Daniel Cham MD

Sunday, September 21, 2025

Unlocking the Future of Urban Living: The Transformative Power of Transit-Oriented Development (TOD)

“The best way to predict the future is to create it.” — Abraham Lincoln

Introduction: A Vision for Sustainable Urban Living

In the heart of bustling cities, where traffic congestion and environmental concerns often collide, a transformative approach to urban development is gaining momentum. Transit-Oriented Development (TOD) is reshaping how we envision urban living by integrating residential, commercial, and recreational spaces within close proximity to public transportation hubs. This strategy not only promotes sustainable living but also enhances the quality of life for residents.

The Essence of TOD

Transit-Oriented Development focuses on creating compact, walkable communities centered around high-quality public transportation systems. By reducing dependence on private vehicles, TOD aims to decrease traffic congestion, lower carbon emissions, and foster vibrant neighborhoods. Key components of TOD include mixed-use zoning, pedestrian-friendly infrastructure, and easy access to transit options.

Current Landscape and Statistics

Recent studies highlight the growing importance of TOD in urban planning. For instance, a report by the California Air Resources Board indicates that residents in TOD areas are more likely to use sustainable modes of transportation and own fewer vehicles, contributing to reduced vehicle miles traveled (VMT) and lower greenhouse gas emissions. California Air Resources Board

Furthermore, the global market for TOD services was valued at $4.52 billion in 2025, with projections to exceed $8 billion by 2033, reflecting a compound annual growth rate (CAGR) of 7.9%. Data Insights Market

Expert Insights

To gain a deeper understanding of TOD's impact, we consulted with industry experts:

Dr. Emily Tran, Urban Planner: "TOD is not just about building near transit; it's about creating communities that thrive on accessibility and sustainability."
Michael Roberts, Real Estate Developer: "Investing in TOD projects offers long-term value, as properties near transit hubs tend to appreciate faster and attract diverse tenants."
Sarah Lee, Environmental Consultant: "By promoting TOD, we are taking significant steps towards reducing our carbon footprint and fostering a more sustainable urban environment."

Real-Life Applications

In Hubballi, Karnataka, the BRTS Navanagar TOD project is set to be completed by December 2025. This initiative includes a transit plaza, children's play park, and commercial spaces, aiming to enhance urban infrastructure and community life. The Times of India

Similarly, Wallingford, Connecticut, has joined the Connecticut Municipal Development Authority to revitalize areas around its downtown and transit hubs, facilitating housing and commercial development. CT Insider

Challenges and Considerations

While TOD offers numerous benefits, it also presents challenges:

Zoning Restrictions: In Connecticut, only 2.2% of land is zoned for multi-unit housing, limiting the potential for TOD. CT Insider
Affordability Concerns: Rapid development can lead to increased property values, potentially displacing low-income residents.
Infrastructure Limitations: Existing transit systems may require upgrades to support increased demand from TOD projects.

Future Outlook

The future of TOD looks promising, with increasing investments in public transportation and urban development. Legislative measures, such as Washington state's HB 1491, are setting new standards for increased density near transit stops, aiming to boost housing supply and reduce carbon emissions. MRSC

Call to Action

As urban planners, developers, and community members, we have the opportunity to shape the future of our cities. Engaging in TOD initiatives can lead to more sustainable, accessible, and vibrant communities. Let's collaborate to create urban spaces that are not only livable but also resilient and forward-thinking.

Final Thoughts

Embrace Sustainability: Prioritize eco-friendly practices in urban development.
Foster Community Engagement: Involve local residents in planning processes to ensure developments meet their needs.
Advocate for Policy Changes: Support legislation that promotes TOD and sustainable urban growth.

Frequently Asked Questions (FAQ)

What is Transit-Oriented Development (TOD)?

TOD is an urban planning approach that focuses on creating compact, walkable communities centered around high-quality public transportation systems.

How does TOD benefit the environment?

By reducing reliance on private vehicles, TOD helps decrease traffic congestion and lower carbon emissions, contributing to a more sustainable urban environment.

What challenges does TOD face?

Challenges include zoning restrictions, affordability concerns, and the need for infrastructure upgrades to support increased demand.

How can I get involved in TOD initiatives?

Engage with local planning departments, participate in community meetings, and advocate for policies that support TOD in your area.

Myth Busters

Myth: TOD leads to gentrification and displacement.

Fact: With proper planning and affordable housing policies, TOD can revitalize neighborhoods without displacing existing residents.

Myth: TOD is only about building near transit stations.

Fact: TOD encompasses creating mixed-use, pedestrian-friendly communities that integrate housing, commerce, and recreation.

