To ensure your organization maximizes the benefits of its telehealth program and stays compliant with evolving regulations, we've outlined essential strategies to help you grow your telehealth services and remain ahead of industry changes.

Recent studies reveal how telehealth usage has fluctuated across medical specialties since the height of the COVID-19 pandemic. Mental health services continue to rely heavily on virtual care, while fields like cardiology have seen a decline in telehealth use. According to research published in npj Digital Medicine, telehealth adoption has faced notable changes over the past few years. In 2019, telehealth accounted for less than 1% of healthcare visits, skyrocketing to 31.2% during the pandemic’s peak in 2020, only to taper off to 5.8% by the third quarter of 2023.

As telehealth continues to shape the future of healthcare, organizations must adapt to its evolving role in patient care. Understanding the trends and leveraging the right approach will position your healthcare organization to thrive in this dynamic environment.

Telehealth Utilization Trends

Telehealth usage during the pandemic revealed significant disparities, driven by factors like race, age, location, and primary language, which impacted access and utilization. Researchers from Northwestern University Feinberg School of Medicine analyzed electronic health records (EHR) data from Illinois hospitals. Their study looked at telehealth use and no-show rates among 444,752 adult patients across 1.97 million outpatient visits between January 1, 2021, and July 1, 2022, a period they termed the "sustained pandemic phase."

Telehealth accounted for over 10% of visits, while no-shows made up 4.27% of all appointments. Mental health, endocrinology, and genetics specialties saw the highest telehealth use, ranging from 19.8% to 64.5% of total visits. Meanwhile, specialties like cardiology, dermatology, and obstetrics-gynecology had an early surge in telehealth use during March and April 2020, but this declined over time. On the other hand, fields like primary care, pulmonology, and oncology saw renewed growth in telehealth use after a drop-off following May 2020.

A recent MGMA Stat poll, conducted in 2024, indicated shifting trends in telehealth demand. Less than half of medical group leaders (45%) reported stable or increased patient demand for telehealth, while 55% saw a decline. Those observing rising demand responded by upgrading their systems, integrating telehealth into electronic health records (EHR), and hiring additional staff to manage the growing volume. For others, patient demand had leveled off since the pandemic, with more predictable surges during cold and flu season.

For many specialties, patients still appreciate the convenience of telehealth, but seniors and pediatric clients often prefer in-person care. Despite the decline in telehealth demand, the resurgence of in-person visits has driven the need for additional clinic space and supplies, contributing to on-site diagnostic testing and boosting revenue.

This study coincides with Congress debating the future of pandemic-era telehealth waivers. These regulatory flexibilities, such as removing geographic restrictions for telehealth services and allowing federally qualified health centers to provide telehealth, were extended through 2024. There is increasing pressure to make these changes permanent, though Congress is currently considering a two-year extension through 2026.

Telehealth Licensing and Credentialing

In most situations, federal and state laws require healthcare providers to be licensed both in the state where they are delivering telehealth services (the “distant site”) and in the state where the patient is located (the “originating site”). For example, a provider based in Washington offering a telehealth consultation to a patient in Florida must hold licenses in both states.

Thankfully, many states have introduced telehealth-specific licenses and exceptions, making it easier for out-of-state providers to offer services via telemedicine. Some states also participate in licensing compacts, allowing certain specialties to obtain licenses that are valid across multiple states. The most common are the Nurses Licensure Compact (NLC) and the Interstate Medical Licensure Compact (IMLC), which streamline cross-state licensing for various healthcare professionals.

Here’s a breakdown of some key licensing compacts:

• IMLC: Interstate Medical Licensure Compact
• APRN: Advanced Practice Nurse Compact
• ASLP-IC: Audiology and Speech-Language Pathology Interstate Compact
• CC: Counseling Compact
• DC: Dietitians Compact
• EMS: Recognition of EMS Personnel Licensure Interstate Compact (REPLICA)
• NLC: Nurses Licensure Compact
• OT: Occupational Therapy Compact
• PA: Physician Assistant Compact
• PSY: Psychology Interjurisdictional Compact (PSYPACT)
• PTC: Physical Therapy Compact
• SW: Social Work Licensure Compact

To speed up the licensing process, providers can also use the Uniform Application for Licensure—a web-based tool that simplifies license portability by gathering all necessary credential information in one place. This application helps eliminate the need to re-enter data when applying for multiple state licenses and streamlines credential verification.

Currently, 20 states, including Arizona and Florida, offer some form of telehealth registration process. While the terminology—telemedicine license, registration, certification, permit, or waiver—may differ across states, these processes ensure board oversight of out-of-state providers operating in their jurisdictions. Additionally, these registrations may limit practices, such as prohibiting the provider from opening a physical office or offering in-person care within the state.

It’s worth noting that while state boards may be authorized to issue special telehealth licenses or registrations, the implementation of these policies can vary. Some states may offer temporary licenses in certain circumstances, but it’s crucial to verify each state’s specific requirements to ensure compliance with telehealth regulations.

