Where Most Clinics Lose Revenue in Hybrid Care—And How to Fix It
Where Most Clinics Lose Revenue in Hybrid Care—And How to Fix It
Hybrid care isn’t new anymore. But for most clinics, the revenue strategy still treats it like an add-on. That’s costing you.
Between mismatched visit types, documentation gaps, and payer-specific modifier rules, hybrid visits are introducing billing inconsistencies that go undetected until revenue’s lost. And most “fixes” don’t go far enough.
Here’s where advanced teams are focusing—and what you can do this quarter to stop the bleed.
1. Track Modality Drift by Provider
Most EHRs don’t track when a visit scheduled as telehealth is actually completed in person—or vice versa. This “modality drift” creates subtle billing mismatches that disrupt CPT assignment, modifier usage, and documentation prompts.
What to do:
- Pull data from the last 60–90 days comparing scheduled modality vs. actual chart documentation (location, encounter notes).
- Rank providers by drift % and denial % on hybrid visits.
- Flag patterns: often, a handful of providers account for most errors or write-offs.
Why it matters:
Drift undermines automation rules. It’s also an early warning for operational slippage or poor documentation discipline.
2. Refactor Your SOP Using Denial Codes
If your SOP for hybrid or virtual visits hasn’t been updated since implementation, it’s probably misaligned with your actual denial data.
What to do:
- Export the last 90 days of CO-197, CO-18, and CO-50 denials from hybrid visits.
- Tag them by encounter type, department, and front-end steps (intake, auth, coding).
- Walk your SOP line by line and flag any steps that correlate with frequent denials.
Why it matters:
Many SOPs were designed around scheduling flow, not reimbursement outcomes. Refactoring through denial analysis grounds them in financial performance—not just compliance.
3. Create a Virtual Care Reimbursement Heat Map by Payer
Not all payers handle hybrid visits the same—and few teams are benchmarking payment patterns by payer + CPT + modifier.
What to do:
- For each top-10 payer, map the following over the last 3 months:
- Top CPTs used in hybrid/telehealth
- % paid vs. denied
- Average reimbursement
- Common modifier combinations
- Visualize where you’re losing margin (e.g. 99441s getting paid $0, or 99213s denied for place of service mismatch)
Why it matters:
This lets you shift from blanket training or process changes to payer-targeted interventions. It’s how teams reclaim dollars without touching headcount.
4. Don’t Let “Post-Visit” Follow-Ups Stay Invisible
Your team knows follow-up phone calls happen. But are they tracked? Audited? Reimbursed?
What to do:
- Audit 2 weeks of provider-patient communication logs (portal messages, phone calls, video check-ins).
- Quantify how many would meet time-based billing thresholds (e.g. 99442).
- Train providers on thresholds by payer—some now allow these codes even if related to recent E/M visits.
Why it matters:
Most clinics write these off as too small to bill. But over the course of a quarter, these add up to thousands in hidden revenue—especially when multiple providers are under-documenting.
Ready to Trace the Real Leaks?
If you’ve already fixed the basics and still see inconsistencies in hybrid visit revenue, it’s time to dig into the nuance.
At BettyWell, we help clinics map hybrid care from scheduling to denial—and identify where documentation, coding, and payer logic are misaligned.
Book a 20-minute Ops & Revenue Review to walk through your top 3 hybrid visit pain points and leave with an action plan that pays for itself.