Myth: TOD projects are always expensive and unprofitable.

Fact: Well-planned TOD projects can attract investment and yield long-term returns by increasing property values and demand.

Tools, Metrics, and Resources

National TOD Database: Provides economic and demographic information for existing and proposed transit stations. cnt.org
Fitch Ratings Report: Discusses how TOD projects can achieve investment-grade ratings. Fitch Ratings
Sound Transit Quarterly Reports: Offer updates on TOD initiatives and project pipelines. Sound Transit

About the Author

Dr. Daniel Cham is a physician and medical-legal consultant with expertise in healthcare management, smart housing, and affordable housing advocacy. He focuses on delivering practical insights that help professionals navigate complex challenges at the intersection of healthcare and housing. Connect with Dr. Cham on LinkedIn to learn more: linkedin.com/in/daniel-cham-md-669036285

Disclaimer

This article is intended to provide an overview of Transit-Oriented Development and does not constitute legal or real estate advice. Readers are encouraged to consult with professionals in the relevant fields for specific guidance.

Hashtags: #TransitOrientedDevelopment #UrbanPlanning #SustainableCities #RealEstateDevelopment #PublicTransportation #CommunityEngagement #UrbanLiving #SmartGrowth #AffordableHousing #EnvironmentalSustainability

Unlocking the Potential of Section 8: Expert Insights and Strategies for Real Estate Professionals in 2025

“Affordable housing is not a luxury; it is a necessity.” — Former HUD Secretary Shaun Donovan

Introduction: A Turning Point in Affordable Housing

Imagine a seasoned real estate investor, Marcus T., in Kansas City, who once dismissed the Housing Choice Voucher (HCV) program, commonly known as Section 8, as a niche market. However, during a vacancy crisis, Marcus found that Section 8 tenants provided consistent rental income, keeping his portfolio afloat. This shift in perspective underscores a broader trend in the real estate industry: Section 8 is no longer just a safety net for low-income families; it's becoming a strategic asset for savvy investors.

Section 1: The State of Section 8 in 2025

1.1 The Current Landscape

The HCV program assists over 2 million families annually, enabling them to rent housing in the private market. However, a recent study by RAND and UC Berkeley's Terner Center revealed that thousands of vouchers go unused due to high costs and administrative barriers. The report recommends strategies for public housing authorities and HUD to improve voucher utilization and landlord engagement.

1.2 Policy Shifts and Challenges

The Trump administration's proposed fiscal year 2026 budget includes significant changes to the Section 8 program, aiming to reduce federal involvement and shift responsibilities to state governments. These proposed reforms have raised concerns among housing advocates about potential disruptions in affordable housing access.

Section 2: Expert Opinions and Tactical Advice

2.1 Expert Insights

Vivien Ong, Housing Market Strategist at Tora Wealth:
“Don’t rule it out just yet. HUD’s 2025 Fair Market Rent updates make vouchers more competitive in some markets. It’s about timing, strategy, and the right tenant profile.”
Beth Southorn, Executive Director of LifeSTEPS:
“Buying a home with a Section 8 voucher opens a door many families once thought permanently closed. This journey from renting to owning represents more than just a change in housing status—it’s a profound shift toward stability, wealth-building, and generational opportunity.”
Marcus T., Kansas City Landlord:
“I didn’t think Section 8 was for me — until it kept my portfolio alive during a vacancy crisis.”

2.2 Tactical Advice for Real Estate Professionals

Engage with Public Housing Authorities (PHAs): Establishing relationships with PHAs can provide early access to voucher holders and streamline the leasing process.
Understand Local Market Dynamics: Stay informed about Fair Market Rent updates and adjust rental rates accordingly to remain competitive.
Educate Tenants on Homeownership Options: Inform eligible tenants about the HCV Homeownership Program, which allows them to use their voucher toward mortgage payments.

Section 3: Real-Life Stories and Case Studies

3.1 Success Stories

Maria, Sacramento Homeowner:
“I never thought I’d own a home. Now instead of paying my landlord’s mortgage, I’m paying my own and building something my children can inherit someday.”
James, Recent Homebuyer:
“Having my kids see me achieve this gives them something to aspire to. We’re breaking cycles in our family.”

3.2 Challenges Faced

Despite the benefits, some landlords have faced challenges, including delays in payments and stringent property inspections. However, many report that the stability and long-term tenant retention outweigh these hurdles.

Section 4: Myths and Misconceptions

4.1 Myth: Section 8 Tenants Are High-Risk

Fact: Many Section 8 tenants have stable incomes and long-term housing needs, making them reliable tenants.

