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Since its establishment in 1984, Bill of Health Services, Inc. has been helping healthcare providers face the challenges of accurate billing, coding and reimbursement. The company has grown to a highly-respected firm known nationally and has transformed itself over the years to provide an expansive scope of services that meet the ongoing and evolving needs of healthcare clients, tailoring our services to every client.

Medicine is a business and we serve as our clients’ business partner.

We are pro-active and responsive with our clients, going above and beyond to assist them. Having worked with scores of practices in most specialties over the past 34 years, we offer our guidance and expertise on both "front office" and "back office" operations. Due to this level of detail and attention along all fronts, much of our growth has been through referrals from satisfied clients.

Our revenue cycle management services ensure accurate claim submission and payment posting, negotiation with payers, analyses of trends, and much more.


Evaluation and Management Documentation Changes for 2021

  • Changes only apply to office and outpatient visits
  • E/M code will be based on Medical Decision Making (MDM) or Time
  • E/M code 99201 will be eliminated
  • Continue to document medically appropriate History and Examination

    MDM Elements

  • Number of diagnoses or management options
  • Amount and/or complexity of data to be reviewed
  • tests, documents, orders, or independent historian(s) [e.g., parent]; each unique test, order, or document is counted to meet a threshold number
  • Independent interpretation of tests not reported separatelyDiscussion of management or test interpretation with external physician/other QualifiedHealth Professional (QHP)/appropriate source (not reported separately)
  • Risk of complications and/or morbidity or mortality of patient management decisions made at the visit, associated with the patient’s problem(s), treatment(s)Includes possible management options selected and those considered, but not selectedAddresses risks associated with social determinants of health


  • Includes face-to-face and non-face to face time with patient
  • Document total time in medical record.
  • Preparing to see the patient (e.g., review of tests)
  • Obtaining and/or reviewing separately obtained history
  • Performing a medically necessary appropriate examination and/or evaluation
  • Counseling and educating the patient/family/caregiver
  • Ordering medications, tests, or procedures
  • Referring and communicating with other healthcare professionals (when not reported separately)
  • Documenting clinical information in the electronic or other health record
  • Independently interpreting results (not reported separately) and communicating results to the patient/family/caregiver
  • Care coordination (not reported separately)

  •  E/M Code Total Time (2021) E/M Code Total Time (2021)
     99201 Code Deleted 99211 No Time Component
     99202 15-29 minutes 99212 10-19 minutes
     99203 30-44 minutes 99213 20-29 minutes
     99204 45-59 minutes 99214 30-39 minutes
     99205 60-74 minutes 99215 40-54 minutes


Thank you to all our healthcare professionals and first responders who are risking their lives to care for others.

Effective on April 26, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and it suspended this program to Part B suppliers effective immediately. The agency announced this following payment of over $100 billion to healthcare providers and suppliers and in consideration of the $175 billion recently appropriated for healthcare provider relief payments. CMS will not accept any new applications for the Advance Payment Program, and they will reevaluate all pending applications. However, providers can still apply for funds through the CARES Act Provider Relief Fund (see below).

CARES Act Provider Relief Fund

As part of the CARES Act, the Department of Health and Human Services (HHS) has approved $30 billion for healthcare providers. This is a grant and does not have to be paid back.

Payment will be based on the Taxpayer Identification Number (TIN) 2019 fee for service Medicare payments.

The formula used to determine the dollar amount is the following: Divide the 2019 Medicare fee for service received (exclude Medicare Advantage payments) by $484,000,000,000 (total payments made in 2019) and multiple that amount by $30,000,000,000.

If Medicare payments are electronic, providers will receive a direct deposit from Optum Bank with “HHSPAYMENT” as the payment description.

If paper checks are typically received, look out for a paper check.

Providers must sign an attestation confirming receipt of the funds and agreeing to Terms and Conditions. Not returning the payment within 30 days of receipt will be viewed as Acceptance of the Terms and Conditions.

If you have not yet received this grant, contact your Medicare MAC.


The CMS Accelerated and Advance Payment Program

This program is a loan and must be paid back. It is intended to provide necessary funds when there is a disruption in claims submission and/or claims processing.

