Internal Medicine Medical Billing and RCM Services
We run billing for independent internal medicine practices: complex office visits and their add-ons, hospital and observation care, split or shared visits and Medicare Advantage coding, inside the EHR you already use.
- 3 to 5% of collections, month to month
- Works inside your EHR, no migration
- Free RCM audit in 48 hours
“I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.”
Internal medicine billing
Where internal medicine revenue leaks
Internal medicine carries the most complex patients in outpatient care, and most of its revenue rides on the visit code. The losses come from visits leveled below the work, add-ons left off, hospital visits coded on rules that changed, and diagnoses that never make it from the note to the claim.
- 01
Visit levels the note does not carry
Office visits are leveled on medical decision making or total time on the date. A complex chronic visit documented as a list of conditions, with no assessment or plan for each, codes low or does not survive review.
- 02
Add-ons that go missing
G2211 left off the follow-up visits it was built for, and prolonged time sent to Medicare as 99417, a code Medicare does not recognize.
- 03
Hospital visits on old rules
Inpatient and observation stays have shared one code family since 2023, and split or shared visits need modifier FS. Claims built on the deleted observation codes, or without the modifier, come back unpaid.
- 04
Consults sent to Medicare
Medicare stopped paying consultation codes in 2010. A Medicare referral is billed as a new or established patient visit, while many commercial plans still pay consults.
- 05
Diagnoses that never reach the claim
Medicare Advantage payment follows the diagnoses documented and coded at visits. A chronic condition that is managed but never coded does not count for the patient.
Office visits
Visit levels, G2211 and prolonged time
Office and outpatient visits are leveled on medical decision making or on total practitioner time on the date of the visit. For internal medicine, decision making is usually the stronger path: the number and complexity of problems addressed, the data reviewed and the risk of the management chosen. A note that lists conditions without an assessment of each does not support the level the work deserved.
G2211 is the add-on for that continuing work. Medicare has paid it with office and outpatient visits since 1 January 2024 when the practitioner is the continuing focal point for the patient's care, or is managing a serious or complex condition over time. It is not paid with modifier 25 for a same-day procedure, except, since 2025, when the other service is an annual wellness visit, a vaccine administration or a Part B preventive service. For 2026 it also applies to home and residence visits, 99341 to 99350.
Prolonged time and consultations are where Medicare and commercial payers split. Medicare pays prolonged office time with G2212, not CPT's 99417, and has not paid consultation codes since 2010. The claim has to follow the payer, not the habit.
| Code | What it reports | Where claims go wrong |
|---|---|---|
| G2211 | Add-on for the continuing relationship with a patient, or ongoing care of a serious or complex condition | Left off chronic follow-up, or added to a visit billed with modifier 25 for a procedure |
| G2212 | Medicare's prolonged office time, starting 15 minutes past the maximum time CMS assigns to the visit | Replaced with 99417, which Medicare does not recognize |
| 99417 | CPT prolonged time, for commercial plans that follow CPT | Sent to Medicare, or counted from the wrong starting point |
| 99242–99245 | Office consultations | Billed to Medicare, which has not paid consultation codes since 2010 |
Source: CMS CY2025 PFS final rule fact sheet · CMS MM14315 · Medicare Claims Processing Manual, chapter 12
Hospital care
Hospital, observation and split or shared visits
Since 2023, inpatient and observation stays have shared one code family, hospital inpatient or observation care. The separate observation codes are gone, and the setting no longer changes the code.
When a physician and a nurse practitioner or physician assistant share a hospital visit, the claim goes under whoever performed the substantive portion. Since 2024 that means more than half of the total time, or the substantive part of the medical decision making. The claim carries modifier FS. Split or shared billing applies only in facility settings such as hospitals and skilled nursing facilities, never to office visits, and for critical care the substantive portion is still measured in time.
Prolonged time on a split or shared visit is billed only when time chose the visit level, by the practitioner who spent more than half of it.
| Code | What it reports | Where claims go wrong |
|---|---|---|
| 99221–99223 | Initial hospital inpatient or observation care | Billed on the deleted observation codes, or with the wrong level for the decision making documented |
| 99231–99233 | Subsequent hospital inpatient or observation care | A shared visit billed without modifier FS, or under the practitioner who did not do the substantive portion |
| 99234–99236 | Admission and discharge on the same date | Billed as two separate visits on one date |
| 99238 / 99239 | Discharge day management | Time not documented when the longer discharge code is billed |
Source: CMS MM13064 · CMS change request 12604
Medicare Advantage
Medicare Advantage and risk adjustment
For a Medicare Advantage panel, coding decides more than the visit payment. Plans are paid on risk scores built from the diagnoses documented and coded for each patient. For 2026, CMS calculates every score using only the 2024 CMS-HCC model, completing its three-year phase-in.