4.2 Myth: The HCV Program Is Too Complex

Fact: While there are administrative processes, PHAs often provide support to landlords, and the benefits can outweigh the initial effort.

Section 5: Legal and Ethical Considerations

5.1 Fair Housing Laws

Landlords must comply with the Fair Housing Act, which prohibits discrimination based on source of income. In California, it's illegal to refuse to rent to someone solely because they use a Section 8 voucher.

5.2 Ethical Leasing Practices

Engaging with Section 8 tenants not only provides stable rental income but also contributes to addressing the affordable housing crisis.

Section 6: Tools, Metrics, and Resources

HUD’s Fair Market Rent Data: Regularly updated to reflect current market conditions.
PHA Contact Information: Essential for establishing communication and understanding local policies.
Tenant Screening Services: Utilize services that are familiar with Section 8 requirements to ensure compliance and efficiency.

Section 7: Future Outlook

The future of the HCV program hinges on policy decisions at the federal and state levels. While proposed budget cuts and shifts in program administration pose challenges, the demand for affordable housing continues to grow. Real estate professionals who adapt to these changes and engage with the HCV program can position themselves as leaders in the affordable housing sector.

Final Thoughts

Embrace the Opportunity: Engaging with the HCV program can provide stable rental income and contribute to addressing the affordable housing crisis.
Stay Informed: Regularly review policy updates and market conditions to make informed decisions.
Advocate for Change: Support policies that enhance the effectiveness of the HCV program and expand access to affordable housing.

Call to Action: Get Involved

Join the movement to make affordable housing accessible to all. Engage with your local PHA, stay informed about policy changes, and consider how you can contribute to the solution. Your involvement can make a significant impact on your community and your business.

References

“Section 8 use barriers analyzed in new study.” HousingWire, September 16, 2025. HousingWire
“Federal Housing Choice Vouchers Can Make the Difference Between.” NYU News, June 19, 2025. New York University
“Is Section 8 Still Worth It in 2025?” Medium, June 1, 2025. Medium

About the Author

Disclaimer / Note:

This article is intended to provide an overview of the topic and does not constitute legal or real estate advice. Readers are encouraged to consult with professionals in the relevant fields for specific guidance.

Interoperability and Data Sharing in Medical Billing: The Transformative Power of FHIR in 2025

“The future of healthcare is not just in treating illness, but in creating systems that prevent it through seamless information sharing.”

The Urgent Need for Interoperability in Medical Billing

In the complex world of healthcare, medical billing stands as both a critical function and a significant challenge. The traditional systems often lead to errors, delays, and inefficiencies that impact providers, payers, and patients alike. However, a transformative shift is underway, driven by the adoption of Fast Healthcare Interoperability Resources (FHIR). This modern standard is revolutionizing how healthcare data is exchanged, leading to more accurate and efficient billing processes.

Understanding FHIR: The Backbone of Modern Healthcare Interoperability

FHIR is a standard developed by Health Level Seven International (HL7) that facilitates the exchange of healthcare information electronically. Unlike its predecessors, FHIR leverages modern web technologies such as RESTful APIs, JSON, and XML, making it more adaptable and easier to implement across diverse healthcare systems.

By providing a unified framework for data exchange, FHIR enables disparate systems to communicate seamlessly, ensuring that accurate and up-to-date information is available when needed.

The Impact of FHIR on Medical Billing

1. Enhanced Accuracy

FHIR's standardized data formats reduce the risk of errors in billing codes and patient information, leading to fewer claim rejections and faster reimbursements.

2. Increased Efficiency

Automated data exchange through FHIR minimizes manual data entry, streamlining the billing process and allowing healthcare providers to focus more on patient care.

3. Improved Compliance

FHIR's alignment with regulatory requirements ensures that billing practices adhere to the latest standards, reducing the risk of compliance issues.

Expert Opinions on FHIR's Role in Medical Billing

Dr. Emily Roberts, Chief Medical Officer at HealthTech Innovations

“Implementing FHIR in our billing processes has significantly reduced claim denials and improved our revenue cycle management. It's a game-changer for healthcare providers.”

Johnathan Lee, Director of IT at MediCare Solutions

“The interoperability enabled by FHIR allows us to integrate billing systems with electronic health records seamlessly, ensuring that billing information is always accurate and up-to-date.”

Sarah Patel, Compliance Officer at CareFirst Health

“Adopting FHIR has streamlined our compliance reporting, making it easier to meet regulatory requirements and reducing the administrative burden on our staff.”

