Internal medicine billing continues to evolve in 2025, introducing new complexities across E/M documentation, telehealth policies, and chronic care services.
Internists face challenges in navigating payer rules, coding structures, and compliance requirements, which directly impact collections and revenue cycles.
This guide breaks down the current billing landscape for internal medicine. It explains how specialized billing services help optimize collections, prevent claim denials, and streamline compliance with changing rules.
Table of Contents
Why Is Internal Medicine Billing Difficult in 2025?
What Makes Internist Billing Unique?
Internal medicine practices handle a broad scope of services from chronic condition management to acute evaluations and preventive screenings. This diversity results in higher documentation demands and greater coding complexity.
Key reasons billing is challenging include:
- Complex coding guidelines for time-based and MDM-based E/M visits.
- Frequent changes to telehealth and split/shared visit rules.
- Underuse of care coordination billing opportunities.
- Modifier errors and POS mismatches causing denials.
- Inconsistent documentation for shared provider workflows.
Internists often work within hospital-owned environments where practice profitability is scrutinized. The shift toward value-based care requires accurate reporting, proactive coding, and audit-ready documentation.
What E/M Coding Changes Must Internists Follow in 2025?
What Rules Apply to Office Visits?
The 2025 E/M structure continues to support two pathways for coding: Medical Decision Making (MDM) and Total Time. Physicians can select the approach that best reflects the work performed during a visit.
MDM-based coding evaluates the complexity of diagnoses, data reviewed, and risks managed.
Time-based coding includes the total time spent on the date of the encounter, covering pre-visit review, counseling, coordination, and documentation.
Clear documentation is required to support either method. The structure must define conditions managed, decisions made, and work performed before and after the encounter.
What’s New with Split or Shared Visits?
CMS requires that the billing provider perform the substantive portion of a shared visit. This can be determined by either MDM or total time. The provider who performs the majority of the key work must be the one submitting the claim.
Key documentation elements include:
- Attribution of tasks between providers
- Attestations specifying who performed which parts
- Time logs or clinical details supporting MDM
Shared visits are common in hospital-affiliated settings and must meet compliance expectations under updated CMS definitions.
What Changes Apply to Telehealth Billing?
Internists offering telehealth must use the correct Place of Service (POS) codes and applicable modifiers.
For Medicare audio-visual visits:
- POS 10 (patient at home)
- POS 02 (patient at healthcare facility)
- No modifier required
For Medicare audio-only visits:
- POS 10 (patient at home)
- Modifier -93 required
- FQ modifier required for FQHCs/RHCs
For commercial payers:
- Often requires modifier -95 for audio-visual visits
- POS requirements vary by payer
Important Note: Always verify individual payer policies as commercial plans may differ from Medicare rules.
Understanding the difference: billing vs coding
Clearinghouses improve claim scrubbing efficiency
How Should Internists Approach CCM, PCM, and RPM?
Many internists have eligible patients for care management billing, but do not bill for these services due to unfamiliarity or documentation complexities. To leverage these opportunities, it’s critical to understand the specific requirements for:
- Chronic Care Management (CCM): For patients with two or more chronic conditions expected to last at least 12 months (CPT 99490, 99491, etc.).
- Principal Care Management (PCM): For patients with a single serious chronic condition (e.g., advanced COPD, cancer) requiring frequent adjustments (CPT 99424–99427).
- Remote Physiologic Monitoring (RPM): For tracking physiologic data (e.g., blood pressure, glucose) outside the office (CPT 99453, 99454, 99457, etc.).
Key Billing Requirements
To bill correctly, practices must:
- Document a comprehensive care plan (e.g., problem list, medications, coordination with specialists).
- Obtain and record patient consent (annual consent for CCM/PCM; explicit consent for RPM).
- Track time spent (e.g., at least 20 min/month for CCM 99490; at least 30 min/month for PCM 99424).
Billing Flexibility
- These services can be billed monthly and may be layered under payer-specific rules:
- CCM and RPM can often be billed together if services are distinct (e.g., CCM for care coordination + RPM for vitals monitoring).
- PCM and CCM generally cannot be billed for the same condition (PCM is for a single condition; CCM requires multiple).
Note: Medicare and private payers may differ in policies—verify guidelines to avoid denials.
What Billing Errors Reduce Internist Revenue?
The Most Common Mistakes in Internal Medicine Billing
Billing mistakes often arise from systemic workflow issues, documentation, and staff training. These include:
1. Undercoding E/M Levels
When documentation supports a higher level of complexity but a lower CPT code is used, practices miss out on appropriate reimbursement.
2. Omitting CCM and RPM Billing
Chronic care services are frequently provided but not billed due to lack of consent forms, incomplete documentation, or misunderstanding of eligibility.
3. Using Incorrect POS or Modifiers
Incorrect use of place-of-service codes or missing modifiers leads to avoidable claim rejections, particularly in telehealth billing.
4. Missing Modifier -25
Modifier -25 is essential when billing an E/M visit with a procedure on the same day. Missing it often causes bundling issues or denials.
5. Weak Denial Management
Practices that do not appeal denied claims or fail to track trends often experience unnecessary revenue loss over time.
Understand NPI and why it’s critical
How Do Internist Billing Services Solve These Problems?
Why Should Internists Consider Specialized Billing Services?
Internal medicine billing services offer targeted solutions designed for the complexity of general and subspecialty care. These services use specialized workflows to ensure coding accuracy, documentation compliance, and proactive claim management.
