5 Telehealth Billing Errors Costing Clinics Thousands (and How to Catch Them Before Claims Go Out)
5 Telehealth Billing Errors Costing Clinics Thousands (and How to Catch Them Before Claims Go Out)
Even well-run teams are seeing revenue slip through the cracks in telehealth billing—and many don’t realize it until quarterly reports drop.
We work with clinics that are sharp, disciplined, and attentive. But when we audit their virtual care claims, we still see money left on the table—because of small issues buried in clearinghouse settings, template logic, or front-desk handoffs.
This guide shares the 5 highest-impact telehealth billing errors we see—and how advanced teams are fixing them upstream.
1. Missing or Stripped Modifiers (-95, -GT)
You might be adding them at coding—but is your clearinghouse passing them through?
Common pattern: EHR or billing software applies the correct modifier, but a downstream rule in your claim scrubber or EDI config strips it before submission.
What to check:
- What % of billed 99213/99214 telehealth claims last month included -95 or -GT?
- Are specific payers returning high rates of CO-50 or CO-197 denials linked to modifier errors?
📊 Benchmark:
In our audits, modifier leakage rates above 8–12% are common—even in teams that believe they’re compliant.
2. Incorrect Place of Service (POS) Logic by Payer
Some payers want POS 02 (telehealth). Others require POS 11 (office) + -95. One rule doesn’t fit all—and few systems map POS logic dynamically.
What to check:
- Is POS logic hardcoded or mapped per payer in your billing rules?
- Are you relying on visit type alone to set POS, or capturing patient location too?
📊 Signal to Watch:
If your average reimbursement for telehealth 99214s varies by more than 15% across payers, POS misalignment is likely driving it.
3. Undocumented or Underused Time-Based Codes (99441–99443)
Quick phone visits often meet criteria for time-based billing—but providers default to portal notes, or skip documentation altogether.
What to check:
- Are providers prompted to log time + method (e.g., phone, video)?
- Do you track what % of total telehealth visits fall under 99441–99443?
📊 Benchmark:
If time-based codes represent less than 3–5% of your total virtual visit volume, you’re likely underbilling.
4. Modality Drift Between Scheduling and Delivery
A visit starts as in-person, but patient requests to switch to phone or video. Unless the front desk updates the visit type, your claim includes the wrong POS and no modifier.
What to check:
- How often does visit modality change after scheduling?
- Is there a process to reconcile scheduled vs. actual delivery modality?
Best practice:
Set up a daily QA sweep of telehealth visits flagged for modality change post-scheduling. In our work, this alone has recovered 4–5 figures per quarter for mid-size clinics.
5. Virtual Visits Documented as Portal Messages
Quick follow-ups via phone or video get logged in the portal—but not coded or submitted. These visits often qualify for 99421–99423 or 99441–99443.
What to check:
- Are asynchronous messages reviewed weekly for billing eligibility?
- Are providers trained to distinguish between message threads and real-time consults?
Missed signal:
If your providers are handling more than 10 messages per day and none are being billed, you’re leaking hundreds of billable touchpoints per month.
What the Most Advanced Teams Are Doing
- Building payer-specific telehealth billing maps (modifiers, POS, CPT thresholds)
- Running monthly audits of modifier presence by CPT and payer
- Assigning QA staff to catch modality drift before claims are released
- Benchmarking utilization rates for time-based and phone codes across provider panels
Want to Benchmark Your Own Data?
We help clinics identify silent loss in virtual care billing—from modifier leakage to underused codes. Our Ops & Revenue Review gives you clear insight into:
- Modifier pass-through rates
- POS logic accuracy by payer
- Time-based code usage compared to volume benchmarks
- Modality drift risks and automation gaps
Book a 20-minute Ops & Revenue Review and get actionable insights tied directly to your EHR, your workflows, and your claims.