Telemedicine / Telehealth
Telemedicine billing requires strict precision because payers apply different rules for audio visual vs. audio only encounters, specific place of service codes (POS 10 for patient at home, POS 02 for telehealth outside the home), and required modifiers (95 for synchronous audio visual, 93 for audio only). We ensure accurate ICD 10 CM diagnosis coding, CPT and HCPCS telehealth coding, correct modifier usage, and compliant E/M level selection across virtual professional fee encounters. Our team reviews documentation for patient identity verification, consent, technology used, time (when applicable), and the exact location of both patient and provider to confirm payer required telehealth elements are fully supported.
Telemedicine denials frequently arise from incorrect POS (10 vs. 02), wrong or missing modifiers (95 vs. 93), incomplete documentation of modality, absent consent, and payer specific restrictions on audio only services. We address these issues by refining telehealth templates, validating payer specific billing rules, and issuing provider queries when clarification is required. Our audits identify missed billable components such as prolonged services, care management codes linked to virtual care, and separately reportable services delivered around telehealth encounters. We reinforce HIPAA compliance, documentation integrity, and payer policy adherence while optimizing pro fee charge capture for virtual visits across IP/OP/ED and office based workflows.