Selecting the right billing partner isn’t just administrative. It’s a strategic decision that affects your revenue, compliance, and operational efficiency.
Internal medicine billing demands specialized expertise: accurate E/M coding, accurate chronic care documentation, and up-to-date knowledge of Medicare and private payer policies. A misstep can mean delayed payments, audits, or lost revenue.
According to published research in the Journal of the American Medical Association (AMA), billing mistakes can cost up to 15-20% of possible income.
This guide outlines the key questions to ask potential billing services, ensuring you partner with a team that understands internists’ unique needs. (See how internal medicine vs family practice billing differs in scope.)
You’ll discover how to:
- Evaluate true billing expertise (beyond generic claims processing)
- Verify performance metrics (clean claim rates, denial resolution, etc.)
- Spot red flags that could put your revenue at risk
Whether you’re transitioning from in-house vs outsourced billing or reassessing your current vendor, these insights will help you make an informed choice and avoid costly pitfalls.
Looking for a trusted partner? Explore our specialty internal medicine billing services.
Table of Contents
Why Should Internists Ask These Questions?
Internal medicine billing isn’t just complex. It’s a constantly shifting landscape. Here’s what makes it uniquely challenging:
- Ever-changing E/M guidelines: Frequent guideline changes that demand real-time expertise.
- Chronic & transitional care: CCM, TCM, and RPM require precise documentation and payer-specific rules.
- High-risk modifiers: Misusing modifiers (e.g., 25, 59) for same-day services triggers audits or denials.
- Payer fragmentation: Medicare, Medicare Advantage, and private insurers each have their compliance abnormalities.
Standard billing services often treat claims as a numbers game. But for internists, billing is a clinical workflow extension. Errors don’t just delay payments; they disrupt patient care.
9 Must-Ask Questions Before Hiring an Internal Medicine Billing Service
Choosing the wrong billing partner can cost you revenue, time, and compliance security. Below are the critical questions to ask vendors, along with what to listen for, red flags, and pro tips to protect your practice.
1. Do You Specialize in Internal Medicine Billing?
Why It Matters: Internal medicine requires expertise in E/M coding (e.g., 99214, G2211), chronic care management (CCM/TCM), and payer-specific rules.
✅ Ask:
- “What percentage of your clients are internal medicine practices?”
- “Can you share examples of denied claims you’ve overturned for internists?”
🔴 Red Flag: A vendor whose client base is mostly surgeons or OB/GYNs.
Make sure your vendor is updated on E/M coding changes for internists to avoid claim errors.
2. What’s Your First-Pass Claim Acceptance Rate?
Why It Matters: A rate >95% minimizes cash flow delays. Below 90% suggests inefficiency.
✅ Ask:
- “What’s your denial rate for internal medicine claims?”
- “How quickly do you resolve and resubmit denials?”
💡 Tip: Request 6–12 months of performance reports.
Internal Medicine Revenue Cycle Management Best Practices: Full RCM Guide
3. Are Your Coders AAPC- or AHIMA-Certified?
Why It Matters: Certified coders reduce audit risks and stay current with CMS updates.
✅ Ask:
- “Do your coders hold CPC or CCS-P credentials?”
- “How do you train staff on annual CPT/ICD-10 changes?”
📌 Key Insight: Uncertified coders often miscode E/M levels or modifiers (e.g., 25, 59).
4. How Do You Handle Chronic Care Management (CCM) Billing?
Why It Matters: CCM (99490, 99487) requires strict documentation, consent, and time tracking missed billing = $20K+ lost annually per provider.
✅ Ask:
- “How do you verify patient eligibility and document time?”
- “What’s your process to ensure compliance with Medicare’s CCM rules?”
🔴 Red Flag: No clear workflow for CCM or RPM billing.
5. What’s Your Fee Model? Are There Hidden Costs?
Why It Matters: Transparent pricing (typically 4–8% of collections) prevents surprises.
✅ Ask:
- “Is your fee percentage-based or flat-rate?”
- “Are there extra charges for claim follow-ups or EHR integration?”
⚠️ Watch For: Fees for resubmissions, credentialing, or reporting.
6. Can You Integrate With Our EHR/PM System?
Why It Matters: Seamless sync with systems like Athena, Epic, or eCW reduces manual errors.
✅ Ask:
- “Which EHRs do you support? Is API integration included?”
- “Do you offer real-time dashboards for A/R tracking?”
📊 Ideal: Automated claims submission and denial alerts.
