Despite all the information about telehealth (TH) published and available since the Spring of 2020, misconceptions and misunderstandings still exist and can be costly in lost revenue and billing error recoupments. CMS has published a very comprehensive guide to TH for providers – with tons of external links for more info – and below are some handy tips and ideas.

  • Appropriateness for TH varies and it can be less useful for certain types of complaints, such as abdominal, eye, GYN and dental. In addition, any situation in which a physical exam would change your recommendations is not ideal for a TH encounter.
  • Your patient portal may already have some TH functionality built in; check it out. Otherwise, consider these questions when evaluating a TH platform: does it protect PHI? Do you or the patient need special equipment? Do patients need to download an app before the visit? Is the information encrypted?
  • During the pandemic, HHS temporarily allowed providers to use Apple Face Time, Zoom, Skype, etc., which are non-public facing. Tik Tok, Facebook Live and other public-facing tech cannot be used. Since it seems some form of TH will remain after the public health emergency, it’s advisable for providers to use this time to research a more secure platform. You can monitor updates from HHS here.
  • Establish (or refine) your TH workflow and protocols. After a year of TH, you probably have a sense of what works and what needs tweaking. Some things to consider are: how you’ll support patients with disabilities (visual or hearing) for whom some TH platforms may not be successful; how easily can your M.A. greet the patient and conduct screenings, etc. before you see the patient; how to obtain consent for the TH visit; obtaining payment after the visit; and more.
  • Page 8 of the document lists great tips for all aspects of the visit, from how to prepare for it, how to establish rapport with a new patient, outlining the session so patients know what to expect and what the patient can do if he loses connectivity.
  • Behavioral health seems to be widely needed and accepted via TH. The CMS document has a section to help you maximize your BH care, from making sure the patient has a safe space to communicate freely, to paying special attention to voice nuances, tempo, pitch and inflection to get a broader picture of what’s going on.
  • The last section focuses on billing and includes several links to CMS policy memos and an updated list of covered TH services. Remember, for Medicare, use the POS code you would’ve used if the service was provided in person., and use the CPT modifier 95 for TH services provided in real-time.

The new CMS document is a must-read for all providers and their billing staff to make sure you maximize delivery and payment of your TH visits.

Coleman Consulting Group was established in 2001 as a full-service consulting firm, catering to the needs of physician practices. Over the years, our menu of services has evolved into four practice specialties: risk adjusted reimbursement (MRA); medical coding, billing and compliance services; human resources management; home health and nurse registry licensure, accreditation and compliance; and physician practice management. Learn more at