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Telehealth RCM
Telehealth Billing Services
Revix MD manages the coding, claims, and payer follow-up behind your telehealth visits, so reimbursement does not depend on which modifier someone remembered to attach.
Telehealth Claims Support
Why It Matters
A video visit can be clinically documented correctly and still be denied because the claim contains an incorrect place-of-service code, modifier or payer-specific billing combination. Getting the encounter right clinically and getting it billed correctly are two different things and telehealth is where the two most often come apart.
Telehealth reimbursement is not a smaller version of standard billing. It runs on its own rules and those rules shift by payer, by state and by service line. Medicare, state Medicaid programs, and commercial payers each maintain separate telehealth policies and they do not move at the same pace or land on the same requirements. A practice that treats virtual visit billing as an extension of its normal workflow tends to lose revenue quietly, a few points at a time, until it shows up as an unexplained rise in days in A/R.
Telehealth Revenue Cycle Milestones
The Challenges
What makes telehealth billing harder to get right
Challenge
Details
Payer-specific telehealth policies
Policies that change with little advance notice.
Modifier and place-of-service combinations
Combinations that vary by payer, provider type, modality, and service line, there is no single universal modifier set that applies across all claims.
Documentation
Documentation that has to justify the encounter as clinically appropriate for a virtual format, not just clinically appropriate in general.
State Medicaid telehealth rules
Medicaid rules that differ significantly from one program to the next, since Medicaid gives states broad discretion over covered telehealth providers, modalities and locations.
Technical stoppages
Claims that get stopped on technical grounds, a mismatched POS code, an incorrect modifier before anyone reviews the clinical content.
Split staff focus
Front-desk and billing staff split between patient-facing work and denial follow-up, with telehealth-specific denials easy to lose in the queue.
Our Services
What we handle across the telehealth billing cycle
CPT and HCPCS coding for audio-video and audio-only encounters. The correct code family, modifier and place-of-service entry depend on the payer, the service, the modality and the provider type – including newer telemedicine-specific E/M codes that some payers have adopted and others have not. We verify current payer policy before a claim goes out rather than applying one standard rule across every payer. (See how the AMA structured the newer telemedicine E/M code set.)
Before the visit is billed, we confirm more than general benefit coverage. That includes:
Important Note
Benefit verification confirms the information available from the payer at the time of inquiry – it does not guarantee coverage or payment. CMS maintains a year-specific list of services payable as Medicare telehealth, which we check as part of this step. (Current Medicare telehealth services list.)
Where the patient is physically located during the encounter can affect state licensure requirements and Medicaid coverage, independent of where the provider is based. We check location and licensure alignment before the claim is submitted, since state Medicaid programs set their own rules on covered providers, modalities, and originating locations.
Checking claims against payer-specific edits before submission – POS, modifier and NPI mismatches are caught here, before they become denials.
Telehealth documentation is checked against payer expectations for the format of the visit, not just the clinical content. That includes:
We treat rejections, denials, and underpayments as separate problems with separate workflows:
Rejection
The claim failed before it reached adjudication and needs correction and resubmission.
Denial
The payer adjudicated the claim and declined payment, requiring a payer-specific appeal.
Underpayment
The payer paid, but less than the contracted or expected amount, requiring reconciliation and payer follow-up.
Appeals are filed using the documentation each payer specifically requests for telehealth-related denials.
Matching remits against claims so underpayments and payer errors are flagged rather than lost in the ledger.
Regular reporting built around the metrics that matter for telehealth volume specifically – defined below.
What this does and does not include:
Our telehealth billing service covers professional claims coding, eligibility and service-level verification, claim scrubbing, submission, denial and underpayment follow-up and reporting. If your practice also needs credentialing and payer enrollment, prior authorization management, patient billing and statements, facility claims, RHC/FQHC-specific billing or remote patient monitoring billing, let us know during the billing assessment – we will confirm what’s in scope for your practice before work begins.
Our Process
How a telehealth claim moves through our team
Stage
Details
1. Intake & eligibility
Telehealth benefit and service-level coverage confirmed before the encounter is billed
2. Coding & modifier assignment
CPT/HCPCS code, POS entry and modifier applied based on current payer policy
3. Claim scrubbing
Claim checked against payer edits before submission
4. Submission & tracking
Claim submitted and tracked through adjudication; claims are monitored against defined follow-up intervals, and overdue accounts are assigned for action
5. Payment posting
Remits reconciled against expected reimbursement to flag underpayments
6. Denial follow-up & appeals
Denials worked by root cause; appeals filed with payer-specific documentation
7. Reporting
Clean claim rate, A/R aging and denial trends reported on a regular cycle
Your practice is limited to two things: keeping documentation and encounter details available for our team, and confirming your billing assessment scope up front so nothing falls between “your workflow” and “ours.”
