Where Revenue Leaks in Hybrid Care

Healthcare organizations implementing hybrid care models frequently encounter revenue leakage points that can significantly impact their bottom line.

Common Sources of Revenue Leakage

1. Documentation Gaps

When providers transition between virtual and in-person care, documentation often falls through the cracks. We’ve identified that the most common documentation gaps occur during the handoff between telehealth and in-person follow-up visits.

These gaps typically manifest in three ways:

• Incomplete capture of billable services performed during virtual visits
• Missing documentation of medical necessity for follow-up care
• Inconsistent documentation formats between virtual and in-person encounters

2. Coding Inconsistencies

Telehealth coding requires specific modifiers and place-of-service codes that, when missed, can lead to claim denials or underpayment. Common coding errors include:

• Incorrect use of telehealth modifiers (95, GT, GQ)
• Failing to use the appropriate POS code (02 for telehealth)
• Inconsistent application of time-based coding rules for virtual visits

Solutions That Work

Implementing these three changes can dramatically reduce revenue leakage:

1. Standardized Handoff Protocols

   By creating clear documentation requirements for each care transition point, organizations can ensure continuity of billable information. This should include templates specifically designed for hybrid care pathways.

2. Automated Billing Rules

   Embedding telehealth-specific rules into your billing system prevents coding errors before claims are submitted. These rules should automatically flag missing modifiers and documentation requirements.

3. Revenue Cycle Staff Training

   Regular training on telehealth billing requirements ensures your team understands the nuances of hybrid care reimbursement. Focus on the differences between payer requirements, as these vary significantly.

Case Study: Recovered Revenue

A multi-specialty clinic implemented these changes and recovered $127,000 in previously unbilled services within the first 60 days. Their denial rate for telehealth claims dropped from 12% to under 3%.

Next Steps

If you’re experiencing revenue leakage in your hybrid care model, start by conducting a focused audit of 20-30 patient journeys that included both virtual and in-person components. This will quickly reveal your specific leakage points and inform your improvement strategy.

Need help identifying your revenue leaks? Book a call for a complimentary assessment of your hybrid care billing processes.