The Impact of Telemedicine on Medical Billing Challenges and Best Practices
In 2023, at least 80% of Americans had used telemedicine once in 2023. Just last year, over 116 million preferred virtual consultations, highlighting the growing demand for telehealth.
Once a niche service, telemedicine has become a cornerstone of modern healthcare, reshaping medical billing practices. As virtual care expands, revenue cycle management (RCM) must adapt to address its unique challenges and opportunities.
In this blog, we’ll explore how telemedicine transforms RCM and what healthcare providers need to know to stay ahead.
Understanding Telemedicine
Telemedicine leverages digital technology to provide healthcare services remotely, offering unprecedented convenience and accessibility. Whether for routine check-ups, chronic disease management, or specialist consultations, virtual care eliminates geographic barriers, reduces patient wait times, and enhances healthcare efficiency.
The COVID-19 pandemic accelerated telemedicine adoption, transforming it from a supplementary service to a mainstream healthcare solution.
- In 2019, only 16% of office-based physicians used telemedicine. By 2021, this number surged to 80.5%.
- 74% of millennials favor telehealth appointments, highlighting a major shift toward digital healthcare among younger adults.
- AI-powered tools, such as automated patient triage and remote monitoring, have enhanced virtual care efficiency.
With telemedicine’s rapid innovation and evolution, understanding its impact on medical billing services is crucial for providers to optimize care delivery, streamline billing, and ensure long-term financial sustainability.
Impact of Telemedicine on Medical Billing Practices
As telemedicine continues to expand, which is projected to reach $455 billion by 2030, efficient billing is critical for maximizing revenue and reducing claim denial.
Unlike traditional in-person visits, telehealth involves unique coding requirements, payer policies, and compliance considerations. To optimize revenue cycle management (RCM) in telemedicine, healthcare providers must address these challenges using best practices:
Challenges and Best Practices to Optimize Medical Billing
Challenge 01: Complex Telehealth Coding and Documentation
Best Practice 01: Outsource Telehealth RCM to Experts Utilizing AI-Driven Solutions
Challenge 02: Changing Telemedicine Reimbursement Policies
Best Practice 02: Real-Time Eligibility Verification for Virtual Consults
Challenge 03: Telemedicine Regulatory and Compliance Issues
Best Practice 03: Continuous Staff Training and Policy Monitoring for Telehealth Billing
Challenge 04: Virtual Patient No-Shows and Scheduling Gaps
Best Practice 04: Proactive Scheduling and Patient Engagement in Telehealth
Challenge #1: Complex Telehealth Coding and Documentation
Nearly 15% of all submitted telehealth claims are denied, often due to documentation errors.
As telehealth CPT codes evolve and payer guidelines vary, coding mistakes become more common.
Best Practice #1: Outsource Telehealth RCM to Experts Utilizing AI-Driven Solutions
One of the main reasons is that telemedicine medical billing varies by state, with complex regulations that can be challenging to navigate.
Outsourcing RCM to telemedicine billing experts like Synapse simplifies the process, as they leverage AI-driven billing solutions to:
- Automate coding and claims processing, reducing manual errors.
- Enhance claim accuracy, minimizing denials and accelerating reimbursements.
- Ensure compliance with evolving payer policies and telehealth regulations.
Challenge #2: Changing Telemedicine Reimbursement Policies
Telemedicine reimbursement policies constantly evolve, leading to higher claim scrutiny and increased denial risks.
According to a 2024 MGMA report, common reasons for telehealth claim denials include:
- Insufficient documentation flagged by payers
- Patient eligibility issues or incorrect ID numbers
- Untimely claim submissions
- Incorrect use of modifiers
- EHR transitions causing registration errors and authorization challenges
As insurers update their policies, healthcare organizations must stay informed and adapt quickly to prevent revenue loss.
