Telehealth Billing Services

Telehealth as the New Norm

Today’s patients increasingly approach healthcare decisions with consumer expectations. They expect experience with convenience in mind, and how they access their care is no exception. Telehealth takes care past the walls of your practice. You can see patients almost anywhere. That widens your reach. It also opens up new ways to run the practice.

A Telehealth Solution Built With Patients In Mind

Telehealth is a beneficial tool to empower patients who may face external hurdles in accessing healthcare. Convenience drives patient satisfaction. Telehealth widens who you can see, and it changes how the visit has to be coded and billed. That part is ours.

Take Your Practice Virtual

Doctor at a laptop reviewing patient records during a virtual visit

What Telehealth Billing Involves

Telehealth is not a separate service line so much as a different set of rules layered over services you already bill, and the rules change by payer, by state and by year. A visit that was payable last quarter can be denied this one because a flexibility lapsed rather than because anything about the care changed.

The four things that decide whether a telehealth claim is paid are the place of service code, the modifier (95, GT, GQ or FQ depending on payer and modality), whether the encounter was audio-video or audio-only, and whether the patient's location is one the plan recognizes. Get the first two wrong together and the claim pays at the wrong rate rather than denying outright, which is worse - it looks fine until an audit.

State law adds a second layer. Payment parity, coverage parity and cross-state licensure all vary, and a provider treating patients in a state they are not licensed in has a compliance problem, not a billing one.

We keep current payer policy per plan rather than a single house rule, code from the documented modality, and check patient location against plan policy before the claim goes out. Where a provider works across state lines we flag the licensure and enrollment gaps before they become recoupments.

Behavioral health carries the most telehealth volume - see mental health billing and credentialing - and enrollment is covered on telehealth credentialing services.

What decides whether a telehealth claim pays

Telehealth billing is not complicated, but it is fussy, and the fussy parts change. Four fields decide most claims.

Place of service

There are two telehealth place of service codes: one for when the patient is at home, and one for everywhere else. They do not pay the same. Some payers pay the home code at the office rate and some do not, so the choice is not cosmetic. Set it per payer in the billing system rather than picking one and using it everywhere.

The modifier

Video visits carry one modifier. Audio only visits carry a different one. Using the video modifier on a phone call is a misrepresentation of the service, and it is easy to find when a payer compares your claims with the platform's records.

Some plans cover audio only for behavioral health and not for anything else. Some cover it for established patients only. Check before the visit, because the patient has already been seen by the time the claim denies.

Where the patient is sitting

For coverage and for licensure, what matters is usually where the patient is, not where you are. A provider licensed in one state seeing a patient who has traveled to another has a licensing problem, not a billing one, and no modifier fixes it.

This is the single biggest risk in a growing telehealth practice, and it grows quietly as patients move.

State law adds a second layer

Payment parity and coverage parity are different things and not every state has both. Coverage parity means the service must be covered. Payment parity means it must be paid at the same rate as in person. A state can require one without the other, which is why a telehealth visit can be covered and still pay less.

Credentialing across states

Being licensed in five states and in network in one is the usual position for a growing telehealth practice. Each state generally needs its own payer enrollment, and enrollment takes longer than licensing. Start both together rather than in sequence.

Neighbouring specialties often share codes, payers and denial patterns. See how we bill for them too, or browse every specialty we bill for.