Hospitalist billing for hospital medicine groups and the physicians and advanced practice providers in them: admissions and observation stays, daily visits, discharges, critical care, and split/shared visits between physicians and nurse practitioners or physician assistants, captured from every hospital you cover.
A hospitalist group gets paid for each encounter its clinicians record during a stay. Admissions, daily visits and discharges are coded from the decision making or time in the note, split/shared visits go out under the clinician who did the substantive portion, critical care is billed by Medicare’s minutes, and charges from every facility are reconciled against the census so none are missed.
$141M
in improper Medicare payments to hospitalists in CMS’s 2025 review, a 13.1% improper payment rate
49.3%
of those hospitalist errors were incorrect coding, the largest single error type
Hospitalists bill only professional services, so every dollar comes from evaluation and management codes. The level of each visit has to match the note, a physician and a nurse practitioner seeing the same patient on the same day can bill only one visit between them, and Medicare counts critical care and prolonged time differently from CPT. Charges are also easy to lose: a patient admitted overnight and discharged by another clinician can leave a gap in the stay.
The note and the census decide the claim. That is why we match each day’s charges to the hospital census and check each visit’s level and billing clinician before the claim goes out.
A hospital stay produces several kinds of claims, each with its own rules about who bills, at what level and how often. Below is where each one goes wrong, and how we handle it.
Pays forInitial hospital and observation care, same-day admission and discharge, and the admitting physician’s role.
Where it breaks
What we do
Pays forSubsequent hospital visits by physicians and advanced practice providers, including visits they share.
Where it breaks
What we do
Pays forCritical care time, prolonged hospital care and discharge day management.
Where it breaks
What we do
When a physician and a nurse practitioner or physician assistant from the same group both see a hospital patient on the same day, Medicare pays one visit, billed by whoever performed the substantive portion. Since 2024, the substantive portion means more than half of the total time the two spent, or a substantive part of the medical decision making. Billed under the physician, the visit is paid at the full rate; billed under the advanced practice provider, it is paid at 85%.
Every split/shared visit needs modifier FS, and the note has to show who did what. The rule applies in the hospital and other facility settings, not in the office, and it also covers critical care, where the two clinicians’ minutes are added together.
What we do: for each shared visit, we read both clinicians’ notes, add their time, decide who performed the substantive portion, and bill the visit once under that clinician with FS. When the notes do not show it, we ask before the claim goes out.
Hospital medicine runs on a small set of visit codes, each with a time or decision-making threshold and a payer-specific twist. These are the ones behind most hospitalist claims.
| Code | What it covers | What payers look for |
|---|---|---|
| 99221 to 99223 | Initial hospital or observation care | The documented decision making or time; AI for the admitting physician on Medicare claims. |
| 99231 to 99233 | Subsequent hospital or observation care | One visit per day for clinicians of the same group and specialty. |
| 99234 to 99236 | Admission and discharge on the same date | Medicare: only for stays of eight hours or more. |
| 9923899239 | Discharge day management | 99239 needs more than 30 minutes documented. |
| 9929199292 | Critical care, first 30 to 74 minutes and each additional 30 | Medicare: 99292 only once total time reaches 104 minutes. |
| G031699418 | Prolonged hospital care | G0316 for Medicare, with its own time threshold; 99418 for plans that accept it. |
| 99497 | Advance care planning | Time documented; can be billed with a hospital visit on the same day. |
| 99252 to 99255 | Inpatient consultations | Commercial plans that pay them; not Medicare. |
Only on the admitting physician's initial hospital visit.
Required on every visit shared by a physician and an advanced practice provider.
A service furnished in part by a resident under a teaching physician's direction.
A visit unrelated to another same-day visit or to a procedure's global period.
Hospital visits by video, for plans and dates that allow it.
Sources: Medicare Claims Processing Manual, chapter 12, sections 30.6 (evaluation and management) and 30.6.12 (critical care); CMS CY 2023 and CY 2024 Physician Fee Schedule final rules. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, visit levels, split/shared billing, critical care time and census reconciliation, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list each hospital you cover and how charges are captured there, and agree how escalations work. Most practices are live within one to two weeks.
Admissions, daily visits and discharges are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, census matched, billing clinician and time thresholds checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Hospitalist revenue is a high volume of evaluation and management claims, and missed charges are the biggest risk. Paying a billing company a share of collections means its fee grows only when more of those encounters are captured and paid.
Summit Billing Solutions charges between 3% and 9% of monthly collections. Your rate depends on encounter volume, the number of hospitals you cover, how charges are captured at each, and the state of the receivables, which we see in the free account review.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, visit levels, split/shared billing, critical care time and charges against the census, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Dr Ste 3, Salem, NH 03079-4827
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
Mon - Fri @ 9am - 5pm
