Telehealth: A Great Missed Opportunity for Revenue Cycle Leaders

By Jason Jobes

Returning to a topic at the request of one of my readers: Let’s look at Medicare 2022 telehealth participation rates by state.

Is telehealth part of your Medicare strategy? If not, it should be.

Thanks for the post suggestion, I love the engagement and idea generation. For others, please continue to engage in the dialogue. I love hearing about questions or challenges you have or are facing to drive content and learning for all of us.

You can reach me at

The graph below shows what percentage of Medicare patients had a telehealth visit in calendar year 2022 by state. The data is aggregated and doesn’t show what type of visit or service line the patient utilized. Overall participation ranged from 12.9% in North Dakota to 48.1% in California. However, you can see some geographical trends, led by performance in the Northeast and West coast.

Additionally, and something I found interesting, is that the participation rate seemed to be lower in some of the more rural states. In fact, the data does allow for segmentation by rural versus urban and overall the data confirms that. In 2022, the participation rate for rural locations was 22.8% versus the 31.4% for urban geographies.

While overall performance in 2023 Q2 (not depicted) is still up versus pre-pandemic levels, there is significant variability in the change of pre-pandemic to post-pandemic performance. 48 states and the District of Columbia all still have higher telehealth usage rates. The two states who have seen a dip in usage since Q1 2020 (pre-pandemic)? Mississippi and Louisiana, both states that often rank at or near last in overall health.

Hawaii and California have done the best job retaining the use of telehealth with participation falling less than 20% from 2020 levels. Whereas a slew of states have seen telehealth rates fall significantly.

Given all the perceived patient access issues that exist, I really am intrigued that telehealth isn’t used more. While I recognize that many patients have complex conditions that require in-person care or follow-up, a shift to patient wellness and continuously engaging patients seems to be an opportunity.

When I wrote about this on LinkedIn I received some wonderful comments about elderly patients struggling with a lack of smart devices and internet access. In rural areas, internet access remains a real issue. The data in the graph supports this; while the Q2 2023 overall use was 12.7%, of the age groups, only those 0-64 were above that average. In fact, 0-64 had 25.4% use, whereas ages 65-74 was only 11.9%, 75-84 10.6%, and 85+ 10.6%.

So, real challenges remain, but so do opportunities. The article (link below) on our website includes some additional CDI and coding opportunities in the telehealth space you might not have thought of. Please check that out next, as well as another interesting article I’m sharing from Beckers on how Mass General Brigham (Massachusetts) is suing to allow clinicians to treat patients in other states remotely.

If Mass General Brigham wins, it could set an interesting precedent, opening doors for other healthcare organizations treating patients across state lines.

Let us know how Norwood can help you get this underutilized service line up and running, or help with your organization’s risk adjustment strategy. Email


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