7. How Do You Ensure HIPAA Compliance?
Why It Matters: Data breaches can lead to significant penalties, ranging from $127 to over $1.9 million per violation, depending on the severity and extent of the breach. Vendors must sign a Business Associate Agreement (BAA) and encrypt Protected Health Information (PHI).
✅ Ask:
- “What safeguards protect patient data (e.g., encryption, access controls)?”
- “How often do you conduct security audits?”
🔐 Non-Negotiable: Avoid vendors who won’t sign a BAA.
8. Can You Provide Internal Medicine References?
Why It Matters: Peer validation reveals real-world performance.
✅ Ask:
- “Can I speak to an internal medicine client?”
- “What’s your average collection rate for allowable charges?”
🎯 Benchmark: Top firms collect 96 to 98% of allowable reimbursements.
9. Do You Manage Prior Authorizations & Eligibility Checks?
Why It Matters: Skipping this step spikes denials by 20–30% (especially Medicare Advantage).
✅ Ask:
- “Do you verify insurance eligibility before visits?”
- “How do you handle prior auths for costly procedures?”
📉 Risk: Vendors who treat auths as an “add-on” service.
Prior authorization challenges explain why this step is non-negotiable.
What Red Flags Should You Watch For in Billing Vendors?
❌ Lack of internal medicine-specific experience
❌ Denial rate above 10%
❌ Uncertified or offshore coders
❌ Extra fees hidden in small print
❌ No real-time performance reporting
❌ Poor integration with EHRs
❌ No BAA or vague answers on HIPAA policies
❌ Inability to provide internal medicine references
Explore common billing errors to avoid that often trigger denials.
Internal Medicine Billing Vendor Comparison Table
| Criteria | Generic Vendor | In-House Staff | MediBill RCM LLC |
|---|---|---|---|
| Internal Medicine Experience | ❌ Limited | ⚠️ Varies | ✅ 10+ years |
| Certified Coders (AAPC/AHIMA) | ⚠️ Sometimes | ⚠️ Varies | ✅ 100% certified |
| Denial Resolution Time | ⚠️ Slow | ❌ Inconsistent | ✅ <48 hours |
| EHR/PM Integration | ⚠️ Partial | ⚠️ Manual | ✅ Seamless |
| Fee Transparency | ❌ Hidden fees | ❌ Overhead cost | ✅ Flat 3.99% |
| HIPAA Compliance | ⚠️ Questionable | ✅ Internal | ✅ Full compliance |
Internal Medicine Billing Partner Checklist
✅ Specialization in internal medicine billing
✅ 95%+ clean claim rate
✅ AAPC or AHIMA-certified coders
✅ Secure EHR/PM system integration
✅ Transparent and fixed pricing
✅ Dedicated CCM and TCM support
✅ HIPAA-compliant data protocols
✅ Proven success with internist clients
Why Is MediBill RCM LLC Trusted by Internists Nationwide?
- 10+ years focused on internal medicine billing
- 3.99% flat fee, no surprises
- 95%+ first-pass claim rate
- Certified coders trained in Latest E/M and CPT changes
- End-to-end support for prior auth, CCM, TCM, and denial recovery
- Integration with all major EHRs, including Epic, eClinicalWorks, Athena
📞 Want to see how much you’re leaving on the table?
👉 Schedule a free internal medicine billing consultation now!
For a complete overview, read our internal medicine billing guide.
Frequently Asked Questions (FAQ’s)
1. What happens if the billing partner doesn’t manage prior authorizations or eligibility checks?
Skipping these steps can increase claim denials by 20–30%, especially with Medicare Advantage. It disrupts revenue flow and leads to repeated claim rework.
2. How can poor documentation of CCM billing impact our practice financially?
Inaccurate or missing CCM documentation can result in over $20,000 in annual lost revenue per provider due to underbilling or rejected claims.
3. What’s the risk of hiring a billing company without certified coders?
Uncertified coders are more likely to misapply modifiers (e.g., 25, 59), undercode services, or miss updates, which increases compliance risks and reduces reimbursements.
See how billing staff training best practices can reduce miscodes.
4. What red flags should we watch for when evaluating billing vendors?
Watch for high denial rates, hidden fees, poor EHR integration, uncertified staff, lack of internal medicine references, or refusal to sign a BAA. These signal operational and compliance risks.
5. What are hidden fees to watch for in billing contracts?
Common hidden charges include claim resubmissions, credentialing, EHR integration, or support calls. Clarify if the billing fee is flat-rate or percentage-based upfront.
