Hi Reader

Weeks 1 and 2 of this series were about friction — the diagnosis, then the patient experience gaps quietly costing you rebookings.

This week is about the money.

Telehealth billing isn't the same as it was when most of you first set it up. Modifiers, place-of-service codes, and payer Telehealth policies have all shifted — some as recently as this year. A setup that was correct in 2021 can be quietly wrong today, and most practices haven't rechecked it since it was first configured.

Here are five specific things worth checking this week — not hypothetical, the actual gaps I see most often.

1. Check your modifiers — 95 vs. GT, and whether either is still right. A lot of practices are still using whatever modifier they set up years ago without checking if it's current for their top payers. Modifier requirements vary by payer and have changed more than once since 2020. Pull your last 10 Telehealth claims and confirm the modifier matches what your top payer's current policy actually asks for — not what it asked for two years ago.

2. Place-of-service code: 02 vs. 10. These two get mixed up constantly, and most clearinghouses won't catch it for you. 02 and 10 mean different things — one is Telehealth not at the patient's home, the other is specifically the patient's home — and payers increasingly reimburse them differently. Getting this backwards on even a handful of claims can mean underpayment you'd never notice without checking.

3. Know your audio-only rules, specifically. Some payers still reimburse audio-only visits differently than video, and the pandemic-era flexibilities that used to cover this more loosely have been narrowing. If any part of your practice still does phone-only visits, don't assume the old rules still apply — check your top payer's current audio-only policy directly.

4. RPM and CCM: recurring revenue most practices already qualify for and never bill. If you're doing between-visit work — checking in on patients, reviewing data, adjusting care — without billing for it, Remote Patient Monitoring and Chronic Care Management exist specifically to pay you for that. It's rarely a new service. It's usually paperwork and workflow layered on top of what you're already delivering. Worth 20 minutes this week to see if you qualify.

5. Track telehealth denials separately from your general AR. If you lump virtual-visit denials in with everything else, you'll miss the pattern. Payer telehealth policies are inconsistent and change without much notice — a denial reason that shows up three times in a month is a policy problem, not a fluke, but you'll only catch it if you're looking at telehealth claims on their own.

None of these require a new biller, a new system, or a new spend. They require twenty minutes and a willingness to check something you probably haven't looked at since it was first set up.

This week's action item: pull your last 20 telehealth claims and check the modifier and place-of-service code on each against your top payer's current policy. That one exercise catches most of what's on this list.

If you want a second pair of eyes on where your billing setup stands, that's exactly what my free 15-minute audits are for — no pitch, just an honest read.

Connect with me on LinkedIn for more Telehealth tips all week long and don't miss next week's Final Tip in the Series -

Thanks for reading,

— Dan

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Also: Want to go back and look at our previous Telehealth Tips? Click Here​