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Understanding and Maximizing Reimbursement with Telehealth & Telemedicine


The use of telemedicine visits skyrocketed to become the default in most clinics when worries about spreading COVID-19 at in-person clinics shut down most medical offices during the spring of 2020.

Prior to that, many providers were hesitant to adopt telemedicine and telehealth widely in their practice because the landscape for reimbursement was uneven, difficult, and confusing. Different payers offered different reimbursement rates for various types of telemedicine and telehealth visits, while others (including some of the country’s largest payers, Medicare and Medicaid) excluded almost all telemedicine visits from reimbursement. Luckily they have revised those requirements to reimburse for most types of visits, a move that providers and patients hope will stick around post-pandemic.

Changing Reimbursement Models

Fortunately, as COVID-19 made face-to-face visits impossible and unsafe, more payers got on board with expanding the types of patient visits eligible for reimbursement, and the reimbursable rates. We hope that payers will continue to offer more access to care through telemedicine and reimburse it at a fair rate to account for the provider’s time, but it’s still important to understand how you can maximize it in your practice.

  • Learn what’s covered and what’s not with each payer so your scheduling team can offer telemedicine in appropriate situations, and ensure that patients come in for face-to-face visits when it’s something that isn’t eligible for telemedicine reimbursement. Consider making “cheat sheets” or hints that help providers, schedulers, front office staff, and medical billing staff meet all the requirements for each payer.
  • Verify patient coverage prior to the appointment to avoid denied claims on the basis that a telemedicine appointment isn’t covered or the patient isn’t eligible.
  • Create templates in your EHR that meet documentation requirements. Telemedicine visits may require different information than in-person encounters, and proper documentation can reduce or eliminate rejected claim submissions. Putting it in your EHR as a template takes the burden off your provider to try and remember all the different information that each payer and each visit type needs.
  • Train billing and coding staff on the differences between in-person and telemedicine billing. If you have a big enough staff you can have certain team members specialize in telemedicine or telehealth billing codes. You can also consider outsourcing to a medical billing service with the right expertise in telemedicine coding to avoid errors that result in lost revenue.
  • Use software that seamlessly connects everything from scheduling to EHR to billing to facilitate the transfer of patient information and improve accuracy.

Get the Right Tools for Your Small Practice

Running a small clinic means you need software specifically geared toward your needs. Software programs built for large hospital systems or multi-location physician clinics often don’t meet the needs of an independent practitioner or a small group. Find out more about how AdvancedMD can improve your medical billing with telemedicine and telehealth today.

Topic: Telemedicine

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