In 2026, there is another wave of growth for telehealth because of the shifting expectations in primary care and new CMS changes. With updated rules for Medicare telehealth services, primary care practices will have to sharpen their billing workflows to prevent claim rejections and avoid payment delays.
Smooth billing will be a must if practices want to stay compliant, profitable, and ready for the year ahead. Here’s what primary care groups need to prepare for as they are working toward effective, error-free telehealth billing in 2026.
1. Streamlined Listing of Telehealth Services
CMS has finalized significant changes to the process for reviewing and adding telehealth services on the Medicare list. The agency is eliminating the line between ‘provisional’ and ‘permanent’ status, and instead will consider only whether a service can be delivered using real-time audio-video communication.
For primary care practices, this means fewer administrative hurdles. Services commonly provided through virtual visits should remain stable under the new framework. Billing teams must stay on top of the updated list each year, as simplified approval does not remove the need for accurate coding and modifier use.
2. Accurate Coding Under Dual Conversion Factors
These telehealth changes coincide with a major shift regarding Medicare reimbursement. For 2026, CMS will use two conversion factors: one for clinicians participating in advanced alternative payment models and another for those who are not.
Even though the increases are modest, practices need to make sure their in-house or outsourced billing team applies the correct factor. Telehealth claims filed under the wrong category risk underpayments and denials. Primary care clinics with mixed provider types must be especially vigilant.
3. Efficiency Adjustments and Their Impact
In addition to the revised conversion factors, CMS is implementing a negative 2.5% efficiency adjustment to work RVUs for non-time-based services. Telehealth services that utilize time documentation are exempt from the cut.
That makes correct documentation more critical than ever. If a telehealth visit counts as a time-based service, time needs to be captured properly by the billing team so that reimbursement goes unscathed. Missed documentation can cause a claim to fall into the lower category of non-time-based claims, which costs the practice financially.
4. Updated Practice Expense Methodology
CMS is also finalizing a significant revision to the practice expense calculation. The changes reflect a higher relative weight for indirect costs for office-based providers compared to facility settings.
These changes should benefit primary care clinics that provide telehealth services from their own sites, but only if claims are submitted with correct place-of-service codes and updated telehealth modifiers. Delays can result from a mismatch between location, service type, and coding.
Why Outsourcing Telehealth Billing Makes Sense for Primary Care
Telehealth adds layers of extra compliance for already stretched clinics. That’s why many primary care groups are increasingly depending on medical billing services like RCM Workshop for coding, claims, audits, and reporting both for in-person and virtual visits. Outsourcing brings certain advantages, such as:
- Reduced denials from expert telehealth coders
- Compliance with the latest CMS regulations
- Increased payment accuracy under dual conversion factors
- Stronger support through documentation
- Detailed reporting on telehealth performance
Specialized primary care billing services also assist practices in implementing 2026 changes without an increased internal burden or having to hire additional staff. Utilizing an outside service will allow seamless telehealth billing without administrative interruptions, making virtual care easier for patients.