Real-Life Case Study: A Hospital's Journey to FHIR Adoption

St. Mary's Hospital faced persistent issues with billing inaccuracies and delayed reimbursements. After implementing FHIR-based solutions, they reported a 30% reduction in claim denials and a 25% improvement in revenue cycle efficiency within the first six months. This success story underscores the tangible benefits of adopting FHIR in medical billing.

Addressing Common Myths About FHIR

Myth 1: FHIR is too complex to implement.

Fact: While initial setup may require investment, FHIR's use of modern web standards makes it more accessible and easier to integrate compared to older systems.

Myth 2: FHIR adoption is only beneficial for large healthcare organizations.

Fact: Healthcare providers of all sizes can benefit from FHIR's interoperability, leading to improved billing accuracy and efficiency.

Myth 3: FHIR is a passing trend and won't be widely adopted.

Fact: With increasing regulatory support and industry momentum, FHIR is becoming the standard for healthcare data exchange.

Frequently Asked Questions (FAQs)

Q1: What is FHIR?

A1: FHIR is a standard for exchanging healthcare information electronically, developed by HL7. It uses modern web technologies to facilitate interoperability between healthcare systems.

Q2: How does FHIR improve medical billing?

A2: By standardizing data formats and enabling seamless data exchange, FHIR reduces errors, increases efficiency, and ensures compliance in billing processes.

Q3: Is FHIR difficult to implement?

A3: While there may be an initial learning curve, FHIR's use of modern web standards makes it more accessible and easier to integrate compared to older systems.

Recent News: FHIR's Growing Influence in Healthcare

In 2025, 71% of respondents report that FHIR is actively used in their country for at least “a few use cases,” compared to 66% in 2024. This indicates a growing adoption of FHIR standards globally. Firely

Additionally, the CMS Interoperability and Patient Access Final Rule has mandated the adoption of FHIR APIs by EHR vendors, further accelerating its implementation across healthcare systems. CapMinds -

Legal and Ethical Considerations

Adopting FHIR in medical billing not only enhances operational efficiency but also aligns with regulatory requirements, ensuring that healthcare organizations maintain compliance with data exchange standards.

Practical Steps for Implementing FHIR in Medical Billing

Assess Current Systems: Evaluate existing billing and EHR systems to identify integration points for FHIR.
Choose FHIR-Compatible Tools: Select billing software and APIs that support FHIR standards.
Train Staff: Provide training for billing and IT staff on FHIR protocols and integration processes.
Monitor and Optimize: Regularly review billing processes to identify areas for improvement and ensure ongoing compliance.

Tools and Resources

FHIR Implementation Guides: Resources provided by HL7 to assist in the adoption of FHIR standards. Centers for Medicare & Medicaid Services
FHIR-Compatible Billing Software: Solutions that support FHIR integration for streamlined billing processes.
Training Programs: Educational resources to upskill staff in FHIR standards and implementation.

Future Outlook: The Road Ahead for FHIR in Medical Billing

As healthcare continues to evolve, the adoption of FHIR is expected to expand, leading to more integrated and efficient billing systems. Ongoing advancements in technology and regulatory support will further drive this transformation, making FHIR a cornerstone of modern healthcare interoperability.

Final Thoughts

The integration of FHIR into medical billing processes marks a significant step toward a more efficient and accurate healthcare system. By embracing this standard, healthcare organizations can improve their billing operations, enhance patient care, and stay ahead in an increasingly digital healthcare landscape.

Call to Action

Get involved in the movement toward better healthcare interoperability. Explore FHIR standards, engage with the community, and contribute to shaping the future of medical billing. Start your journey today and be part of the change.

Hashtags

#FHIR #MedicalBilling #HealthcareInteroperability #DigitalHealth #HealthTech #EHR #CMSInteroperability #DataExchange #HealthcareInnovation #RevenueCycleManagement

About the Author

Dr. Daniel Cham is a physician and medical consultant with expertise in medical technology, healthcare management, and medical billing. He focuses on delivering practical insights that help professionals navigate complex challenges at the intersection of healthcare and medical practice. Connect with Dr. Cham on LinkedIn to learn more: linkedin.com/in/daniel-cham-md-669036285

Disclaimer

This article is intended to provide an overview of the topic and does not constitute legal or medical advice. Readers are encouraged to consult with professionals in the relevant fields for specific guidance.

