Coding, claims and collections for independent hospitalist groups, hospital medicine programs, nocturnist teams and post-acute rounding practices, inside the systems you already run.
Hospitalist revenue leaks between the census and the claim: a patient seen on rounds whose signed note never became a charge, a high-MDM admission billed as 99222, prolonged time past 90 minutes with no G0316, or a split or shared visit sent without modifier FS. One missed 99232 is $70.48 at 2026 Medicare national facility rates, and it repeats every day of the stay. Luxen matches your census to billed encounters, codes each note to documented MDM or time, and works denials inside the hospital systems your physicians already use.
On this page
Hospitalist billing services code and collect for hospital inpatient and observation care: admissions and daily visits (99221 to 99233), discharges, same-day stays, critical care, prolonged care and split or shared visits with NPs and PAs. In 2026 Medicare pays a national $156.32 for a high-level initial hospital visit (99223) before geographic adjustment.
A hospitalist is a physician, NP or PA who cares for hospitalized patients instead of an office panel. Medicare has recognized hospitalist as a physician specialty, code C6, since April 1, 2017. Each hospital medicine model bills differently.
Critical care, G0316 prolonged care, discharges and transitional care management, run by our full-service medical billing team, plus balances patients owe after insurance through patient billing.
Hospitalist revenue is lost where the census, the note and the claim disagree. Dollar figures are 2026 Medicare national facility rates at the $33.4009 conversion factor, before geographic adjustment.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Patient seen, note signed, no charge entered | 99231 to 99233 | The census encounter never reaches a claim | $70.48 per missed 99232 | Census matched to billed encounters by date |
| High-MDM admission billed one level low | 99223, 99222 | Level set by habit, not documented MDM or time | $39.42 per Medicare claim | Admission notes re-leveled against MDM and total time |
| Prolonged care documented, not billed | 99223, G0316 | Total time past 90 minutes never reported | $27.72 per G0316 unit | Time statements checked against Medicare thresholds |
| Admitted and discharged the same date after 8+ hours | 99236, 99223 | Billed as initial care only | $33.40 per stay | Admit and discharge times compared for each stay |
| Patient became critical during a daily visit | 99291, 99233 | Critical care time billed as a subsequent visit | $92.19 per claim | Critical care minutes pulled from the note |
| Physician-led shared visit billed under the NP | 99233, modifier FS | Substantive portion ignored, paid at the 85% NPP rate | $16.03 per visit | Substantive portion checked before release |
Since January 1, 2023, CPT uses one code family for hospital inpatient and observation care; observation codes 99217 to 99220 and 99224 to 99226 are deleted. Each visit is leveled by medical decision making (MDM) or total time on the date of the encounter. Our certified medical coding team checks every note both ways. Rates are 2026 Medicare national facility amounts.
| Code | Service | MDM level | Time met or exceeded | 2026 national rate |
|---|---|---|---|---|
| 99221 | Initial hospital care | Straightforward or low | 40 min | $74.48 |
| 99222 | Initial hospital care | Moderate | 55 min | $116.90 |
| 99223 | Initial hospital care | High | 75 min | $156.32 |
| 99231 | Subsequent hospital care | Straightforward or low | 25 min | $44.09 |
| 99232 | Subsequent hospital care | Moderate | 35 min | $70.48 |
| 99233 | Subsequent hospital care | High | 50 min | $106.88 |
| 99234 | Same-day admission and discharge | Straightforward or low | 45 min | $88.18 |
| 99235 | Same-day admission and discharge | Moderate | 70 min | $142.96 |
| 99236 | Same-day admission and discharge | High | 85 min | $189.72 |
| 99238 | Discharge day management | Not used | 30 min or less | $74.82 |
| 99239 | Discharge day management | Not used | More than 30 min | $106.55 |
99239 needs more than 30 minutes of discharge day management on the date of the encounter. Without a time statement the note supports 99238, $31.73 less. 99239 was billed without a documented discharge time over 30 minutes on 9% of discharge claims (Luxen claim audit).
A visit is initial only when no physician or NPP of the same specialty in the same group has seen the patient during the stay. The principal physician of record adds modifier AI. Medicare pays one hospital visit per practitioner per patient per calendar date, even for unrelated problems.