Best Practice #2: Real-Time Eligibility Verification and Claims Optimization for Virtual Consults
To mitigate reimbursement challenges, providers should:
- Continuously track payer policy updates to ensure claims align with the latest requirements
- Implement real-time eligibility verification to confirm coverage before virtual appointments
- Ensure correct use of modifiers and coding adjustments based on the latest payer guidelines
- Streamline claims submission processes to prevent delays and compliance errors
By actively monitoring policy changes and integrating real-time verification, healthcare organizations can improve reimbursement rates, reduce claim denials, and maintain financial stability.
Challenge #3: Telemedicine Regulatory and Compliance Issues
Healthcare providers must comply with 629 regulatory requirements across nine domains, as reported by the AHA, creating significant administrative burdens.
Key concerns include:
- Staying updated with Medicare, Medicaid, and private insurer regulations
- Adhering to HIPAA and state-specific telehealth laws
- Preventing billing errors through proper training
Best Practice #3: Continuous Staff Training and Policy Monitoring for Telehealth Billing
To maintain compliance and avoid claim denials, healthcare organizations should:
- Conduct ongoing staff training on evolving payer policies and coding changes
- Proactively monitor and update policies based on new regulations
- Perform regular audits and compliance checks
Telehealth providers can reduce regulatory risks and optimize reimbursements by prioritizing education and policy tracking.
Challenge #4: Virtual Patient No-Shows and Scheduling Gaps
Despite lower no-show rates than in-person visits, telehealth encounters still face challenges due to:
- Technical difficulties
- Patient forgetfulness
- Perceived lower urgency of virtual appointments
Best Practice #4: Proactive Scheduling and Patient Engagement in Telehealth
Providers can apply proactive scheduling to reduce missed appointments and keep more patients engaged. These include:
- Using automated reminders
- Conducting pre-visit tech checks
- Entertaining same-day waitlists
- Being more active in patient education
Case in Focus: Transforming Telemedicine for Gastroenterology
One strong example of improving telemedicine services comes from Synapse Gastro Client, which achieved an impressive 93% improvement rate after implementing key virtual solutions tailored to patient care and operational efficiency.
Key Strategies for Success:
Virtual Pre-Op Nurse Support. Patients received dedicated virtual consultations before procedures, ensuring they were well-prepared and informed. This reduced last-minute cancellations, improved compliance with pre-procedure guidelines, and enhanced overall patient experience.
Scheduling Audits to Reduce No-Shows. The practice identified and addressed gaps that contributed to appointment drop-offs by leveraging digital tools to analyze patient scheduling patterns. Automated reminders and real-time scheduling adjustments significantly reduced missed appointments.
Two-Month-Ahead Recall System. A proactive patient follow-up system was implemented, reminding individuals about necessary check-ups and post-procedure care. This structured approach improved long-term patient engagement and compliance with treatment plans.
Synapse Gastro Client enhanced patient outcomes and optimized operational efficiency by integrating a structured telemedicine-driven coordination strategy. These improvements extended beyond clinical care, driving measurable financial benefits:
Stronger revenue cycle management due to streamlined workflows improved billing accuracy, reducing delays in claims processing.
Enhanced medical billing processes as a result of virtual coordination that ensured precise coding, timely claims submissions, and fewer denials, minimizing revenue leakage
Greater practice efficiency allows healthcare providers to focus on delivering high-quality care rather than being bogged down by operational inefficiencies
This case study highlights how structured virtual workflows and telemedicine solutions create a win-win scenario—patients receive better care while practices maximize efficiency and revenue integrity.
Stay Ahead with Technology-Driven Billing Solutions with Synapse
As virtual care grows, healthcare providers must embrace technology-driven solutions such as automated billing software, AI-driven coding tools, and real-time eligibility verification systems.
At Synapse, we’ll help you:
- Ensure timely follow-ups and better patient care with a proactive recall system
- Enhance patient readiness through efficient virtual pre-op nurse support
- Reduce no-shows and optimize scheduling with thorough audits
By adopting a proactive approach, organizations can streamline billing processes, reduce claim denials, and optimize revenue cycle management in the evolving telehealth landscape.
Ready to optimize your telemedicine billing? Let Synapse help—schedule a consultation today!