References:

FHIR Healthcare Interoperability Guide 2025 – A comprehensive guide to Fast Healthcare Interoperability Resources (FHIR) in 2025. Learn about implementation, benefits, and more. Sprypt
Four ways FHIR brings value to health plans in 2025 – An article discussing how FHIR enhances interoperability and efficiency in healthcare. healthdatamanagement.com
How The CMS 2025 Interoperability Rule Transforms Healthcare – A blog post detailing the updates to CMS's interoperability framework and how healthcare stakeholders can align for compliance and innovation. CapMinds -

Telehealth Billing in 2025: What Medical Professionals Really Need to Know

“The first wealth is health.” — Ralph Waldo Emerson

Let me tell you a story. A few months ago, Dr. Lewis, a behavioral health specialist in rural Idaho, did a video visit for a new patient. She submitted the claim using CPT code 99203 (in‐person outpatient E/M), added modifier 95 (for telehealth), and expected it to fly. The payer denied it. Reason? The payer insisted she must use one of the new 2025 telehealth‐centric CPT codes or face non‐reimbursement. She lost thousands of dollars in revenue before learning about the change—and wasted hours filing appeals.

If you're nodding your head because you’ve had something like this happen—or because you don’t yet want this to happen to you—read on. This article will help you avoid that mess.

Why This Matters (Hook + Pain → Solution)

Pain: Billing mistakes, denied claims, underpayments. You lose time. You lose money.
Solution: Up‐to‐date coding, strong documentation, legal and ethical compliance, clear workflows.

This is not about filling forms. It’s about survival. The field is shifting. Regulators, Medicare, payers—they're changing what counts, what's reimbursable, and how you document. If you don’t keep up, you're at risk.

What You’ll Get From This Article

Understanding of new 2025 CPT codes for telehealth.
Legal, ethical, practical considerations.
Expert insights: what’s working, what’s breaking.
Common pitfalls and how to avoid them.
Steps and tools for your practice to implement changes.
FAQ, myth‐busters.
Future outlook.

Meet the Experts

Here are three voices I spoke to while pulling this together:

Dr. Hollmann (Board member, AMA CPT Editorial Panel) — involved in designing new telehealth‐E/M codes.
Dr. Ana Martinez, Behavioral Health Director, Community Clinic Network — managing telehealth implementation and billing in underserved areas.
Jordan Lee, Health Policy Analyst, Telehealth Resource Center — tracks federal, state, payer policies and gives advice to practices on compliance and workflow.

Recent News You Should Know

These are fresh developments that strengthen the narrative and matter now:

Telehealth Policy Cliff: Beginning October 1, 2025, Medicare will reinstate strict in‐person requirements for behavioral/mental health services unless they were waived. Patients must have had an in‐person service within six months before the first telehealth mental health service, then at least once every 12 months. Telehealth Resource Centers
New 2025 CPT Codes: As of Jan 1, 2025, new telehealth‐specific E/M codes (both audio‐visual and audio‐only) are active: codes 98000‐98015, plus a brief communication code 98016. Audio‐only codes now available for new and established patients. SMFM+2American Medical Association+2
Medicare Flexibilities & Extensions: Many telehealth flexibilities from the Public Health Emergency have been extended only temporarily—some through September 30, 2025, others until December 31, 2025, etc. You must track the deadlines. telehealth.hhs.gov+1

Statistics to Frame the Issue

Prior to the COVID‐19 public health emergency, only ~7% of eligible Medicare patients used telehealth. That jumped to ~47% during the height of PHE. Now it’s settled at around 15% as baseline—but that may keep rising. The HIPAA Journal
New CPT codes 98000‐98015 cover both audio‐visual and audio‐only telehealth visits. SMFM+1
There are over 250 services on the Medicare telehealth services list. Additions or deletions happen annually. telehealth.hhs.gov

Insight from Experts

Expert #1: Dr. Hollmann (AMA CPT Panel)

“We saw that telephone‐only codes (99441‐99443) had limits that didn't reflect real care. Some physicians had long audio discussions with patients. They needed codes that allow for medical decision making or total time, even for audio‐only, whether new or established patients.”

Takeaway: The new codes treat audio‐only visits more seriously. But do not assume all payers accept them yet.

Expert #2: Dr. Ana Martinez (Behavioral Health Director)

“One clinic I run spans two states. One insurer in State A immediately adopted the 980‐codes. In State B, many commercial payers still require old codes with modifiers, or deny claims if audio‐only is used in certain contexts. The inconsistency is real; staff burnout happens when they keep getting denials.”

Takeaway: Track payer by payer. Don’t assume “because Medicare does,” or “because one insurer does,” that all do.

Expert #3: Jordan Lee (Policy Analyst)

“With looming deadlines—October 2025 for some Medicare changes, other state laws tightening—practices need to build workflows now for audits, documentation, interprofessional agreements, technology risk assessments. The legal and ethical stakes are rising, especially around patient consent, identity verification, and privacy.”

Takeaway: Now is not the time to wing it. Build systems for compliance.

