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Telehealth has become a routine part of patient care, but billing for virtual services still creates compliance challenges for many healthcare organizations. A telehealth claim can be paid without issue and still create problems later if documentation, coding, or billing requirements don’t align with payer expectations. That’s one reason telehealth audits are receiving more attention from Medicare, commercial payers, and internal compliance teams. Most practices focus on getting claims submitted and reimbursed. Fewer take time to review whether their telehealth processes could stand up to an audit. That’s where a structured review becomes valuable. A strong telehealth billing audit checklist helps practices identify compliance gaps, reduce denial risks, and strengthen billing accuracy before an external review uncovers costly issues. What Should a Telehealth Billing Audit Checklist Include? The telehealth audit should review all areas having a potential impact on reimbursement and compliance. That includes coding, modifiers, patient consent, provider licensure, medical necessity, patient location, supervision requirements, and payer-specific billing rules. It’s not just about detecting errors. It’s to ensure that telehealth services are documented, billed, and supported appropriately. 1. Review Medicare Telehealth Coverage Rules One of the quickest ways to create compliance problems is relying on outdated guidance. Medicare telehealth policies have changed several times over the past few years. Current flexibilities have been extended through December 31, 2027, allowing many beneficiaries to receive telehealth services from home without geographic restrictions. Billing teams should review current Medicare requirements regularly instead of assuming policies remain unchanged. 2. Verify Place of Service (POS) Codes Billing errors are a persistent problem that occurs with POS coding. Generally, Medicare telehealth services are classified as POS 02 for services provided at a location other than the patient’s home and as POS 10 for services provided at the patient’s home. When performing an audit, check submitted claims with patients’ records to verify that the POS code is the same as the documented location at the time of service. 3. Confirm Modifier Accuracy Modifiers provide information to the payers regarding the manner in which care was provided. Audio-video telehealth services are often performed with Modifier 95; these are audio-only services that are sometimes eligible for Modifier 93. Improper use of modifier(s) can lead to claim denials, delays in reimbursement, or compliance issues. An examination of a sample of claims may be helpful to assess whether modifiers appropriately represent the type of encounter. 4. Check CPT Code Selection Telehealth coding continues to evolve. Many organizations still have outdated codes in their billing processes. The 98000-98015 code family for telehealth was added in recent CPT updates, and the older telehealth codes (99441-99443) have been phased out. An audit should ensure that coding templates, billing systems, and staff workflows meet current needs and payer expectations. 5. Audit Audio-Only Documentation Audio-only services remain a high-risk area. Coverage rules vary by payer and specialty, and many services require specific documentation explaining why video technology was unavailable or not used. Behavioral health services generally have broader audio-only coverage than many other specialties. Missing documentation can quickly turn a paid claim into an audit finding. Review audio-only encounters carefully to ensure documentation supports the service billed. 6. Monitor Behavioral Health Requirements Behavioral health telehealth services have unique compliance considerations. While the in-person visit requirement for Medicare is currently waived through 2027, there should still be documentation of the reasoning for continued telehealth treatment when appropriate. Policies may evolve, and having good documentation today can minimize compliance issues in the future. 7. Review Direct Supervision and Incident-To Billing Expanded telehealth coverage doesn’t eliminate supervision requirements. CMS allows virtual direct supervision through real-time audio and video technology. Audio-only communication does not satisfy those requirements. Because incident-to billing continues to receive regulatory attention, practices should periodically review supervision documentation and verify that billing requirements are being met. 8. Verify Patient Consent Documentation Patient consent may seem straightforward, but it remains a common audit checkpoint. When a patient agrees to receive services via telehealth, the telehealth encounter should explicitly note this consent. Consent is sometimes verbal and is also documented in the medical record. Without documentation, “assuming consent” can lead to undue compliance risk. 9. Confirm Provider Licensure and Credentialing There are challenges that come with telehealth that do not occur in person. Providers’ licensure requirements are typically tied to the patient’s location at the time of the encounter, rather than the provider’s location. A telehealth audit should include a review of provider credentials and a comparison against documented patient locations for a sample of encounters. 10. Document Patient Location Correctly Patient location affects both billing and licensure compliance. Many organizations collect an address during registration but fail to confirm where the patient is physically located during each telehealth visit. Patients travel. Locations change. Auditors often expect documentation that reflects where the patient was at the time of service, not simply the address stored in the system. 11. Review Medical Necessity Documentation Telehealth services must be medically necessary like an in-person visit. Just because a person communicated in a virtual encounter does not mean it should be charged. Documentation should support the level of service billed and will clearly demonstrate clinical necessity. If looking at telehealth charts, check documentation against that of a face-to-face encounter. 12. Align Billing With Payer-Specific Requirements One of the most frequent billing issues in telehealth is that not all payers adhere to Medicare guidelines. Each commercial insurance company and Medicaid plan may have different expectations regarding documentation, covered services, modifiers, and CPT codes. A current payer matrix can assist billing teams to remain in sync with each payer’s policies and to prevent unneeded denials. Bonus Review Area: Remote Patient Monitoring Remote Patient Monitoring continues to expand across healthcare. As usage grows, so does payer scrutiny. Organizations should periodically review RPM documentation, patient education records, monitoring activities, and billing workflows to ensure compliance requirements are being met. Final Thoughts Telehealth billing audits do not have to be restricted to large health systems. Documentation, coding, supervision, licensing, and reimbursement are all increasingly under scrutiny