Internal Medicine Billing Experts
Maximize your internal medicine practice revenue with specialized billing for hospital medicine, outpatient care, and chronic disease management. Expert E/M coding, CCM optimization, and comprehensive revenue cycle management.
Internal Medicine Services
- Hospital Medicine Billing
- Outpatient Internal Medicine
- Chronic Care Management
- E/M Coding Optimization
- Consultative Services
- Prolonged Service Capture
Internal Medicine Billing Excellence
Our specialized approach consistently outperforms industry benchmarks
Internal Medicine Billing Challenges We Solve
Complex E/M coding and documentation requirements demand specialized expertise
E/M Coding Complexity and Documentation
Internal medicine encounters involve complex medical decision-making with multiple chronic conditions. Proper documentation of history, exam, and MDM elements is critical. The 2021 E/M changes require understanding time-based vs MDM-based coding selection.
Undercoding costs average internist $75,000 annually; overcoding risks audit penalties
Hospital vs Office Billing Requirements
Hospitalists must navigate different coding rules for inpatient services, observation, consultations, and discharge day management. Place of service codes, admission dates, and discharge timing significantly affect reimbursement.
Incorrect POS coding causes 18% denial rate in hospital medicine
Chronic Care Management and CCM Programs
Internal medicine practices see high volumes of Medicare patients eligible for CCM (99490), transitional care management (99495-99496), and chronic care remote monitoring. Documentation requirements are extensive and time-based.
Properly billed CCM adds $40-60 per patient monthly - missed by 70% of practices
Prolonged Services and Time Documentation
Complex medical management often extends beyond typical visit times. Prolonged service codes (99354-99357) require precise time documentation and cannot be billed with certain E/M codes. Many practices fail to capture this additional revenue.
Average 8-12 prolonged service opportunities monthly go unbilled per physician
Multiple Chronic Condition Documentation
Internal medicine patients present with multiple comorbidities requiring complex treatment plans. All conditions addressed must be documented with specificity for risk stratification and appropriate E/M level assignment.
Incomplete problem list documentation reduces E/M levels by average of one code level
Consultation vs Referral Coding
Medicare eliminated consultation codes, but many commercial payers still recognize them. Understanding when to use consultation codes (99241-99245) versus new patient codes affects reimbursement and requires payer-specific knowledge.
Consultation code misuse triggers $15,000+ in audit takebacks annually
Comprehensive Internal Medicine Service Lines
Expert billing across all internal medicine practice settings
Hospital Medicine (Hospitalist Services)
Comprehensive inpatient medical management including admissions, daily rounds, consultations, and discharge planning.
Initial Hospital Care
99221-99223Comprehensive history, exam, and MDM for new admissions
Subsequent Hospital Care
99231-99233Daily inpatient management and progress notes
Hospital Discharge Day
99238-99239Discharge planning, summaries, and prescriptions
Critical Care Services
99291-99292ICU-level care with time-based billing
Outpatient Internal Medicine
Office-based care for adult patients with chronic diseases, preventive care, and acute illness management.
Office Visits (Established)
99213-99215Follow-up visits for chronic disease management
New Patient Visits
99203-99205Comprehensive new patient evaluations
Annual Wellness Visits
G0438-G0439Medicare annual wellness exams
Preventive Medicine
99385-99397Preventive care visits all ages
Chronic Care Management
Non-face-to-face care coordination for patients with multiple chronic conditions.
Chronic Care Management
9949020+ minutes monthly care coordination
Complex CCM
9949160+ minutes monthly for complex patients
Principal Care Management
99424-99427Single complex chronic condition
Remote Patient Monitoring
99453-99458Device setup and data monitoring
Consultative Services
Specialty consultation for complex medical conditions referred by other physicians.
Office Consultations
99241-99245Outpatient consultation services
Inpatient Consultations
99251-99255Hospital consultation services
Second Opinion Services
Varies by payerExpert medical opinions
Preoperative Clearance
99213-99215Surgical risk assessment
Internal Medicine Practice Success Stories
Real results from internal medicine practices we've transformed
Multi-Physician Internal Medicine Group
8 physicians, 2 NPs - outpatient focusedChallenge
Practice was undercoding E/M visits by average of one level, missing CCM revenue opportunities entirely, and experiencing 14% denial rate due to documentation deficiencies.
Solution
Implemented EHR documentation templates optimized for 2021 E/M guidelines, trained staff on time-based vs MDM coding, and launched comprehensive CCM program with dedicated care coordinators.
Results
- ✓E/M level distribution optimized - 45% increase in level 4-5 visits
- ✓CCM program enrolled 340 patients generating $106K monthly
- ✓Denial rate reduced from 14% to 2.1%
- ✓Net practice revenue increased $890,000 annually
Hospital Medicine Group Revenue Recovery
12-hospitalist group serving 200-bed hospitalChallenge
Hospitalists weren't capturing critical care time, discharge day management was inconsistent, and prolonged service codes were never billed despite frequent complex cases.
Solution
Deployed hospital medicine coding specialists, implemented time-tracking protocols for critical care and prolonged services, and created discharge day documentation workflow.