What Do These Services Include?
E/M Code Validation Tools
Software audits each note to recommend the most appropriate CPT level based on documentation.
Pre-Submission Claim Scrubbing
Before submission, check each claim for errors, missing modifiers, and POS issues.
Automated Chronic Care Billing
Tracks consent, documentation, and time logs for monthly billing of CCM and RPM services.
Payer Rule Mapping
Ensures that claims are tailored to the specific requirements of each commercial payer and Medicare.
Shared Visit Workflow Compliance
Includes templates and macros that track provider contributions and generate compliant notes.
What Are the Operational Benefits?
Working with a dedicated billing team can:
- Reduce denied claims through proactive validation.
- Improve cash flow with faster claim approvals.
- Ensure billing for all eligible services.
- Reduce administrative burden on physicians.
- Maintain compliance with evolving CMS policies.
These improvements help practices maintain financial viability, especially in narrow operational margins.
Benefits of outsourcing medical billing services
What Can Internists Do Today to Optimize Their Billing?
Immediate Steps to Improve Revenue
Internists can take the following actions:
✅ Review EHR templates to support MDM and time documentation.
✅ Audit the current use of CCM, PCM, and RPM codes.
✅ Validate shared visit workflows in hospital settings.
✅ Cross-check telehealth billing for POS and modifier compliance.
✅ Train staff to detect missing modifiers like -25, -59, and -95.
✅ Implement a denial tracking system with reason codes.
✅ Conduct regular code audits to catch undercoding patterns.
✅ Consider outsourcing billing if in-house accuracy is low.
Download the full billing process workflow PDF
Key Takeaways for Internist Billing in 2025
- E/M levels must be selected using total time or MDM, supported by complete documentation.
- Shared visit billing requires attribution and time or complexity justification.
- Telehealth claims must align with current payer rules for POS and modifiers.
- Chronic care services must be documented, consented to, and tracked to bill.
- Billing services with internist experience reduce denials and increase collections.
Medical billing checklist for full compliance
Frequently Asked Questions (FAQs) on Internist Billing Services
What makes internal medicine billing more complex in 2025?
Internal medicine billing in 2025 is more complex due to evolving E/M coding frameworks, modifier rules, care coordination billing, and payer-specific telehealth requirements. Internists must adapt workflows to align with documentation and compliance standards.
How do internists choose between MDM and time-based E/M coding?
Internists can select either Medical Decision Making (MDM) or total time for E/M levels. The decision should reflect how the work was performed and must be supported by clear clinical documentation in the patient record.
What are the documentation requirements for shared visits in 2025?
Shared visit claims must include provider attribution, start/stop times (for time-based coding), or MDM role descriptions. The billing provider must perform the substantive portion of the visit, and all actions must be documented.
Which place-of-service (POS) codes are used for telehealth in 2025?
For Medicare:
- POS 10 is used when the patient is at home.
- POS 02 applies when the patient is at a facility.
- For audio-only visits: Modifier -93 is required.
- For commercial payers: POS rules vary and often require modifier -95 for audio-visual visits.
Can internists bill both CCM and RPM for the same patient?
Yes, if the services are for different purposes. CCM supports care coordination, while RPM involves physiologic monitoring. Both can be billed in the same month under payer-specific guidelines when properly documented and separated.
What is the main difference between CCM and PCM billing?
CCM is for patients with two or more chronic conditions requiring ongoing coordination. PCM targets a single high-risk condition needing frequent adjustments. Both require consent, time tracking, and care plan documentation.
Why are modifier errors the top cause of claim denials in internal medicine?
Modifiers like -25, -59, -95, and -93 trigger bundling rules and validate code combinations. Missing or incorrect modifiers cause claims flagged or denied by payers’ automated systems.
What are the most common billing errors made by internists?
The most common include undercoding E/M visits, failing to bill for CCM or RPM, using incorrect POS codes, missing necessary modifiers, and not appealing denials effectively. These issues can cause long-term revenue leakage.
How can billing services help internal medicine practices?
Billing services optimize E/M coding, manage CCM/RPM workflows, scrub claims before submission, map payer-specific rules, and reduce denials. They also ensure compliance with evolving CMS and commercial payer regulations.
What immediate steps can internists take to improve billing accuracy?
Internists should audit care management usage, validate modifier use, review telehealth POS settings, check shared visit workflows, and implement denial tracking systems. Staff training and EHR template updates also help minimize coding errors.
Why is documentation so critical for billing in 2025?
Complete and structured documentation supports coding accuracy, meets payer requirements, and protects against audits. It also ensures proper attribution for shared visits and validates time- or MDM-based billing choices.
Final Thoughts
Internist medical billing services require a strategic approach that aligns clinical workflows with evolving payer expectations.
Internists who document accurately, apply correct E/M coding, and use automation or expert billing partners are likelier to improve collections and maintain compliance.
Need help optimizing your billing processes?
MediBill RCM LLC, a top medical billing, coding, and credentialing company in Texas and across the USA, specializes in internal medicine billing. Our expert team delivers end-to-end support, including E/M code audits, CCM/RPM billing automation, and denial prevention workflows.
📞 Schedule Your Free Billing Audit Today
Contact Us → Custom Revenue Optimization Plan
Related Post
- Best Medical Billing Software for Internal Medicine Practices
- Complete Guide to Internal Medicine Billing: CPT, ICD-10, Modifiers & Reimbursement Tips
For official guidance, refer to:
