue.
Does Transcure Work With Your Existing EHR in New York?
Transcure works within the EHR your New York pulmonology practice already uses, so billing fits your existing workflows.
What Do New York Practices Say About Transcure's Pulmonology Billing?
See how our pulmonology billing services cut denials and grew collections for New York practices after switching to Transcure.
Jackie Judd
Practice Manager
Wilson Creek Internal Medicine
As a practice manager, I was looking to streamline the medical billing process. I tried other companies, but they were all complicated and took too much of my time. Fortunately, I found Transcure. They excel in tailoring solutions to fit my requirements.
Amber Vaughan
Office Manager
Idaho Kidney & Hypertension Institute
We are a large practice with 15 providers. Transcure has been working with us for the last 5 years. This billing company has been a great asset to us. I work with Transcure and they provide everything I ask for. The team is friendly and very pleasant to work with.
Ashlee Rose
Practice Manager
Harding Memorial Healthcare
We’ve been working with Transcure for 8 years now and I just wanted to say how happy we are with their services. They always get back to us quickly and are very easy to work with. They get my bills paid in record time and help us to generate millions in revenue.
Frequently Asked Questions (FAQs)
Get answers to the most common questions New York pulmonology practices ask about our billing services, compliance, and state-specific regulations.
Does Transcure work with all three New York Medicaid managed care plans?
Yes, Transcure bills and manages authorizations across Fidelis, Healthfirst, MetroPlus, and other New York Medicaid managed care plans. We track each plan’s rules separately so the same service isn’t approved by one plan and denied by another.
How quickly can Transcure start billing for a New York pulmonology practice?
Transcure onboards most pulmonary practices within 5 to 7 business days. We handle EHR integration, Medicaid plan verification, and payer credentialing in parallel, so billing continues without a gap during the switch.
What if my New York practice is audited by a Medicaid managed care plan?
We maintain the documentation trail, coding rationale, and authorization records a plan requests during an audit. This way, your practice has what it needs on hand, rather than scrambling to reconstruct it.
Can Transcure take over billing mid-contract with our current vendor?
Yes, Transcure can start alongside or after an existing vendor relationship ends, without disrupting active claims or patient billing. We coordinate the transition so no claims fall through the gap between vendors.