Internal Medicine Billing Services

Internal medicine focuses on adult care and managing chronic diseases such as diabetes, hypertension, and other preventive healthcare needs. Physicians in this field handle the above cases through multiple diagnoses and intricate treatment plans. The wide range of conditions and treatments addressed in internal medicine requires the precise use of medical codes to ensure accurate billing and reimbursement. Healthcare providers need to apply ICD-10 codes for diagnoses, CPT codes for procedures, E/M codes for evaluation and management services, HCPCS codes for supplies and services, and appropriate modifiers to convey specific details about the services provided. 

However, many internal medicine physicians struggle with applying the correct codes for the services provided. These billing complexities often result in coding errors, claim denials, and payment delays, diverting their attention from their primary focus on delivering quality patient care.

At Invensis, as a leading internal medicine medical billing company, we simplify the billing process by:

• Gathering patient demographics, medical history, and insurance payer details such as coverage type, prior authorization status, effective dates, expiration dates, and claims address to ensure internal medicine claims processing with minimal errors.
• Reviewing medical records and encounter notes to capture all billable services and procedures.
• Assigning CPT and ICD-10 codes within 99202 – 99215/ 99202 – 99205/99211 – 99215/ 99242 – 99245 ranges to capture aspects like outpatient, office, or emergency department visits, preventive services, chronic disease management, and vaccinations based on documented services and diagnoses.
• Generating claims using assigned codes and including all necessary information for accurate billing.
• Performing thorough reviews to ensure claims are complete and comply with insurance payers, including Medicare, Medicare Advantage Plans (Part C), Medigap, and private insurance payers like UnitedHealth, Humana, etc.
• Submitting claims electronically through secure EDI (Electronic Data Interchange) systems to insurance companies and payers.
• Posting payments received from insurance payers and patients into the billing system.
• Reconciling payments with claims and adjusting accounts for any discrepancies.
• Calculating out-of-pocket expenses (deductibles, copayments, coinsurance, etc.) with the help of EOB and informing patients about their financial responsibility.
• Resolving claims disputes in explanation of benefits (EOBs) and initiating the appeals process to gain maximum reimbursement for the services rendered.
• Implementing collection strategies for outstanding patient balances, including payment plans and reminders.
• Generating detailed financial reports, including revenue, claim status, and denial trends.
• Analyzing billing performance metrics such as clean claims rate, average days in AR, claims denial rate, charge entry lag, average reimbursement per encounter, and cost per claims processed to identify areas for improvement and optimize internal medicine RCM.