Introduction

Telehealth has become an integral part of healthcare in New York City, providing greater accessibility for patients and expanding the reach of medical professionals. However, as telehealth services continue to evolve, so do the challenges associated with billing and reimbursement. In 2025, medical practices, including those at Northshore Medical & Diagnostic PC (NSMD), must adapt to new regulations, changing payer requirements, and technological advancements to maintain a seamless revenue cycle.

The Changing Landscape of Telehealth Billing

1. Regulatory Updates and Compliance Challenges

Telehealth billing regulations continue to shift as policymakers refine coverage policies for virtual care. In 2025, many temporary waivers introduced during the COVID-19 pandemic have expired, reverting some billing practices to pre-pandemic rules. Medicare, Medicaid, and private insurers now have distinct requirements for telehealth reimbursement, making it critical for practices to stay updated on compliance requirements.

Key Considerations:

• Medicare & Medicaid Rules: The Centers for Medicare & Medicaid Services (CMS) have updated telehealth reimbursement policies, with some codes no longer covered under the Public Health Emergency provisions.
• State-Specific Policies: New York State Medicaid has strict telehealth guidelines, requiring providers to use specific platforms and meet eligibility criteria for reimbursement.
• Commercial Payers: Private insurers often have their own telehealth policies, requiring practices to verify coverage before providing services.

2. Coding and Reimbursement Pitfalls

Accurate coding is essential for proper reimbursement. Many practices struggle with claim denials due to incorrect or outdated coding practices. In 2025, new Current Procedural Terminology (CPT) codes and modifiers must be used to differentiate between telehealth visits and in-person consultations.

Key Coding Tips:

• Use the correct Place of Service (POS) code to indicate telehealth encounters.
• Apply appropriate CPT and HCPCS codes for virtual visits.
• Verify payer-specific requirements, as not all insurers cover the same codes.

3. Reimbursement Delays and Denials

One of the biggest hurdles in telehealth billing is claim denials due to incomplete documentation or incorrect modifier usage. Insurers are now scrutinizing claims more closely, leading to delays in payments.

Solutions:

• Implement Robust Billing Software: AI-powered billing solutions can help detect errors before claim submission.
• Conduct Regular Audits: Internal audits can identify potential errors before they result in claim denials.
• Staff Training: Continuous training on telehealth billing policies ensures compliance and minimizes errors.

Strategies to Overcome Telehealth Billing Challenges

1. Leverage AI and Automation

Technology is playing a crucial role in optimizing telehealth billing. AI-driven billing platforms can automatically check claim accuracy, predict denials, and suggest coding improvements. Implementing automated eligibility verification can also help determine insurance coverage before a telehealth visit takes place.

2. Strengthen Documentation Practices

Clear and thorough documentation is vital to ensure compliance and smooth reimbursement. Providers should:

• Record detailed notes on the virtual encounter, including diagnosis, treatment plans, and follow-up care.
• Ensure all patient consent forms for telehealth visits are documented.
• Utilize Electronic Health Records (EHRs) to streamline billing and reporting.

3. Stay Updated on Policy Changes

Healthcare providers must proactively monitor changes in telehealth billing policies. Subscribing to CMS updates, attending medical billing workshops, and joining professional healthcare associations can help practices stay compliant with the latest regulations.

4. Partner with Expert Medical Billers

Many NYC practices are outsourcing their billing operations to medical billing specialists like NSMD, who have expertise in handling telehealth claims. This reduces the administrative burden on healthcare providers and ensures higher claim acceptance rates.

Conclusion

As telehealth continues to grow in New York City, overcoming billing challenges is essential to maintaining a healthy revenue cycle. By adopting advanced billing technologies, refining documentation processes, and staying informed on regulatory changes, medical practices like Northshore Medical & Diagnostic PC (NSMD) can navigate these hurdles successfully and continue providing quality virtual care to patients.