When a hospitalist and an NP or PA in the same group both see a patient, whoever performs the substantive portion bills with modifier FS. Since 2024 the substantive portion is more than half of the total time, or a substantive part of the MDM. When an NP or PA bills under their own NPI, Medicare pays 85% of the physician fee schedule amount. Modifier FS was missing on 12% of split or shared hospital visits, across 7,900 hospitalist claims (Luxen claim audit).
Medicare does not pay 99418. It pays G0316, a 15-minute add-on, when the primary visit was selected by time and total time passes these thresholds:
| Primary visit | CPT time | First G0316 at | Time counted |
|---|---|---|---|
| 99223 | 75 min | 90 min | Date of visit |
| 99233 | 50 min | 65 min | Date of visit |
| 99236 | 85 min | 110 min | Date of visit to 3 days after |
G0316 pays $27.72 per unit at the 2026 national facility rate.
99291 covers the first 30 to 74 minutes and pays $199.07. Medicare pays 99292 ($100.20) only once total critical care time reaches 104 minutes. A significant, separately identifiable hospital visit earlier the same day is billed with modifier 25. Split or shared critical care carries FS, with 99292 added at 104 cumulative minutes.
Medicare pays same-day visits by physicians in different specialties when each handles a different aspect of care and the claims carry different diagnoses. Medicare has not recognized consultation codes since January 1, 2010, so consultants bill initial care, 99221 to 99223, without modifier AI.
Hospital visits use the same codes either way. Place of service 21 is inpatient; observation is typically billed at 22, on-campus outpatient hospital. Under the two-midnight rule, inpatient admission is generally appropriate when the admitting physician expects hospital care to cross two midnights (42 CFR 412.3).
Under Method II, a critical access hospital bills the reassigned professional services of its physicians and practitioners, and Medicare pays 115% of the fee schedule amount (42 CFR 413.70). A 99223 at the 2026 national rate becomes $179.77. Groups covering rural hospitals in Wyoming medical billing and Montana medical billing markets need to know which facilities elected Method II before building a claim.
At an in-network hospital, an out-of-network hospitalist cannot use notice and consent to balance bill, because federal rules list items and services provided by hospitalists and intensivists as ancillary services (45 CFR 149.420). The patient owes in-network cost sharing.
Each hospitalist needs privileges at every hospital and enrollment with every payer before claims pay, and Medicare Part B claims must be filed within 1 calendar year of the date of service. Medicare lets you enroll hospitalists under specialty code C6. Credentialing lapses delayed payment for 1 in 12 providers added in the prior year (Luxen billing reviews). Our provider credentialing team tracks privileges and payer enrollment by hospital.
Medicare stopped recognizing consultation codes on January 1, 2010, and does not recognize inpatient consults 99252 to 99255 (CMS MLN006764). A consultant bills initial hospital care, 99221 to 99223. Each consult code denies and must be rebilled before the filing limit. Coding and modifier errors caused 21% of denials (Luxen claim audit).
Medicare does not pay 99418 for hospital visits; it pays G0316, starting at 90 minutes with 99223, 65 minutes with 99233 or 110 minutes with 99236 (CMS MLN006764). Each rejected 99418 leaves $27.72 per unit unpaid. 99418 was billed to Medicare instead of G0316 on 8% of prolonged care claims (Luxen claim audit).
Observation codes 99217 to 99220 and 99224 to 99226 were deleted on January 1, 2023, and observation and inpatient visits now share 99221 to 99239 (AMA 2023 E/M guidelines). A rejected claim resent without correction becomes a duplicate. Duplicate claim denials made up 9% of denials, mostly from resubmitting instead of correcting (Luxen claim audit).
The practitioner who performs the substantive portion, more than half of total time or a substantive part of the MDM, bills the split or shared visit with modifier FS (CMS CY 2024 PFS final rule). A physician-led 99233 billed under the NP loses $16.03; an NP-led visit billed under the physician is an overpayment. Modifier FS was missing on 12% of split or shared hospital visits (Luxen claim audit).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
We work inside the hospital and practice systems your hospitalists already use. No migration and no new screens for physicians.
We sign the BAA before access and bill from the census, ADT feed, signed notes and remittances your group already receives.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Luxen billing reviews, 410 practice billing reviews, Jan 2025 to Jun 2026:
Luxen client data, 38 client practices, Jan 2024 to Jun 2026:
Our hospital census and professional billing report never matched. Luxen reviewed 3,100 encounters, identified 186 missing charges, and recovered $64,800 without changing the system our physicians use.
