In today’s evolving healthcare environment, internal medicine practices face more than just patient-care challenges. Every day, billing missteps, payer rules and under-monitoring of key metrics silently drain revenue and constrain growth. At MBNC, we’ve seen first-hand how routine errors in coding, documentation and claim‐management translate into tens of thousands of dollars in lost revenue annually.

Here’s the hard truth: If your billing team isn’t tracking the right performance metrics and has gaps in workflow controls, you’re leaving money on the table.

Why Internal Medicine Billing is Especially Prone to Revenue Loss

Internal medicine has a unique billing profile. Industry data shows about 8% of first-submission claims in single-specialty practices are denied; some reports estimate up to 20% of claims denied overall, with up to 60% of denied claims never being resubmitted.

Complex Chronic Care Coding

Chronic care management (CCM) and transitional care management (TCM) codes require meticulous time tracking and documentation. Missing even one required note or timestamp can turn a reimbursable service into a denial.

Documentation Gaps

Internal medicine physicians often handle high patient volumes. Incomplete progress notes or missing details in the EHR can result in under-coding or rejected claims.

Payer Scrutiny:

CMS and private insurers have become increasingly aggressive in auditing E/M documentation. Even small discrepancies between the note and billed code can trigger recoupments or denials.

These factors combine to create “revenue-leaks”, which means delayed or denied claims, undercharges, missed billing opportunities and inefficient workflows.

Three Major Revenue-Leak Areas And Their Impact

1. Delayed or Missed Charge Entry

If you’re not submitting claims quickly, ideally within 48 hours of service, you increase your risk of denials, late payments, or loss of payer responsiveness.

Impact: Your cash-flow suffers, your accounts Receivable (A/R) grows, and your write-offs increase.

2. Underbilling Evaluation & Management (E/M) Levels

Many internal medicine practices routinely bill 99213 instead of 99214, even when documentation supports the higher level. The result? Thousands in lost revenue over time.

Impact: Reduced reimbursements and lower RVUs despite high patient volumes.

3. Missed Modifier Usage

Modifiers like 25, 59, or 24 are crucial for clarifying procedures performed on the same day. Missing them often leads to denials for “duplicate services.”

Impact: Unnecessary write-offs and rework time for rebilling. Common Billing Mistakes in Internal Medicine

Common Mistakes Costing Internal Medicine Practices Revenue

At MBNC we frequently see internal medicine practices making the following mistakes:

• Underbilling E/M Levels: defaulting to lower codes for “safety” or convenience.
• Missed Modifier Usage: neglecting modifier 25, 59, or 24 during same-day visits.
• Poor Chronic Care Documentation: missing time logs or required patient consent.
• Inadequate Follow-Up on Denials: failing to resubmit corrected claims.
• Weak Eligibility Verification: leading to coverage denials at submission.

How to Stop Revenue from Slipping Away

Internal medicine practices need proactive billing discipline backed by data and regular audits. Here are a few ways to stop your revenue from leaking:

Regular Coding Audits

Conduct quarterly internal or outsourced audits to catch underbilling, missed modifiers, and documentation errors early.

Track Key Performance Indicators (KPIs)

• Clean Claim Rate: 90–95%.
• Net Collection Rate: Greater than or equivalent to 95%.
• Days in A/R: less than 30 days.
• Denial Rate: Less than 5%.

Continuous Staff Training

Keep billing and front-office staff updated on coding updates, payer changes, and modifier rules.

Outsource or Partner with Experts

A specialized internal medicine billing team, like MBNC, can manage coding precision, optimize denial follow-up, and maximize reimbursement accuracy.

Partner with MBNC

Hidden revenue leaks in internal medicine aren’t inevitable, they’re often the result of repeatable billing and workflow flaws. By identifying the right KPIs, tightening your processes, and staying ahead of payer rules, you can transform billing from a cost centre into a profit centre.

At MBNC, we specialise in internal-medicine billing and coding services that plug these leaks, accelerate cash flow and ensure you’re collecting what you’ve earned.