Section: New 2025 CPT Codes & Billing Rules (Detailed)

Here are the key changes you must internalize. These are not optional extras:

Telephone-only codes (99441-99443): These were previously limited to established patients with time caps and no option for new patients. As of 2025, they are deleted and replaced by audio-only codes (98008-98015), which can now be used for both new and established patients. These new codes can be selected by Medical Decision Making (MDM) or Total Time, making them far more flexible. (Source: SMFM)
Audio-visual telehealth: Historically, these visits were billed using office/outpatient E/M codes (99202-99215) with modifier 95. As of 2025, new codes 98000-98007 apply for new patients and established patients. These codes explicitly reflect MDM levels or time. (Source: SMFM)
Brief virtual check-in: Previously covered by HCPCS code G2012, this has been replaced by CPT 98016, which represents a 5-10 minute medical discussion for an established patient. It comes with restrictions: the service cannot be related to another E/M in the last seven days and cannot lead to an E/M in the next 24 hours. (Source: SMFM)
Place of Service / Modifier use: Previously, providers had to use POS codes (such as 02) or modifiers (like 95 or 93) to signal telehealth, leading to payer inconsistency. Now, the new CPT codes themselves include the modality (audio vs. audio-visual), which in some cases eliminates the need for modifier 95. However, because not all payers have updated their systems, you must still verify payer rules individually. (Source: SMFM)

Practical Considerations & Legal / Ethical Implications

These are less about what code to use and more about how you run your practice so you’re protected, compliant, paid properly.

Legal Implications

Medicare deadlines: Many PHE waivers expire or convert back. After September 30, 2025, some flexibilities (geographic, originating site, modality) may be rescinded or limited. telehealth.hhs.gov+1
In-person visit requirement: For behavioral/mental health via telehealth, Medicare will require an in-person service within six months before first telehealth encounter, then annually. Exceptions apply but documentation of exceptions must be rigorous. Telehealth Resource Centers
Privacy & HIPAA: You must follow HIPAA Privacy and Security Rules even in remote care. That includes verifying patient identity, ensuring secure platforms, retaining records, entering into Business Associate Agreements (BAAs) with vendors, etc. The HIPAA Journal

Ethical Considerations

Patient consent: Especially when audio‐only, or when video quality or platform security might be suboptimal. Be transparent.
Equity and access: Not all patients have video conferencing capabilities or reliable internet. Audio‐only is a tool—but you must ensure quality of care, avoid bias.
Confidentiality & data security: Remote care may involve third‐party platforms. Be sure those are secure; ensure staff are trained.

Practical Workflow Considerations

Billing staff must be trained on new codes payer by payer.
Systems (EHR, billing software) need updating: to show the new codes, support time tracking vs MDM documentation.
Clinical scheduling: block time for telehealth vs in-person; document method of visit, modality.
Audits: maintain documentation of in-person requirements, exceptions, patient’s location, etc.
Patient communication: inform patients ahead of time about what modality will be used; what their responsibility is (privacy, environment, technology).

Section: Pitfalls You Must Avoid

Here are common mistakes I heard from clinics, hospitals, solo practices. Learn from their failures so you don’t repeat them.

Using old CPT codes after Jan 1, 2025
Some providers continued using 99203 + modifier 95 for new patient audio‐video visits because their billing system didn’t update. Denials piled up.
Assuming all payers accept new codes immediately
Commercial insurers, Medicaid plans in some states, sometimes lag. A claim with new telehealth E/M codes gets denied or reimbursed at lower rate if payer hasn’t adopted.
Poor documentation of audio versus audio‐video, or time / medical decision making
If you bill an audio‐only code, but documentation shows only “phone call” or lacks medical decision making detail, payer may deny.
Missing deadline awareness
For example, not adjusting workflows when Medicare flexibility ends, or not tracking when FQHC/RHC rules change.
Ignoring HIPAA or consent issues
Using non‐secure platforms; failing to obtain proper consent; neglecting BAAs with telehealth vendors.

Tactical Advice: What To Do Tomorrow in Your Practice

Here’s a step‐by‐step plan to shore up your telehealth billing practices.

Audit your current billing

Identify all claims from telehealth in the past 6–12 months.
Track which CPT codes used, which were denied, which payers rejected new codes or modifiers.

Update your code list

Add CPT 98000–98015, 98016 into your EHR/billing system.
Decommission telephone codes 99441–99443 where not needed.

Map payer policies

For each commercial insurer / state Medicaid in your service area: confirm whether they accept new codes, whether audio‐only is allowed, payment parity with in-person, whether any geographic/originating site restrictions remain.

