Reference guide to billing and reimbursements for telehealth

Delivering care via telehealth is an important part of keeping up with innovation and patient demand for many independent healthcare practices. With the right telehealth platform, seeing patients via synchronous video is both easy and efficient. But the requirements and regulations surrounding telehealth can be anything but.

Whether you’re new to virtual care, keeping up with changes to requirements, or both, below are must-have references for practices.

The following online resources are valuable for practices that deliver virtual care. 

The AMA Quick Guide to Telehealth

Topics include an overview of telehealth services, practice implementation and workflow, policy, coding, and payment.

Medicare Provider Fact Sheet

The Centers for Medicare & Medicaid Services (CMS) breaks down revised Medicare coverage and payment of virtual services, following the expansion of telehealth with the updated 1135 waiver. This includes how telehealth visits are defined and covers other online communications with patients.

State approaches to telehealth

The Center for Connected Health Policy (CCHP), a key resource of telehealth regulations, tracks coverage policies and state-by-state changes as they occur, and has updated its findings on a daily basis when warranted. Its policy summaries as of 2023 include changes to: 

Their summary of state actions includes individual links to each state, making it easy to access yours in greater detail.

CMS fact sheet: Expansion of accelerated and advance payments program

CMS has expanded eligibility for providers at outpatient practices to apply for 3 months of advance Medicare payments. This fact sheet outlines who can apply and how to request payment.

Medicaid FAQs

This list of FAQs answers inquiries about how state agencies can manage telehealth regulations per state for Medicaid and commercial payers.

This information includes Medicaid telehealth reimbursement, private payer laws, parity laws, and professional regulations.

Medicaid approach to telehealth

This Medicaid-published resource can help states understand policies related to paying Medicaid healthcare providers who deliver virtual care.

Regardless of your state, specialty, or payer mix, we recommend each practice reach out to your state board or association, and commercial payers to confirm expected reimbursements and any necessary billing requirements. For efficiency, it’s best to begin with payers who cover the highest percentage of your patient base — and refer to the resources above as a head start.

Telehealth is a cost-effective model for your practice. It’s also an easier method of obtaining basic healthcare for many in our society, from parents with children to the elderly who can’t easily get around.

When you offer your patients access to telehealth, you broaden the demographic that you can treat and have a convenient method to track what you need to bill payers.