Chief Operating Officer, regional hospitalist group
Initial, subsequent, and discharge services were being corrected after submission because chart status was unclear. Luxen added a discharge reconciliation step that reduced coding changes from 13% to 4%.
Revenue Cycle Director, hospital-based physician practice
Full engagements are written up in our dental practice case study and our ambulance billing case study.
| KPI | Why it matters for hospitalists | Luxen benchmark |
|---|---|---|
| Days in AR | Many small daily-visit claims per stay | Hospitalist groups carried a median 44 days in AR |
| Unworked denials | A $44.09 subsequent visit looks too small to rework | 19% of denied claims were never reworked or appealed |
| Eligibility | Coverage is confirmed after admission, not before | Eligibility and coverage errors caused 24% of denials |
Benchmarks come from Luxen billing reviews (410 practice billing reviews, Jan 2025 to Jun 2026) and the Luxen claim audit (61,400 claims audited, Jan 2025 to Jun 2026). Practices that reviewed AR ageing monthly carried 12 fewer days in AR. Our denial and AR recovery team reports these by hospital, payer and practitioner.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, depending on encounter volume, number of hospitals and payer mix. No setup or exit fee.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Initial and subsequent hospital care (99221 to 99233) | $102,000 | $3,060 | $6,120 |
| Discharges and same-day stays (99234 to 99239) | $24,000 | $720 | $1,440 |
| Critical care and prolonged care (99291, 99292, G0316) | $12,000 | $360 | $720 |
| Post-acute visits (99304 to 99310) | $12,000 | $360 | $720 |
| Total | $150,000 | $4,500 | $9,000 |
| Cost | In-house | Luxen |
|---|---|---|
| Monthly | $11,850 (7.9% of collections) | $4,500 to $9,000 |
| Annual | $142,200 | $54,000 to $108,000 |
| When a biller leaves | Open biller roles took a median 67 days to fill | No gap in coverage |
| Terms | Salaries, benefits and software | Month to month, 30 days notice |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews). This group collects $1.8M a year. Biller vacancy data: Luxen Practice Manager Survey 2026.
| Partner type | Hospital coding depth | Census reconciliation | Reporting | Terms |
|---|---|---|---|---|
| In-house biller | Depends on one person | Often skipped when busy | Built by your staff | Payroll and turnover |
| Generalist billing company | Office E/M focused | Rarely offered | Standard aging reports | Often annual terms |
| Specialty hospitalist billing company | Hospital E/M and critical care | Sometimes included | Varies | Varies, some charge setup fees |
| Hospital or EHR vendor RCM | Built around facility workflows | Tied to the hospital feed | Inside the vendor platform | Tied to the hospital contract |
| Luxen | Certified coders for hospital E/M, critical care and G0316 | Census matched to billed encounters | By hospital, payer and practitioner | Month to month, no setup or exit fee |
For the wider market, compare medical billing companies.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
Hospitalists bill their professional services separately from the hospital facility charges, using codes such as 99223 for an admission and 99238 for a discharge. At an in-network hospital, 45 CFR 149.420 treats hospitalist services as ancillary, so an out-of-network hospitalist cannot ask you to waive balance billing protections and you owe only in-network cost sharing.
Luxen charges 3% to 6% of collections, depending on encounter volume, number of hospitals and payer mix. For a group collecting $150,000 a month, that is $4,500 to $9,000. Fully loaded in-house billing cost 7.9% of collections for practices under $2M in Luxen billing reviews.
About 2 weeks from signed BAA to working claims; median time from signed BAA to first claims worked was 9 business days across Luxen clients. We start with unbilled census encounters still inside filing limits, so first recovered payments arrive in about 3 weeks. There is no migration, setup fee or exit fee.
Yes. We work inside the hospital EHR and your group practice management system, including Epic, Oracle Health, MEDITECH Expanse, PatientKeeper and athenaOne. We sign a BAA before access and bill from the census, charge feed and signed notes your hospitals already send.
Yes. CMS allows the same practitioner to report discharge day management (99238 or 99239) and TCM (99495 or 99496) for the same patient. The required TCM face-to-face visit cannot take place on the same day the discharge service is reported.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
Book a Billing Review%20(1).avif)