To qualify, the provider/supplier:


  • Must have billed Medicare for claims within 180 days prior to the signature date on the request form
  • Not be in bankruptcy
  • Not be under active medical review or program integrity investigation
  • Not have any outstanding delinquent Medicare overpayments


The applicant will be asked to request a specific amount using an Accelerated or Advance Payment Request form (on each MAC’s website)

Most providers and suppliers can request up to 100% of the Medicare payment for a three-month payment.

Payments should be issued within seven days of receiving the request.

Repayment for providers and suppliers will begin 120 days after issuance of the payment.

Repayment will be made by offsets from new claims.


SBA Loans

Contact your bank to apply for a CARES SBA loan/grant as quickly as possible.

An additional $484 billion for small businesses, hospitals, and testing will be available.

A practice or facility is a business and would qualify.

Medicare Card

Medicare Card

Medicare Beneficiary Identifier (MBI)

Your Medicare patients will soon be receiving new cards called Medicare Beneficiary Identifier (MBI) cards. They are being mailed in different phases by geographic location.

The existing card uses social security numbers and it is known as the Health Insurance Claim Number (HICN). However, the MBI cards are only comprised of eleven numbers and uppercase letters. Each MBI is unique and randomly generated. There is no special meaning to the sequence.

The effective date of each card is the eligibility date for each beneficiary.

There will be a transition period through December 31, 2019 to use the existing or new cards. Effective 1, 2020, only the MBI numbers can be used, regardless of date of service.

  • The MBI’s 2nd, 5th, 8th, and 9th characters will always be a letter.
  • Characters 1, 4, 7, 10, and 11 will always be a number.
  • The 3rd and 6th characters will be a letter or a number.
  • The dashes aren’t used as part of the MBI in computer systems or file formats.’

Beginning in October 2018 and throughout the transition period, the patient MBI will be on every Electronic Remittance Advice (ERA), in the same field as the current HICN.

For additional information, please indicate your question on our contact page.


Medical Billing and Collections

Bill of Health Services works closely with its clients to create and support electronic and efficient processes relating to patient eligibility verification and registration, establishing of financial responsibility for the encounter, ensuring coding and billing compliance, preparing and transmitting clean claims, monitoring payer adjudication, generating patient statements via email and paper, assigning patient payments, arranging collections and much more. Electronic encounter forms and CSV spreadsheets are two means we use to eliminate paper and increase efficiencies for claim submission. We automatically sign new clients up for ERA and EFT payments.

Comprehensive Reporting

There are important reports that every healthcare practice should run on a regular basis.  Bill of Health Services ensures that all necessary reports are delivered every month and in the format that is useful. Ad hoc reports are provided upon request. Most reports are in an Excel format. Bill of Health Services staff is available any time to respond to questions about reporting and to provide clients with additional metrics and key performance indicators to enhance the financial viability of their practices or facilities. Reports are analyzed to recognize trends down to the payer level. This information has been used in negotiating updated fees with payers.

Coding and Compliance

Bill of Health Services Coding and Compliance Division is singularly focused on ensuring that clients adhere to accurate and compliant documentation and coding practices.  Since the inception of this division in 1998, we have worked to maximize clients' revenue while reducing regulatory risk through coding, bundling, documentation and consultative reviews.  Documentation reviews are completed on an as-needed consulting basis and as part of our standard service offering for our clients.

Education and Resources

Complementing our regular client updates on coding and other changes and guidelines that may impact their specialties, Bill of Health Services prides itself on serving as a valuable business partner to our clients. We continually work hard to earn and retain our clients' trust and communicate clearly and often so there are no surprises as the ever-changing healthcare landscape evolves. We're available as a consultative partner with any practice; contact us to discuss how we can help.


Bill of Health Services helped streamline our billing processes and reduced the stress level in our office dramatically. Whenever we had a question, they were only a phone call away.

Our biggest problem was the errors in our internal operations.  Madelon and her team showed us how to reduce the mistakes and became valued partners in making my practice better. 

Bill of Health Services reviewed our recent EOB denials and found some things we could do to improve our reimbursement rate. Thank you Madelon! That goes right to our bottom line.