That is a documentation job before it is a coding one. Each chronic condition managed at a visit needs an assessment and a plan in the note, and its code on the claim. We check that the conditions you manage reach the claim, and that nothing is coded that the note does not support.
When a plan pays you less than Medicare would have, the dispute route is different again. See what to do when a Medicare Advantage plan pays less than Medicare.
Source: CMS 2026 Medicare Advantage and Part D Rate Announcement
Care management
Care management for chronic panels
Internal medicine panels are where care management pays: many patients with two or more chronic conditions, or one high-risk condition that needs a monthly plan, and hospital discharges that start a 30-day transitional care period.
Transitional care management needs contact within two business days of discharge and a face-to-face visit within 7 or 14 days, and only one practitioner can bill it. Chronic care management needs consent and an initiating visit, and can run during the TCM period when no minutes are counted twice. The full code tables, with principal and advanced primary care management, are on our page about primary care billing.
Source: CMS MLN908628 · CMS MLN909188
Comparison
Before and after working with Quilven
A process comparison, not a record of a particular practice and not a promise of outcome. It shows what changes in how claims are handled.
| Area | Before | With Quilven |
|---|---|---|
| Visit levels | Levels chosen by habit, with decision making the note does not show. | Levels matched to the problems, data and risk documented, by payer. |
| Add-ons | G2211 missing on chronic follow-up, and prolonged time sent to Medicare as 99417. | G2211 applied where the relationship supports it, and prolonged time coded to each payer's rule. |
| Hospital visits | Shared hospital visits billed under the physician by default, without modifier FS. | Substantive portion checked by time or decision making, with FS on every split or shared claim. |
| Consults | Consultation codes sent to Medicare and denied. | Medicare referrals billed as new or established visits, and consults kept for payers that pay them. |
| Risk adjustment | Chronic conditions managed at the visit but never coded on the claim. | Conditions assessed in the note carried to the claim, and nothing coded that the note does not support. |
| Rejections | Rejected claims sit in the clearinghouse queue until the filing window closes. | Rejections worked within four to five days, while the claim is still recoverable. |
Which of these applies to your claims is a question the audit answers. Request the audit.
Case study
Where the $5,500 was hiding
One AR recovery engagement, at a family medicine practice in Minnesota, not a internal medicine practice. Shown for method. Individual results vary. One engagement is not a forecast.
We reviewed 245 claims. The rejection queue had no owner, and some claims in it had waited close to a year.
Billed charges in that queue came to roughly $40,000 to $50,000, none of it being worked.
Most of the damage started before the claim was built. Stale coverage, incorrect member IDs and skipped eligibility checks at the front desk caused 70% of the denials.
Not everything could be reopened. On most of the affected claims, a commercial payer's 90-day window had already passed with no proof of submission on file, so appeals were not possible.
What came back was about $5,500, paid on 50 to 55 claims, most of it within 45 to 50 working days.
In their words
What the physician said
What you have provided for me was a detailed of things that are going wrong that needed to change in our practice.
I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.
I appreciate the professionalism, the courtesy, the knowledge.
After the audit the practice changed how it runs: eligibility verified before arrival, no more walk-ins, every patient checked the night before.
Pricing
What Quilven costs
Same pricing as every Quilven engagement, with nothing specific to internal medicine. See how every Quilven service is priced.
AR recovery
12 to 15%
of the recovered amount
No fee on what is not recovered. Where a practice lands in the range depends on claim volume, age of the inventory, and payer mix.
Medical billing
3 to 5%
of collections by monthly volume
A $500 monthly minimum applies. The rate moves with monthly volume, not with headcount on your side.
Credentialing
$150 to $200
per payer application
$200 per application, or $150 each for 8 or more. Can be included in a custom package for billing clients. Payer and state fees are paid by the practice.
Fit
Fit with your EHR
Outsourcing your billing does not require a system swap. We integrate with 30+ EHRs and practice management systems and work inside the one you already have. No data migration, no parallel system, no change to how your staff enters a charge or checks a patient in. If your team is trained on your current software, that training stays valid.
This matters because the usual objection to outsourced billing is that it turns into an implementation project. It does not here. Quilven is a managed service, not software. There is no proprietary platform you are asked to adopt and no license to renew, so the engagement can start on the claims you already have rather than after a build-out.
What you do get is visibility. Apex is our client dashboard, and it shows in real time:
- Net collection rate
- AR aging by bucket
- Denial reasons by payer
- Credentialing pipeline
Apex reads the work we are doing in your system. It is a window, not a replacement, so if the engagement ends your records and workflows are exactly where they were.
Company
Who Quilven is
Quilven is a managed revenue cycle service. Not software, not an EHR, and not a proprietary platform you have to adopt. We work inside the system your practice already uses, across 30+ integrations, with no data migration and no workflow change. Our clients are independent practices with 3 to 25+ providers.
