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Telehealth & Telemedicine Billing Services
Telehealth claims rarely fail on the visit itself. They fail on the place of service, the modifier, an audio-only rule, or a payer policy that changed since the last claim. Qualigenix bills virtual visits, remote monitoring and care management so each claim carries the codes and modifiers the payer expects on the date of service.
How telehealth billing works
Telehealth billing uses the same visit codes as in-person care, plus a place of service code (POS 10 for the patient's home, POS 02 elsewhere) and a modifier such as 95 for video or 93 for audio-only. Medicare's telehealth flexibilities, including care in the patient's home and audio-only visits, run through December 31, 2027, while commercial and Medicaid rules vary by plan and state. Qualigenix bills telehealth, remote patient monitoring and care management for virtual-first and hybrid practices, with a 98.2% first-pass clean claim rate. Call 786-259-0231 to review your telehealth claims with our team.
01
Telehealth E/M code selection
Medicare pays video visits with the standard office E/M codes (99202-99215). The AMA's newer telemedicine codes (98000-98015) are not on Medicare's telehealth list, but some commercial plans now require them. Billing the wrong code family for the payer means a denial on a visit that was otherwise covered.
02
Virtual program authorizations
Remote monitoring programs, behavioral health telehealth and specialty teleconsultations often need prior authorization from Medicaid and commercial plans. Some plans also limit which telehealth vendors or platforms they will pay for.
03
POS 02 vs. POS 10 and modifier 95
The place of service code tells the payer where the patient was: POS 10 for home and POS 02 for anywhere else. Medicare and many commercial payers also want modifier 95 on video visits. A wrong POS or missing modifier can pay the visit at the wrong rate or deny it.
04
Audio-only and originating site rules
Medicare covers audio-only visits through December 31, 2027 when the patient cannot or will not use video, and the claim needs modifier 93 (or FQ for rural health clinics and FQHCs). Mental and behavioral health visits from home are permanent under Medicare. Other services from home depend on the flexibilities staying in place.
05
Payer and state parity checks
Many states have telehealth parity laws for commercial plans, but they differ on whether payment, coverage or both must match in-person care. Medicaid telehealth rules are set state by state. One policy cannot be applied across every payer.
06
Time and consent documentation
Remote patient monitoring and chronic care management need patient consent on file and minutes logged per calendar month. A monitoring code billed without the transmission days, or a management code without the minutes, does not hold up on review.
07
Telehealth denial triggers
Most telehealth denials trace to a POS and modifier mismatch, a service not on the payer's telehealth list, a provider not licensed in the patient's state, two practices billing RPM for the same patient in one period, or missing time records.
08
Licensure and policy deadlines
A provider must be licensed in the state where the patient is during the visit. Medicare's broader telehealth flexibilities are set to end on December 31, 2027 unless Congress extends them again, so billing rules need to be watched against that date.
How Qualigenix gets virtual visits paid
Qualigenix closes each gap with a check that runs before the claim is submitted.
Right-code telehealth E/M
We keep a payer-by-payer map of which E/M code family each plan pays for telehealth, and code each visit to that plan's rule. Qualigenix holds 98.9% coding accuracy and an over/undercoding rate under 2%.
Virtual program auth tracking
We submit and track authorizations for remote monitoring, behavioral telehealth and specialty consults, and hold claims until the approval is on file.
POS and modifier validation
Every telehealth claim is checked for the correct POS, modifier 95, 93 or FQ, and any payer-specific modifier before it goes out.
Audio-only and site rule checks
We confirm whether the visit was video or audio-only, where the patient was, and whether the payer covers that combination on that date of service.
Payer policy verification
We track telehealth coverage and parity rules for each payer and state you bill, and update the claim rules when a policy changes.
Time and consent audits
For RPM, RTM and care management, we check consent, transmission days and logged minutes before billing, so each monthly code is backed by the record.
Denial recovery and appeals
We work telehealth denials by root cause and resubmit or appeal with the corrected POS, modifier or documentation. Across our book of business, 79% of appealed denials are overturned.
Licensure and policy monitoring
We flag visits where the provider's license does not match the patient's state, and we track the December 31, 2027 Medicare deadline and each payer's policy updates.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
Telehealth coding by service type
Qualigenix codes the full range of virtual care, including the remote monitoring codes added in 2026.
Video E/M visits
Medicare pays video visits with office E/M codes 99202-99215 plus POS and modifier 95. Payers that adopted the AMA telemedicine codes want 98000-98007 for synchronous audio-video visits instead.
COMPLIANCE
Virtual care providers we support
Qualigenix bills for telehealth-first practices, multi-specialty virtual care groups, behavioral health telehealth programs, remote monitoring providers, and hybrid in-person and virtual networks.
0%
Audit Pass Rate
<0%
Variance Threshold
Why Qualigenix
0%
IMPROPER PAYMENT RATE
0%
FROM DOC GAPS
0%
FROM CODING ERRORS
$0M+
PAID IN ERROR
QUESTIONS BUYERS ASK
Qualigenix charges a percentage of collections, so the fee moves with what your practice is actually paid. The rate depends on visit volume, payer mix and the services you need, and a billing specialist quotes it after reviewing your numbers.
Yes. We check consent, device transmission days and logged minutes each month, and we bill the 2026 codes 99445 and 99470 when readings or time fall below the older thresholds.
Medicare's telehealth flexibilities, including care at home for non-behavioral services and audio-only visits, run through December 31, 2027 under the Consolidated Appropriations Act, 2026. Behavioral health telehealth from home is permanent.
Yes. We work old telehealth AR by denial reason and payer, and across our clients we have reduced days in A/R from 54 to 36 with a 97.7% net collections rate.
Use POS 10 when the patient is at home and POS 02 for any other location. Medicare and many commercial payers also want modifier 95 on video visits and modifier 93 on audio-only visits.
Yes. Medicare covers audio-only visits through December 31, 2027, billed with modifier 93 or FQ, and we confirm each commercial and Medicaid plan's audio-only rule before billing.
Yes. Qualigenix works with your existing telehealth platform and EHR and has billed across 133 EMR/EHR platforms.
Average onboarding takes 6 days, covering system access, payer setup and a review of open AR. Call 786-259-0231 to start.