Specialty billing / Internal Medicine
Internists manage patients with several active conditions at once, and the billing rarely reflects it. Visits get leveled on habit rather than on documented decision making, transitional care after a hospital discharge goes unbilled, and chronic conditions that drive risk adjustment are treated during the visit but never coded on the claim.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
A patient with four active problems, several medication adjustments and a decision about hospitalization supports a high-level visit. Practices default to a middle code out of caution, and the difference across a full panel is substantial over a year.
Contacting a patient within two business days of discharge and seeing them within the required window is billable, and most internal medicine practices already do it. Without documented contact timing and a face-to-face date, the service cannot be reported.
Chronic conditions must be documented and coded at least annually to count for risk adjustment. Notes that carry conditions forward in a problem list without assessment during the visit do not support reporting them on the claim.
Chronic care management, transitional care management and remote monitoring have overlapping time and exclusivity rules. Billing two services in the same month without checking the interaction produces denials that look arbitrary but are not.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
Either medical decision making or total time on the date of the encounter. Decision making rests on the number and complexity of problems addressed, the data reviewed, and the risk of the management options considered. History and exam no longer drive the level, though they still matter clinically and should reflect the work done.
Interactive contact with the patient or caregiver within two business days of discharge, medication reconciliation by the face-to-face visit, and an office visit within 7 or 14 days depending on complexity. The service is reported after the face-to-face visit. Document the contact date and method, or the claim cannot be supported.
For patients in risk-adjusted plans, documented and coded chronic conditions determine the resources attributed to their care. A condition that is not assessed and coded during the year effectively disappears. Reviewing each patient's active conditions at the annual visit is the practical way to keep capture complete.
In some combinations yes, but the time counted toward each service cannot overlap and certain pairs are mutually exclusive within a month. The safest approach is separate time logs per service and a monthly check before submission. We track these interactions per patient so the combination billed is one the payer will accept.
Claims go out within 48 hours of documentation, denials are worked the week they arrive, and you get a monthly view of where revenue is stuck by payer and by provider. Ten years of working these payers means we usually know which denials are worth appealing and which reflect a workflow problem to fix upstream.
Other specialties
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