Licensure Exemptions

Licensure exemptions offer some flexibility for out-of-state telehealth providers, with 36 states allowing exceptions under specific conditions. These include provider consultations, prior established relationships, emergencies, and cases involving mental health or life-threatening diseases. However, these exceptions are often narrow and apply only in specific situations or to certain types of providers.

For example, many states offer a consultation exemption, which allows providers to consult with other healthcare professionals without being licensed in the same state. This is common in states like Hawaii, Iowa, New Jersey, and Puerto Rico. Additionally, some states, such as South Carolina, Virginia, and Washington, provide exemptions for providers with an already established patient relationship. Other states, like Alabama, grant exemptions for infrequent telehealth interactions—services provided less than 10 days per year or to fewer than 10 patients annually. There are also emergency-related exemptions, such as those in the District of Columbia.

Specialized care exemptions also exist in states like Colorado (for mental health services) or California (for life-threatening diseases). In some cases, state laws may not explicitly address telehealth but offer relevant policies for providers practicing in neighboring states or expedited licensure agreements, such as recent reciprocity processes for physicians in the District of Columbia, Maryland, and Virginia.

Despite these exceptions, each state’s rules vary widely, and providers must carefully review them to ensure they meet all requirements. Additionally, 14 states have adopted both limited licensure exceptions and telehealth registration processes. Even when a state has a licensure exception or registration process, it's crucial to verify specific policies, such as those related to patient consent or prescribing.

Providers should also keep in mind that compliance with state licensure rules does not necessarily guarantee insurance coverage for services. Payer policies differ significantly, and location-based restrictions may apply.

Credentialing for Telehealth

Credentialing for telehealth requires healthcare providers to be officially approved and granted privileges at the facilities where they will provide care, whether they’re working on-site or remotely. This process can be handled through traditional in-house credentialing or via credentialing by proxy, which allows providers to be credentialed by a remote hospital instead of going through the full process at a facility they won’t physically visit.

Credentialing by proxy is particularly beneficial for telehealth, as it enables providers to practice at multiple facilities without needing to complete a separate credentialing process at each one. This streamlines the process, ensuring providers can deliver care more quickly across various locations.

Modern credential management systems have revolutionized how healthcare organizations handle licenses, certifications, and practice privileges. These systems are vital for telehealth, helping providers navigate the complexities of multiple state regulations while ensuring they’re fully credentialed in a timely and accurate manner.

Credsy is a leading solution in this area, transforming how telehealth services manage credentialing. By using Credsy’s software, healthcare organizations across the U.S. have cut administrative workloads by 100,000 hours, reduced onboarding times by 80%, and accelerated the credentialing process by 65%. It’s a game-changer for telehealth providers looking to keep up with expanding demand while maintaining compliance.

Getting Reimbursed for Telehealth

One of the most common challenges for healthcare leaders is figuring out how to secure reimbursement for telehealth services. Reimbursement rates can vary based on the payor—whether it's private insurance, Medicare, or a state Medicaid plan. Payment parity laws, which are determined at both state and federal levels, also play a significant role in what reimbursement looks like.

The Centers for Medicare and Medicaid Services (CMS) has made full telehealth payment parity permanent for many services, meaning those services are reimbursed at the same rate as in-person visits. Other services are covered under temporary extensions through the end of 2024.

Pay parity laws

43 states, along with the District of Columbia and the Virgin Islands, have implemented pay-parity laws. These laws generally fall into two categories:

• Payment parity for telehealth: This ensures that telehealth services are reimbursed at the same rate as in-person care.
• Telehealth service or coverage parity: Also known as access parity, this ensures that the same types of services available in person are also covered for telehealth. However, it doesn’t always guarantee the same reimbursement rate as in-person services.

Navigating these laws can be complex, but understanding the differences between payment parity and coverage parity is crucial for getting reimbursed properly.

Understanding Telehealth Billing

Telehealth billing typically falls into three categories: Medicare, Medicaid, and private payor guidelines.

Medicare Telehealth Billing Guidelines

In 2020, CMS expanded the scope of telehealth services covered for Medicare patients. This update allows a broader range of healthcare providers, including physicians and licensed clinical social workers, to offer virtual care for various services. CMS’ most recent fee schedule for Medicare reimbursement became effective on January 1, 2023. While this expansion extends telehealth coverage, some reimbursements are set to expire at the end of 2024. As of July 2024, CMS proposed a 2.8% reduction to the conversion factor for the 2025 physician fee schedule, which may affect billing rates. Each state continues to reevaluate telehealth reimbursement policies for both private payers and CMS services.

Medicaid Billing for Telehealth Services

Medicaid’s coverage of telehealth services varies by state. During the public health emergency, many states expanded their Medicaid coverage for telehealth. In October 2023, the Center for Connected Health Policy (CCHP) released its executive summary of state telehealth laws and Medicaid policies. Several states have since announced changes to their Medicaid reimbursement policies, reflecting ongoing adjustments to telehealth coverage.