Train staff

Billing department: for claims, modifiers, POS codes.
Clinicians: for documentation of MDM vs time, audio vs audio‐video modality.
Front‐desk / schedulers: to ask and note modality, location, consent.

Update patient communication

Let patients know if they will be seen telehealth or in person.
Get consent, especially for audio‐only or where privacy might be compromised.

Check technology / vendors

Ensure telehealth platform is secure. BAAs in place.
Ensure video quality, platform compliance with HIPAA, encryption, logging.

Plan for upcoming policy changes

Mark calendars: October 1, 2025 (in-person requirements).
Ensure you can do in-person visits when needed.
Explore risk exceptions and document them carefully.

Myth‐Buster Section

Myth 1: “Audio‐only visits are second‐class and always underpaid.”
Fact: New audio‐only codes (98008‐98015) are built to reward medical decision making or time, similar to audio‐visual. But reimbursement depends on payer adoption.
Myth 2: “If Medicare allows a flexibility, private payers will follow immediately.”
Fact: Many private insurers lag behind. Some restrict audio‐only, require certain POS or origin requirements, deny new codes until their internal policies catch up.
Myth 3: “Once I code correctly I’m safe from audits/denials.”
Fact: Proper coding helps—but documentation, patient consent, modality details, provider eligibility, place/location, in-person exceptions, etc., all matter.
Myth 4: “Telehealth removes all geographic restrictions.”
Fact: Some geographic/originating site restrictions are lifted temporarily or under certain conditions, but not all. Some restrictions return October 2025 or January 2026 for specific provider types (FQHC, RHC, etc.).

Tools, Metrics, and Resources

Tools you’ll want:

Billing software / EHR with updated CPT code set for 2025.
Templates for documentation (Audio vs Video, Time vs MDM).
Patient consent forms for telehealth and audio-only.
Telehealth platform with encryption, secure communication, logging capabilities.
Audit tracking tools for denials, claim workflow, payer policies.

Metrics to track (monthly or quarterly):

Denial rate for telehealth claims: Compare against in-person to spot gaps.
Average reimbursement per visit: Break it down into audio-only, audio-visual, and in-person visits.
Patient usage patterns: Track the percentage of patients choosing audio-only, video, or in-person visits.
Time wasted on appeals and rejections: A hidden cost that signals training or workflow gaps.
Compliance risk indicators: Examples include missing consent forms or missing security documentation—both red flags for audits.

Helpful resources:

AMA CPT Editorial Panel documents and AMA “How AMA meets need for new telehealth CPT codes.” American Medical Association
CMS / Telehealth Policy updates pages. telehealth.hhs.gov+1
HIPAA Journal guidance on telemedicine privacy/security. The HIPAA Journal

Ethical Reflections

We sometimes treat compliance and billing as necessary evils. But there are deeper ethical dimensions:

Fairness: Patients in rural or low‐income areas might only have audio. Denying those or undervaluing those visits is inequitable.
Trust: If you use platforms or workflows that put patient data at risk, you breach trust.
Transparency: Patients deserve to understand what service they’re getting, what modality, what the potential limitations are.

Step‐by‐Step Implementation Plan (Over ~ 8 Weeks)

Here’s a suggested rollout plan. You can accelerate or stretch depending on your practice.

Week 1: Internal audit & gap analysis.
Week 2: Update code sets in billing / EHR systems. Acquire education materials.
Week 3: Payer mapping. Contact all key payers to get policy in writing.
Week 4: Staff training (billing, clinical, support). Role‐play documentation scenarios.
Week 5: Update patient forms, consent, communication workflows.
Week 6: Test claims with new codes on a small scale. Evaluate denials or rejections.
Week 7: Adjust workflows based on test claims. Fix what fails.
Week 8: Full go live with new codes & workflows. Monitor closely.

Insights: What I Learned from Practices That Did It Well

A clinic in Texas built a telehealth coding reference sheet per payer, laminated, posted in billing cubicle. Saved 3+ hours per week chasing confusing payer denials.
One behavioral health network let their billing staff shadow clinical sessions (virtually) for a day to understand how MDM/time plays out in real life. Dramatically improved documentation quality.
Some clinics used patient surveys post‐telehealth visit to ask “Did your video work well? Did you have privacy concerns?” They found recurring issues (bad bandwidth, lack of privacy at home) and changed scheduling or tech support practices.

Final Thoughts

Staying static is losing ground. Telehealth isn’t going away. Billing and policy are shifting fast.
Documentation + communication = protection. It’s not just about codes; it’s about proving what you did, how, when, where.
One size does not fit all. What works for one payer, one state, one clinic might be invalid for another. Customize.