Pricing is straightforward. AR recovery is 12 to 15 percent of the recovered amount. Medical billing is 3 to 5 percent of collections by monthly volume, with a $500 monthly minimum. Credentialing is $150 to $200 per payer application.
The entry point is a free RCM audit. It takes 48 hours and returns a line-by-line recoverable revenue estimate by payer, so the first thing you get from us is a diagnosis you can act on with or without us.
We lead with method and evidence rather than tenure. Quilven was founded in 2025 by Raief Shick. QUILVEN, LLC is registered in Wyoming, with its principal office at 1603 Capitol Ave, Cheyenne, WY 82001. Reach us at (202) 490-9406 or info@quilven.com.
Fit
Who this is for
Independent internal medicine practices with 3 to 25+ providers, including groups with hospital rounds, nurse practitioners and physician assistants sharing visits, or a large Medicare Advantage panel.
It also fits practices whose biller has just left, or whose billing company submits claims but does not work the denials. See what to do first when a biller quits and how to check whether denials are being worked.
It is not for hospitals billing facility claims.
At a glance
Internal medicine billing service facts
- Service
- Managed medical billing and revenue cycle management for internal medicine practices
- Covers
- Office and hospital visits, observation stays, split or shared visits, care management, Medicare Advantage coding
- Delivery model
- Managed service, not software, not an EHR
- Systems
- 30+ EHR and practice management integrations, no data migration
- Practice size served
- 3 to 25+ providers, independent and physician-owned
- Pricing
- 3 to 5% of collections by monthly volume, $500 monthly minimum, month to month
- Entry point
- Free RCM audit, 48 hours, recoverable estimate by payer
- Reporting
- Apex dashboard: net collection rate, AR aging by bucket, denial reasons by payer
- Area served
- United States
- Data handling
- Aging totals only to start, no patient data required
Related guides and services
- Medical coding servicesCertified coders working inside your EHR.
- Denial management servicesDenials worked by reason code and appealed on time.
- Provider credentialing servicesNew providers enrolled with every payer before their first visit.
- Why AR over 90 days keeps climbingWhat the aging report says about your billing.
FAQ
Internal medicine billing questions
Sources
Sources
Checked 29 October 2026. Rules and published figures change, so confirm the current version before you rely on one.
- CMS CY2025 Physician Fee Schedule final rule fact sheet (G2211)
- CMS MM14315, CY2026 Physician Fee Schedule final rule summary
- CMS Medicare Claims Processing Manual, chapter 12, physicians and non-physician practitioners
- CMS MM13064, hospital inpatient or observation care and split or shared visits
- CMS change request 12604, split or shared visits from 2024
- CMS 2026 Medicare Advantage and Part D Rate Announcement fact sheet
- CMS MLN908628, Transitional Care Management Services (August 2025)
- CMS MLN909188, Chronic Care Management Services (June 2025)
Next step
Start with a free RCM audit
The audit takes 48 hours and returns a line-by-line recoverable revenue estimate by payer, plus the repeating root causes behind your denials. We only need aging totals to begin. No patient data, no contract, no obligation to work with us afterward. If your aging is healthy we will tell you that.
Answer three questions below and book a line-by-line audit of your internal medicine claims.
Where is the money leaking right now?
Pick the one that hurts most. We start there.
How old is your oldest unpaid claim?
A round number is fine. We verify it in the audit.
How big is the practice?
Just you, or a group. Either is welcome.
Last bit — where do we send the report?
No patient data. We only need aging totals to start.
(202) 490-9406 · info@quilven.com · Book 15 minutes
Who does the work
Your revenue cycle is run by named people with real credentials, not an anonymous queue. Named leads and their certifications are introduced during onboarding, with photos and direct contacts.
Raief Shick
Owner
A long-time business owner who has built and run companies in recruitment and e-commerce before Quilven.
Haris Khan
Client Partnerships Lead
Leads business development, working with U.S. healthcare providers and medical practices from first conversation to signed agreement.
Essa Khan
Head of Growth
Runs Quilven's marketing, SEO and Google Ads. Full-time in SEO since 2022.
Steven Tyler
Client Solutions Director
Works with medical practices on denials, credentialing and full-cycle revenue cycle work. A registered nurse before moving into revenue cycle.
Behind every account
Dedicated account manager
One person owns your account, knows your practice and is your single point of contact.
AAPC-certified coders
Coders holding CPC and COC credentials, with coding experience across the specialties we serve.
Credentialing specialists
Provider enrollment and recredentialing, handled by people who work payers and panels every day.
AR and denial analysts
Analysts who work aged AR and appeals on a set cadence, by code, until each claim resolves.