Efficient Telehealth Billing: Best Practices to Streamline Claims with expEDIum

Is your clinic offering telehealth services — but struggling with delayed reimbursements, frequent denials, or billing bottlenecks? You’re not alone. With the rapid rise in virtual care, many providers face a steep learning curve when it comes to billing correctly and getting paid on time.

Telehealth isn’t just a convenience for patients — it’s a revenue stream. But improper documentation, inconsistent coding, or lack of payer-specific workflows can turn that stream into a drip. In this post, we look at how to build a robust telehealth billing process — one that minimizes denials, accelerates cash flow, and ensures compliance — from the perspective of expEDIum’s billing expertise.

Why Telehealth Billing Needs Its Own Strategy

Telehealth billing is fundamentally different from traditional in-person billing. Some of the unique challenges include:

• Different billing codes and modifiers (e.g., place-of-service codes, telehealth modifiers)
• Documentation requirements (patient consent, audio/video logs, encounter notes)
• Payer-specific rules — which vary widely between insurers or across geographies
• Increased scrutiny and audit risk, especially if documentation is incomplete or inconsistent

As telehealth becomes a mainstream mode of care — seen widely across specialties including mental health, chronic care management, follow-ups, and remote monitoring — the number of claims processed via telehealth is rising steadily. A recent estimate puts telehealth services at over 20% of outpatient encounters in 2025, up from negligible levels pre-2020.

But with volume comes vulnerability: a single missed modifier, wrong place-of-service code, or vague documentation can result in denials, delayed payments, or even compliance issues.

Common Mistakes in Telehealth Billing That Lead to Denials and Delays

1. Incorrect Coding or Missing Modifiers / Place of Service (POS) Codes
   The most frequent cause of telehealth denial is incorrect coding — especially wrong POS codes or missing modifiers. Some practices continue using in-person codes when billing telehealth, triggering immediate rejections. According to billing industry surveys, up to 20% of telehealth claims are denied on first submission due to coding mistakes or incomplete documentation.

A denial at the first submission means delays, extra administrative effort for rework, and revenue leakage — especially harmful for small to mid-size clinics.

2. Insufficient Documentation to Support Telehealth Encounters
   Telehealth visits may require different documentation than in-person visits — such as signed consent, logged duration, audio/video session records, and detailed Progress Notes that justify medical decision-making (MDM), especially if using time-based billing. Without proper records, insurers often reject claims, or in audits, flag them for denial.
3. Lack of Payer-Specific Workflows and Inconsistent Internal Processes
   Not all payers treat telehealth the same — some may reimburse at parity with in-person visits; others may reimburse less, or impose stricter documentation requirements. Failing to adapt your billing workflows accordingly (for example, not using right modifiers, not checking payer guidelines, or submitting generic claims) often leads to delays or rejections.
4. Manual, Inefficient Claim Submission & No Pre-Submission Checks
   Relying on manual billing processes, without thorough scrubbing or validation, increases the chances of simple human errors: wrong patient info, missed CPT codes, outdated insurance data, etc. Such mistakes often translate into denials or requests for correction — costing time, resources, and revenue.
5. No Denial Management or Regular Audits
   Without a system to track denials, reasons, and resubmissions, clinics lose visibility into recurring issues — and often fail to appeal valid claims. Over time, this leads to accumulated revenue leakage and inefficient billing cycles.

Building a Robust Telehealth Billing Process — Best Practices

Here are proven steps to streamline telehealth billing and protect your revenue flow:

• Develop a Payer-Specific Billing Matrix
  Create a cheat-sheet for every payer that details accepted CPT codes, POS codes, modifiers, documentation requirements, and reimbursement parity. This ensures each claim is tailored correctly before submission.
• Standardize Documentation Templates for Telehealth Visits
  Use structured templates for telehealth encounters — capturing consent, time spent (if time-based), MDM justification, patient acknowledgment — to meet payer documentation standards. Train clinicians and staff to populate these consistently after every virtual session.
• Automate Claim Scrubbing and Pre-Submission Validation
  Before sending claims, use software or checklist-based workflows to validate entries: correct CPTs, modifiers, POS, patient demographics, insurance eligibility, and required documentation attached. Automation or an experienced billing team reduces manual errors significantly.
• Implement a Denial-Tracking & Appeal Workflow
  Log all denials with reason codes, track appeals, and use data to identify patterns (e.g., repeated coding mistakes, payer-specific trends). Use this insight to refine internal workflows and prevent future errors.
• Stay Updated on Telehealth Billing Policies and Code Changes
  Telehealth guidelines evolve quickly — new CPT codes, modifiers, POS rules, and payer policies emerge regularly. Stay updated so your billing stays compliant and optimized.
• Leverage Outsourced RCM or Expert Billing Support (If Volume Justifies It)
  For practices with high telehealth volume or limited billing bandwidth, outsourced Revenue Cycle Management (RCM) — like what expEDIum offers — can plug gaps in internal expertise, reduce administrative burden, and ensure professional handling of claims, appeals, and payer relations.

The Cost of Inaction — Why Efficient Telehealth Billing Matters

When telehealth billing is inefficient or error-prone, the consequences are more than just delayed reimbursements. They include:

• Strained cash flow, affecting operations and investments
• Increased administrative workload and burnout for staff
• Reduced patient trust due to billing delays or disputes
• Opportunity cost — every rejected or delayed claim is lost revenue that could have funded better care or expansion

Given that telehealth outpatient encounters now account for a significant portion of overall visits, these inefficiencies can add up fast.

But good billing — done right — boosts revenue, reduces overhead, and enables clinics to grow their telehealth services sustainably.

How expEDIum Approaches Telehealth Billing Differently

At expEDIum, we recognize that telehealth is here to stay — and billing for it requires as much strategy as delivering care. Our approach involves:

• Building payer-specific workflows;
• Using automated claim-scrubbing tools;
• Ensuring structured documentation and compliance;
• Tracking denials and appeals as part of a continuous improvement cycle;
• Providing transparency and support to clinics so they can focus on care, not paperwork.

We never treat billing as a side-task — but as a core function that sustains your practice’s financial health.

Telehealth offers remarkable convenience and reach — but only if paired with smart, efficient billing practices. By treating billing as a priority rather than an afterthought, clinics can avoid common pitfalls, minimize revenue leakage, and build a sustainable virtual care model.

If you’re running telehealth services and want to streamline your billing, reduce denials, and ensure consistent reimbursements, expEDIum is ready to help. Reach out to learn how we can support your practice’s telehealth billing needs — so you can deliver care with confidence and financial clarity.