Telehealth: What It Is, How It Works & How to Get Paid

Telehealth, tella health, telea medicine—however you want to spell it, this is one of the fastest-growing advancements in healthcare today. Over the last five years, understanding telehealth has become crucial as more providers and patients turn to virtual healthcare solutions. But what exactly is telehealth? Why is it used? Who benefits from it? And—let’s be real—the big question: Can you bill for it?

Key Takeaways

• Telehealth allows virtual healthcare visits via video, phone, and digital platforms.
• Most insurance plans, including Medicare, cover telehealth—but billing rules are changing in 2025.
• POS codes (2, 10) and CPT modifiers affect reimbursement rates.
• Some specialties, like mental health and dietetics, benefit more from telehealth.
• Providers must comply with HIPAA and state licensing laws for telehealth visits

Let’s break it all down and get into the nitty-gritty of understanding telehealth—what it is, how it works, and why it’s reshaping healthcare as we know it.

What is Telehealth?

At its core, telehealth is a virtual platform that allows healthcare providers to see and treat patients using electronic communication—think video calls with your doctor instead of in-person visits.

This isn’t just some futuristic concept anymore. Understanding telehealth means recognizing that it’s here, it’s growing, and it’s already integrated into many medical practices. With just a camera and microphone, patients can connect with healthcare professionals from anywhere—at home, in their car, at work, or wherever they need care.

However, telehealth isn’t a one-size-fits-all solution. While it can be a fantastic tool for efficiency, convenience, and patient satisfaction, there are cases where virtual visits just don’t cut it. Some medical issues require in-person assessments, hands-on evaluations, or procedures that telehealth simply cannot provide.

How Does Telehealth Work?

A telehealth platform is typically provided through an Electronic Medical Records (EMR) system, though some companies specialize solely in telehealth services. These platforms must be HIPAA-compliant to ensure patient data remains secure.

Fun fact: Zoom actually had a HIPAA-certified version during the pandemic. Whether that’s still available today is another story, but most healthcare providers stick to EMR-integrated telehealth solutions—why? Because everything is in one place:

• Scheduling
• Patient portals
• Billing
• Telehealth visits

It’s just easier when everything is streamlined.

Patients log in from their device, join their scheduled appointment, and interact with their provider virtually. Just like an in-person visit, they discuss their chief complaint, review their health concerns, and receive medical guidance—all from a secure digital connection.

Understanding telehealth means knowing that it doesn’t replace traditional medicine—it enhances it. In many cases, telehealth makes patients more likely to seek care, since they don’t have to deal with the hassle of commuting, waiting rooms, or scheduling conflicts.

Billing & Insurance for Telehealth

Let’s talk money. Can you bill for telehealth visits? Absolutely. But—there’s a catch.

Understanding telehealth billing requires knowing which insurance providers cover what. Some general rules:

• Most insurances follow Medicare guidelines.
• Medicare telehealth rules are changing on April 1, 2025.
• Place of service codes matter (more on that in a second).
• Some telehealth visits require specific modifiers on claims.

Right now, telehealth billing uses place of service (POS) codes like:

Some insurance companies require both a POS code and a modifier on the CPT code. Others don’t. You have to check each payer’s guidelines to make sure you’re getting reimbursed correctly.

And let’s be honest—insurances love changing the rules. What was covered 100% during the pandemic might only be reimbursed at 80% or even less today. That’s because telehealth visits require fewer resources (no office space, no supplies, etc.), so insurers have started paying less for them.

If you’re a healthcare provider using telehealth, staying up to date with Medicare and private insurance changes is crucial—or you could end up losing revenue.

Who Benefits Most from Telehealth?

While understanding telehealth means knowing its limitations, there are plenty of specialties that thrive in a virtual setting. Medicare has even permanently approved telehealth for:

• Behavioral health & counseling
• Dietitians & nutritionists
• Social workers & therapists

These fields rely heavily on conversations, making telehealth a perfect fit. Why not make healthcare more accessible across state lines? A behavioral health provider in Oregon, for example, could see patients in multiple states, helping bridge the mental health provider shortage.

