Strategies for making telehealth compliant and profitable.

Was using telehealth a priority for your provider group before COVID? If you are like many practices, it wasn’t even on your radar. The COVID pandemic pushed telehealth to the forefront, and a service that was little more than an afterthought became a lifeline both for practices and patients. A study published by Health and Human Services (HHS) found that over forty percent of Medicare primary care visits were via telehealth in April of 2020, a massive jump from the .1% utilization before the health emergency.

Now that patients and providers have discovered the value of telehealth, it’s here to stay. Many practices are asking how to ensure compliance after emergency health initiatives are lifted and how to optimize the service best as patient volumes return to normal. Here are our top tips and strategies to maximize telehealth after the pandemic.

Cover your legal bases

Check with your malpractice provider to confirm that telehealth visits are covered under your policy after the health emergency ends. Contact your state medical association or society for information about vendors and other state-specific/specialty information. Often telemedicine is only payable if the patient is in the same state as the provider. Confirm individual payer policies about telehealth visits in general and any out-of-state restrictions.

Determine which services offer the most value in terms of time and convenience

If your office has been using telehealth services during the pandemic, you most likely already have a good idea of where they are most effective. However, there may be other services to offer. An excellent guide to finding additional services can be found in available telemedicine codes.

Analyze the profitability of telehealth

First, check payer fee schedules to find reimbursement rates. Then, determine the costs associated with utilizing telehealth. Be sure to include expenses related to any software or hardware, labor for providers and support staff, and any miscellaneous costs such as office space rental and furniture. After you have worked out roughly how much visits cost to conduct, take another look at your fee schedules to determine which visits are in your practice’s best interest. After analyzing the data, you may see that certain visits are profitable for some payers and not others. Analysis will tell you where to continue providing or expanding services, and which ones to limit.

Decide which patient populations can access telehealth

In the interest of creating a provider-patient relationship, some practices may want to consider seeing only established patients virtually after emergency measures have been lifted. There may be other patient populations that may benefit more from in-person rather than virtual visits.

Optimize your telehealth schedule

According to the HFMA, the average primary care physician sees about 12 patients per 4-hour shift. “With telehealth, physicians may be able to ‘see’ 16 or more patients in that timeframe.” Consider assigning different time values to telehealth visits. Also, consider blocking off certain times per day for low-level same-day visits or routine check-ins, or even create virtual visit shifts for providers. Switching back-and-forth from in-person to virtual visits slows down efficiency which will impact profitability.

Confirm telehealth coding and payer payment policies

Invest in telehealth training for your coders to ensure you are capturing all available revenue. Many professional organizations have issued guidelines, such as the American Academy of Pediatrics and the American Psychological Association. Be sure that documentation meets payers’ standards by reviewing their telemedicine policies.

The future of telehealth

Telehealth technology and policies will continue to evolve. As they do, an exciting subset of telehealth is Digital Health Technology (DHT). DHT devices gather health information from the patient and electronically transmit data to the provider. Strides are being made in hypertension and other disease management, and DHT has the potential to bring telehealth to a whole new level. If you are soon investing in a telehealth platform or EHR, the potential for integration of DHT may be an important criterion to consider.

Changing telehealth rules and policies can be confusing – using the right partner for electronic health, practice management and billing software makes it easy. Contact us today at (412) 424-2260 or visit to learn how we can help you optimize telehealth visits, streamline claims, and maximize revenue.