According to the National Center for Health Workforce Analysis, the United States will experience a shortage of over 20,000 internal medicine physicians by 2038. While this gap represents an opportunity for internal medicine providers to expand their practices and meet patient needs, it will also bring about new challenges.
Internal medicine revenue cycle management is one of the chief barriers between smooth operations and long-term growth. The unique billing and coding complexity in IM practices can lead to bottlenecks within your RCM workflows that delay revenue. Poor RCM hurts your margins, stifles growth, and places strain on your staff.
Here’s how internal medicine providers can overcome these challenges and capitalize on growth opportunities with healthcare revenue cycle management solutions.
RCM includes the full financial life cycle of patient care. It begins the moment a patient books an appointment and continues until final payment is posted.
Compared to other specialties, internal medicine revenue cycle management can be more complex due to frequent visits and overlapping services. IM practices also face heavier documentation burdens.
To improve internal medicine RCM, you’ll need to assess the following stages:
Each step impacts how quickly you can resolve RCM claims. Small breakdowns early in the process can create downstream issues that prevent you from collecting revenue on time.
Common pain points that occur in internal medicine revenue cycle management include:
For example, your practice may encounter higher denial rates on E/M visits due to insufficient documentation for high-complexity patients. Overlapping preventive and problem-focused visits are another common headache that you must address to make internal medicine RCM more efficient.
Common internal medicine revenue cycle management headaches include these specific challenges.
Internal medicine revenue cycle management involves taking in a large volume of E/M service claims. These visits are often at Level 4 or 5 due to the complexity of patient cases. While the visits may be clinically justified, they face more intense scrutiny from payers on the grounds of medical necessity and documentation sufficiency.
Even minor inconsistencies in your billing documentation can trigger denials or force downcoding, which leads to revenue leakage. This leakage can be hard to detect if your practice lacks strong RCM analytics tools. If you can’t find where you are leaving money on the table, you’ll be unable to resolve the problem.
Coding rules change frequently, and internal medicine spans a broad range of diagnoses. Your billing team must stay current with the latest CPT and ICD updates. This is a shared responsibility that requires you to provide ongoing education and auditing.
Manual solutions alone won’t keep your practice running smoothly. You need automated support to avoid undercoding and overcoding issues. Otherwise, you may miss billable services entirely. These errors compound over time and erode your margins, which may already be razor-thin.
Internal medicine RCM involves managing both chronic care and value-based care models, each of which relies on different sets of commonly used codes. For example, underbilling or submitting the incorrect documentation for CPT 99490 (Chronic Care Management) can lead to lost revenue for your practice.
Your billing team needs the support of automated tools to help categorize visits by type (i.e., value-based or CCM) so that they can apply the appropriate set of codes. Once visits are properly classified, you can more easily flag issues and add supporting documents to increase first-pass acceptance rates.
Do you have a clear view into how different payers reimburse for the same services? Many practices lack this insight, which means that underpayments go unnoticed and trends are hard to spot. This makes it difficult to challenge payers or improve contracts.
Integrating automation into high-friction RCM steps and reimbursement workflows can provide the insight required to hold payers accountable. You can identify underpayment trends and level the playing field during contract negotiations.
Denials in RCM are often the result of incomplete data, a lack of visibility, and overreliance on manual processes. To resolve these challenges, you need to reduce manual work and increase visibility into the entire revenue life cycle.
Automating eligibility checks and prior authorization workflows helps you prevent avoidable denials before care is delivered. When your employees know coverage details up front, they can manage expectations for patients and avoid billing surprises that diminish your reputation.
Improving coding accuracy is another critical step. Smart tools that audit documentation and flag missed codes help ensure that services are fully and correctly captured. For example, tools that flag missed HCC codes can help your practice optimize for risk-adjusted payment models.
Next, begin tracking payer performance and denial trends with analytics tools. Use these solutions to improve patient cost transparency. Modern RCM solutions allow you to provide accurate estimates for follow-up labs, same-day procedures, and ECGs, which increases upfront collections.
Want to learn more? Download a free ebook from Rivet, such as Conquering RCM’s Everest or Unlock a Denials Prevention Engine.
Are you ready to adopt a revenue cycle management platform for your IM practice? Here’s what to look for:
Sign up for an upcoming live webinar or view an on-demand webinar to learn more about RCM solutions.
Your internal medicine practice can’t thrive in the current healthcare environment without modern RCM tools. With Rivet, you can spot underpayments and automate claim follow-ups. Our platform also provides real-time contract comparisons to give you leverage during negotiations.
Schedule a demo with Rivet to explore our revenue diagnostic tools.