But not all specialties have the same flexibility. Starting April 1, 2025, Medicare is tightening the rules again. Some specialties will lose telehealth coverage or face stricter billing requirements.

Want to keep up with the changes? Check CMS’s website and your specific insurance payers regularly.

Telehealth Billing, Compliance & Best Practices

Alright, now that we’ve covered what telehealth is, how it works, and the basics of billing, let’s dive deeper into compliance, insurance headaches, and the right way to use telehealth in your practice.

Because let’s be real—understanding telehealth isn’t just about making virtual care work. It’s about doing it right, making sure you get paid, and staying compliant with HIPAA, Medicare, and private insurance policies.

Is Telehealth Always Appropriate?

The short answer? No. While understanding telehealth means recognizing its benefits, it’s not a replacement for traditional care in every case.

Some conditions and complaints simply require in-person evaluation. You can’t:

• Perform a physical exam through a webcam.
• Check vitals like blood pressure or pulse without equipment.
• Conduct hands-on assessments that are critical for diagnosing many conditions.

This is where clinical judgment comes into play. Some providers get tempted to overuse telehealth for convenience—or even just to squeeze in more billable visits—but that’s a slippery slope.

If you’re a provider, ask yourself:

• ✅ Is telehealth safe and effective for this patient?
• ✅ Am I making a sound medical decision, or just trying to fill my schedule?
• ✅ Would an in-person visit provide better care?

Using telehealth the right way means putting patient safety first—not just making life easier for yourself.

How Does Telehealth Compliance Work?

Compliance is a huge factor in understanding telehealth. If you’re using telehealth in your practice, here’s what you need to keep in mind:

1. HIPAA Compliance & Secure Platforms

Not all video platforms are HIPAA-compliant. While Zoom had a HIPAA-certified version during the pandemic, most healthcare providers now use EMR-integrated telehealth platforms.

Why? Because they offer:

• Encrypted video communication (to protect patient data).
• Secure scheduling & patient portals (everything in one place).
• Automatic record-keeping (helps with billing & audits).

If your platform isn’t HIPAA-compliant, you could be in major legal trouble. Always double-check before using any third-party software for patient visits.

2. Insurance Rules: What Gets Covered?

Not all telehealth visits are reimbursed equally. Here’s where it gets tricky:

During the pandemic, telehealth billing was super flexible. Now? Things are tightening up. Medicare’s final telehealth rule changes take effect April 1, 2025, and private insurers usually follow Medicare’s lead.

If you’re offering telehealth services, check each payer’s policy regularly—or risk denied claims and lost revenue.

3. Cross-State Telehealth Rules

One of the biggest benefits of telehealth is treating patients across state lines. But here’s the catch:

📌 You must be licensed in the state where the patient is located at the time of the visit.

Let’s say you’re based in California, but your patient is on vacation in Texas. If you’re not licensed in Texas, you technically can’t provide telehealth care for them (unless Texas has special reciprocity rules).

This is where interstate telehealth licensing comes in. Some states allow out-of-state providers to practice via compacts or temporary waivers, but you need to check before seeing patients from another state.

How to Bill Telehealth Correctly

If you’re offering telehealth visits, getting reimbursed correctly is a must. Here’s what you need to do:

• ✅ Use the right place of service code (POS 2 or POS 10).
• ✅ Check insurance policies for coverage limitations.
• ✅ Know your CPT codes—some require modifiers, some don’t.
• ✅ Stay updated on Medicare’s new rules (effective April 1, 2025).

Ignoring these details can mean denied claims, underpayments, or even compliance violations.

Understanding Telehealth: Frequently Asked Questions (FAQ)

What is Telehealth?

Telehealth (sometimes called telemedicine) is a way for healthcare providers to see and treat patients virtually using video and audio technology. Instead of going to a doctor’s office, patients can connect with providers from home, work, or even their car.

It’s secure, HIPAA-compliant, and widely used for routine medical care, follow-ups, mental health therapy, and more.