Billing Private Insurance for Telehealth

Billing for telehealth with private insurance differs between providers. However, 43 states, the District of Columbia, and the Virgin Islands have laws requiring private insurers to reimburse telemedicine services. To access the latest billing regulations in your state, you can refer to the Policy Finder Tool.

Understanding these guidelines ensures that your healthcare organization remains compliant and maximizes reimbursement opportunities.

Choosing the Right Telehealth Technology

Healthcare facilities often rely on telehealth features built into their electronic health record (EHR) systems like Athena, Epic, Oracle, or Veradigm. Beyond EHRs, other tech options include live video conferencing, mobile health apps, store-and-forward electronic transmission, remote patient monitoring (RPM), and various video/audio tools. Popular examples include Amazon Chime, Doxy.me, GoTo Meeting, Spruce Health, Webex for Healthcare, and Zoom for Healthcare—all of which must comply with HIPAA regulations.

But telehealth isn’t just about video calls or data sharing—it’s also about harnessing the power of emerging technologies like artificial intelligence (AI) to further improve patient outcomes and streamline processes.

Artificial Intelligence (AI) in Telehealth

AI is transforming healthcare and telemedicine, offering a variety of benefits. AI systems boost diagnostic accuracy, automate patient communications, and support clinical decisions while improving operational efficiency. As AI evolves, its use in healthcare must always prioritize ethical, responsible, and cautious practices—especially regarding sensitive patient data.

AI Chatbots and Virtual Assistants

AI-powered chatbots are becoming the first point of contact for many healthcare users. These bots answer common questions, offer basic medical advice, schedule appointments, send reminders, and even assist with initial patient assessments. This helps alleviate strain on clinical staff and ensures patients are directed to the right level of care. With the rise of generative AI, healthcare organizations are exploring large language models like Google’s Med-PaLM, which are performing as well or better than human clinicians in certain tasks. For example, a study found that ChatGPT outperformed doctors in empathy and response quality.

AI-Assisted Medical Imaging

AI is enhancing the accuracy of diagnostic imaging by applying deep learning to CT and MRI scans. These advanced algorithms identify complex patterns, making it easier to detect conditions like tumors or fractures. AI is already being used to treat cardiovascular, neurological, and oncological conditions, offering quicker and more precise results.

Clinical Data Management with AI

As telemedicine grows, so does the need for efficient data management. AI is key in automating the handling of vast amounts of healthcare information. By integrating patient data into EHR systems, AI helps reduce manual entry, eliminate errors, and generate deeper medical insights for diagnostics and treatment planning. One study demonstrated AI's ability to eliminate four months of manual data review in a single trial, saving valuable time for medical teams.

Remote Patient Monitoring (RPM) and Chronic Care

Around 34% of U.S. healthcare organizations now use RPM to track patients’ vitals and health metrics remotely. This allows healthcare providers to detect issues early and adjust treatments for conditions like heart disease, diabetes, and more. RPM’s popularity is also tied to the rise of hospital-at-home (HaH) technology, which provides real-time care monitoring for patients stable enough to stay at home but still require hospital-level care.

Telehealth-Enabled Wearable Devices

Wearables like smartwatches and fitness trackers are becoming integral to telehealth services. These devices offer real-time data that integrates with telemedicine platforms, giving doctors a more comprehensive view of patient health. Advanced sensors are being used to monitor key health metrics, including heart rate, respiration, and temperature. Devices like ADAMM, Embrace 2, and the Leaf Sensor are being employed to detect conditions like seizures, prevent ulcers, and track fertility, offering proactive patient care.

Mobile Health (mHealth) Apps

Mobile health apps are one of the fastest-growing sectors in digital healthcare, with over 350,000 available by the end of 2023. These apps allow individuals to take control of their health by tracking everything from fitness to medication adherence, all while syncing with healthcare providers for a more holistic approach to care.

The Internet of Medical Things (IoMT)

IoMT is connecting a growing number of health-related devices, such as glucose monitors and fitness trackers, to create a more comprehensive picture of patient well-being. These smart devices, when linked to telehealth platforms, allow for better data-driven decisions. As IoT technology improves, it will help healthcare professionals monitor patients more effectively while offering personalized treatment plans.

Conclusion

As telehealth continues to evolve, it's clear that organizations must adapt to changes in utilization, regulatory frameworks, and technology. From fluctuating trends across specialties to the complexities of licensing and credentialing, staying on top of these developments is key to delivering seamless patient care. We’ve seen how mental health and primary care are leading the way in telehealth usage, while other fields are adjusting to new norms post-pandemic.

However, the success of any telehealth program hinges on two critical factors: having excellent providers and ensuring timely reimbursement. Without skilled professionals and an efficient revenue cycle, even the best telehealth platforms can fall short. This is why streamlined credentialing and onboarding processes are so crucial.

Credsy is designed to simplify these challenges, ensuring that healthcare providers are credentialed and onboarded quickly and efficiently. By reducing administrative burdens and speeding up the onboarding process, Credsy helps organizations stay compliant and ready to serve patients when it matters most—allowing them to focus on quality care and financial success.