Results
- ✓Critical care billing increased 340% with proper time documentation
- ✓Discharge day management capture rate: 98% (was 67%)
- ✓Prolonged service codes: 89 additional monthly claims
- ✓Group revenue increased $425,000 annually
Academic Internal Medicine Practice
Teaching practice with residents and fellowsChallenge
Teaching physicians struggled with resident documentation requirements, split-shared visit billing was inconsistent, and consultation code usage was triggering audits.
Solution
Implemented teaching physician documentation compliance program, created split-shared visit workflows, and established consultation vs new patient coding protocols.
Results
- ✓Teaching physician attestation compliance: 100%
- ✓Split-shared visit denials eliminated
- ✓Consultation code audit findings resolved
- ✓Captured $180,000 in previously missed teaching physician revenue
Internal Medicine Billing Questions Answered
Expert answers to your internal medicine billing questions
How do you optimize E/M coding for internal medicine practices under the 2021 guidelines?
We train physicians and staff on the two pathways for E/M level selection: time-based coding (when >50% of encounter is counseling/coordination) and medical decision-making based coding. Our documentation templates prompt for all required MDM elements - number/complexity of problems addressed, amount/complexity of data reviewed, and risk of complications. We conduct regular coding audits to ensure physicians are coding to the appropriate level supported by documentation, typically increasing level 4-5 visit percentages by 30-45% while maintaining audit-proof documentation.
What is your approach to chronic care management (CCM) billing?
We implement comprehensive CCM programs including patient enrollment workflows, care plan development templates, time-tracking systems, and monthly care coordinator protocols. Our approach ensures all required elements are documented: patient consent, care plan, 20+ minutes of non-face-to-face time, and comprehensive care coordination. For complex CCM (99491), we identify patients requiring 60+ minutes monthly. We typically achieve 60-80% enrollment rates among eligible Medicare patients, generating $40-60 per patient monthly compared to industry average of 15-20% enrollment.
How do you handle the differences between hospital and office billing?
Our hospital medicine specialists understand the distinct requirements for inpatient coding including initial hospital care (99221-99223), subsequent hospital care (99231-99233), and discharge day management (99238-99239). We ensure proper place of service codes, understand observation vs inpatient status implications, and capture critical care services with precise time documentation. For practices seeing patients in both settings, we implement location-specific documentation requirements and ensure proper modifier usage to prevent place-of-service denials.
Do you help with consultation code billing for commercial payers?
Yes, while Medicare eliminated consultation codes, many commercial payers still recognize them with higher reimbursement than new patient codes. We maintain payer-specific policies and determine when consultation codes (99241-99245 office, 99251-99255 inpatient) are appropriate versus new patient codes. This requires documentation of the 3 R's: Request from another physician, Rendering of opinion/advice, and Report back to requesting physician. For Medicare patients, we use appropriate new or established patient codes instead.
How do you capture prolonged service revenue?
Prolonged services (99354-99357) are frequently missed revenue opportunities in internal medicine. We implement time-documentation protocols capturing total face-to-face time and clearly noting when encounters exceed typical times. For office visits exceeding base code time by 15+ minutes, we bill add-on prolonged service codes. Our hospitalists use mobile time-tracking apps to document prolonged bedside care. This typically adds 8-12 prolonged service codes monthly per physician, each generating $100-150 additional revenue.
What about teaching physician billing in academic settings?
Academic practices have unique requirements for teaching physician documentation. We ensure compliance with CMS teaching physician rules including proper attestation statements ('I personally performed the key portions of the service'), presence during key portions of service, and resident documentation review. For split-shared visits, we implement protocols ensuring both resident and attending physician document appropriately. Our academic medicine specialists prevent the common pitfalls that trigger teaching physician audits while maximizing legitimate revenue.
How do you handle multiple chronic condition documentation?
Internal medicine patients typically present with 4-6 chronic conditions requiring ongoing management. We implement problem-oriented documentation systems ensuring every condition addressed is listed with current status and management plan. Our templates prompt for ICD-10 specificity (e.g., Type 2 diabetes with diabetic neuropathy vs just diabetes diagnosis). For Medicare Advantage patients, we ensure all HCC conditions are documented annually for risk adjustment. This comprehensive documentation supports higher E/M levels while enabling accurate risk stratification.
What metrics should internal medicine practices track for revenue optimization?
Key metrics include: E/M level distribution (target: 40-50% level 4-5 for established patients), RVU per encounter (hospitalists: 1.8-2.2, outpatient: 1.3-1.6), CCM enrollment rate (target: 60-80% of eligible patients), clean claim rate (target: 95%+), days in AR (target: <30 days), and denial rate (target: <3%). We provide monthly scorecards with physician-specific benchmarking, identifying outliers for targeted education and documentation improvement.
Optimize Your Internal Medicine Practice Revenue
Join hundreds of internists and hospitalists who have increased revenue by an average of 28% with our specialized billing services. Get a free practice assessment today.
✓ E/M coding expertise ✓ CCM program implementation ✓ Hospital medicine specialists