What’s the Difference Between Telehealth and Telemedicine?

✅ Telehealth is a broad term that includes all remote healthcare services—video visits, phone consultations, remote monitoring, and even patient education.

✅ Telemedicine is a specific type of telehealth that refers to clinical care provided remotely (like diagnosing a condition or prescribing medication via video chat).

So, telemedicine is a part of telehealth, but telehealth covers more than just virtual doctor visits.

Can You Bill for Telehealth Visits?

Yes! But it depends on the insurance provider and the type of visit.

Most private insurers and Medicare cover telehealth, but rules vary. Some important factors:

• Place of service (POS) codes matter (use POS 2 or POS 10).
• Some visits require modifiers (insurance-specific).
• Reimbursement rates differ (some insurers pay less for telehealth than in-person visits).

Since Medicare’s telehealth rules are changing on April 1, 2025, it’s crucial to stay updated.

What Kinds of Visits Are Best for Telehealth?

Telehealth works great for:

• ✅ Mental health therapy & counseling
• ✅ Follow-up visits for chronic conditions
• ✅ Prescription refills & medication management
• ✅ Dietitian & nutritionist consultations
• ✅ Simple acute conditions (like colds, rashes, or UTIs)

It’s not ideal for:

• ❌ Emergencies (stroke, heart attack, severe injuries, etc.)
• ❌ Physical exams that require hands-on assessments
• ❌ Diagnostic tests (like X-rays, EKGs, or blood work)

Providers should always decide if telehealth is appropriate for each case.

Do Patients Need Special Equipment for Telehealth?

Nope! A basic smartphone, tablet, or computer with a camera and microphone is enough.

Some remote monitoring programs may require additional devices (like blood pressure monitors or glucose meters), but for most visits, it’s as simple as clicking a link and joining a video call.

Is Telehealth Secure and HIPAA-Compliant?

Yes—if you use the right platform.

Telehealth must be done through HIPAA-compliant video conferencing tools (like those integrated with EMR systems). Regular FaceTime or Skype is not HIPAA-compliant.

During the pandemic, Zoom offered a HIPAA-compliant version, but most healthcare providers stick with EMR-based telehealth platforms for built-in security.

Can You Use Telehealth Across State Lines?

It depends. Providers must be licensed in the state where the patient is located during the visit.

Some states allow temporary telehealth waivers or compact licensing, but you can’t assume telehealth automatically works across state lines. Always check state regulations before treating an out-of-state patient.

How Do Telehealth Payments Work?

Patients may still owe a copay—just like an in-person visit.

Some telehealth platforms allow patients to pay their copay before the visit when they check in online. Others may bill the patient later.

Medicare and private insurers often cover telehealth visits at a lower rate than in-person visits, so providers should verify reimbursement rates beforehand.

What Are the Biggest Challenges with Telehealth?

• ❌ Billing & reimbursement changes – Medicare and private insurers keep changing the rules.
• ❌ Licensing restrictions – Providers can’t automatically treat patients in every state.
• ❌ Tech issues – Patients may struggle with bad WiFi, poor camera quality, or login problems.
• ❌ Clinical limitations – Some conditions require in-person exams and testing.

Despite these challenges, telehealth continues to expand, and more providers are adopting it every year.

What’s Changing for Telehealth in 2025?

🚨 Big Medicare changes are coming April 1, 2025. 🚨

• Some telehealth visits will no longer be covered.
• Reimbursement rates may change.
• Certain specialties (like behavioral health) will keep permanent telehealth approval.
• Private insurers will likely follow Medicare’s new rules.

If you provide telehealth, check CMS and private insurance policies regularly to stay compliant and avoid billing surprises.

Final Thoughts on Understanding Telehealth

Telehealth is a game-changer in modern healthcare, but using it effectively requires the right approach. When done properly, it makes healthcare more accessible, more efficient, and more convenient for patients and providers alike.

But remember: Telehealth isn’t a replacement for in-person care—it’s a tool. Use it wisely, stay compliant, and keep patient safety first.