Payer Policy
How We Keep Payer Policy Current
Telehealth policy does not sit still. Medicare updates its telehealth services list annually through the Physician Fee Schedule rulemaking process, and commercial and Medicaid payers issue their own updates on their own timelines. We monitor CMS rulemaking, published state Medicaid telehealth policy, and commercial payer bulletins relevant to your payer mix, and update our claim-scrubbing edits when a policy changes. Material changes affecting your practice are reviewed with your team before they change how a claim is billed.
Active tracking for CMS guidelines, individual state Medicaid guidelines, and top private payer policy schedules.
Compliance & Data Handling
Compliance & Data Handling
We sign a Business Associate Agreement with practices before handling protected health information, apply role-based access so staff only see the data needed for their part of the claim, and follow standard secure access and transmission practices for any PHI that passes through our systems. This aligns with HHS guidance stating that covered entities and their technology vendors must meet HIPAA Privacy, Security and Breach Notification requirements for telehealth, including entering into a BAA where the vendor handles PHI beyond simply transmitting it.
What We Report
What We Report
The percentage of claims accepted on first submission without payer edits or rejections
Claims that clear payer adjudication without requiring resubmission or correction
Denials tied to telehealth policy, modifier, or POS issues, tracked separately from your overall denial rate
The gap between contracted/expected reimbursement and what was actually paid
Average time from submission to adjudication, by payer
The recurring root causes behind telehealth denials for your practice specifically
For telehealth claims, tracked apart from your overall A/R aging where volume allows
Why Revix MD
Why Practices Choose Revix MD
Working knowledge of Medicare telehealth policy, state-specific Medicaid rules, and commercial payer requirements – applied by payer, not treated as one generic rule set.
We work inside your existing EHR and practice management system rather than asking your team to adopt new software.
An assigned billing team that knows your payer mix and specialty, instead of a rotating pool handling your claims.
Claims are scrubbed against payer-specific edits before submission – where most avoidable telehealth denials start.
Reporting on the specific metrics listed above, not vague “regular updates.”
Who We Serve
Specialties where telehealth billing carries the most risk:
Physicians & Primary CareTelemedicine-Only PracticesBehavioral Health ClinicsMental Health ProvidersNurse PractitionersUrgent Care CentersMulti-Specialty Practices
Let's look at where your telehealth claims are losing revenue
A short billing assessment shows you where denials, underpayments, and coding gaps are affecting your practice’s reimbursement.
Frequently Asked Questions
What CPT codes are used for telehealth visits?
It depends on the service, modality, patient status, provider type, and payer. Some payers still use standard office/outpatient E/M codes with a telehealth modifier and place-of-service entry; others have adopted the newer telemedicine-specific CPT code family (98000-98016) introduced by the AMA and Medicare has not treated all of those newer codes as payable. We verify each payer’s current policy before submission rather than defaulting to one code set.
What is the difference between POS 02 and POS 10?
POS 02 indicates the patient was somewhere other than home during the visit; POS 10 indicates the patient was at home. Payers can reimburse each differently, and getting this wrong is a common source of underpayment rather than outright denial.
Do Medicare and Medicaid bill telehealth the same way?
No. Medicare follows federal telehealth policy set annually through the Physician Fee Schedule process. Medicaid telehealth rules are set state by state and states have broad discretion over which providers, modalities, and locations are covered – so what’s billable in one state’s Medicaid program may not be billable in another’s.
What's the difference between a rejected claim, a denied claim, and an underpayment?
A rejection means the claim failed before it reached payer adjudication – usually a technical error. A denial means the payer adjudicated the claim and declined to pay it. An underpayment means the payer paid, but less than the contracted or expected amount. We handle each with a different workflow rather than treating them as interchangeable.
Does verifying eligibility guarantee the claim will be paid?
No. Eligibility verification confirms what the payer’s system shows at the time we check – it reflects the information available at that moment, not a payment guarantee.We adhere to rigorous HIPAA standards and payer-specific protocols to ensure total data security. Our team continuously monitors updates in medical coding and federal regulations.
How do you reduce telehealth claim denials?
We scrub claims against payer-specific edits before submission, so mismatched modifiers, POS codes, or NPIs get caught before they become denials and we keep payer policy edits updated as CMS, state Medicaid programs, and commercial payers change their rules.
Can you work with our existing EHR or practice management system?
Yes. We work inside the systems your practice already uses rather than requiring a new platform.
Is our patient data handled securely?
We operate under a signed Business Associate Agreement, apply role-based access controls, and follow standard secure access and transmission practices for PHI, consistent with HHS guidance on HIPAA and telehealth technology.