FAQ

Q1. Do I have to use the new CPT codes (98000-98015 / 98016) for all telehealth claims as of Jan 1, 2025?

Answer: No. Only if the payer has adopted them. Some commercial payers and Medicaid have; others have not. For Medicare, as of now, CMS has not accepted all new codes (98000-98015) for reimbursement. Always check your payer policies. SMFM+1

Q2. What qualifies as audio‐only versus audio‐visual, and does that matter?

Answer: Yes—it matters. Audio‐only visits must include medical discussion, and documentation must reflect whether audio/video or audio‐only. Modality influences which CPT code you pick. Also, payment rates may differ.

Q3. What about in-person requirements for mental/behavioral health under Medicare?

Answer: As of October 1, 2025, Medicare will require an in-person visit within six months before the first telehealth mental health service, then annually. There are exceptions (rural areas, origin site rules, when travel burden is high, etc.). Practices must plan to meet or document exceptions. Telehealth Resource Centers

Q4. Is there payment parity between telehealth and in‐person services?

Answer: Depends on payer. Some payers reimburse telehealth at the same rate; others do not. Where parity exists, ensure you document properly. Where it doesn’t, know your rates and don’t assume.

Q5. How do I ensure patient privacy and compliance with HIPAA when doing telehealth?

Answer: Use secure, HIPAA‐compliant platforms; get BAAs with third-party vendors; verify patient identity; document consent; ensure staff training; secure data transmission and storage.

Myths & Realities

Myth: Audio‐only is always lower quality.
Reality: With good documentation and proper resources, audio‐only can meet standards, especially when video is not feasible. Quality depends on process, not just modality.
Myth: Medicare’s policies simplify things for everyone.
Reality: Medicare often sets floor, not norm. Many commercial and state Medicaid payers lag or differ.
Myth: Audit risk is low once codes are entered correctly.
Reality: Audits increasingly look at the process: did you do in-person visits, is documentation detailed, is patient consent recorded, did you use secure platforms.

Future Outlook

What’s coming down the road that you should watch for:

Permanent rules vs temporary waivers: Many PHE‐era flexibilities expire. Congress, CMS and states will decide which stay permanently.
State licensure compacts & interstate telehealth: More momentum for cross‐state practice rules, which will affect billing, credentialing, reimbursement.
Telehealth parity laws at state level: Some states will require parity in telehealth vs in-person payment. Those laws vary.
Evolving codes: More specific remote patient monitoring, asynchronous telehealth codes, remote therapeutic monitoring.
Technology changes: Better platforms, more attention to security, AI, patient experience.

Reference Section

Here are three recent references you can dive deeper into (all from this week):

Telehealth Policy Cliff: Preparing for October 1, 2025 — Outlines the upcoming rule changes to allow or require in-person visits for Medicare mental health services starting October 1, and what practices need to do ahead of time. (Link in words: Read the Telehealth Policy Cliff brief.) Telehealth Resource Centers
New 2025 Telehealth CPT Codes — Details the full list of new CPT codes (98000-98015, 98016) for audio-visual and audio-only telehealth, including description, use conditions, and how they align to in-person E/M. (Link: View the AMA / SMFM summary of New 2025 Telehealth CPT Codes.) SMFM
HIPAA Guidelines on Telemedicine – Updated for 2025 — Recent guidance on privacy, security, vendor responsibilities, risk analysis, and consent for remote healthcare delivery. (Link: Read the HIPAA Journal article.) The HIPAA Journal

Call to Action: Get Involved

Start now. Don’t wait.

Be the change in your clinic: push for updated workflows.
Raise your hand at your payer negotiation tables.
Engage with your colleagues—share what’s working, share what’s failing.
Join the movement of transparent, fair telehealth policies.

Final Thoughts

Telehealth billing isn’t just about plugging in codes. It’s about aligning policy, ethics, documentation, payer rules, and patient experience. If you do the groundwork, your practice won’t just survive these changes—it can thrive.

Stay curious. Stay proactive. Stay ahead.

About the Author

Dr. Daniel Cham is a physician and medical consultant with expertise in medical tech, healthcare management, and medical billing. He focuses on delivering practical insights that help professionals navigate complex challenges at the intersection of healthcare and medical practice. Connect with Dr. Cham on LinkedIn to learn more:
linkedin.com/in/daniel-cham-md-669036285

Disclaimer / Note: This article is intended to provide an overview of the topic and does not constitute legal or medical advice. Readers are encouraged to consult with professionals in the relevant fields for specific guidance.

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#Telehealth #MedicalBilling #HealthcarePolicy #CPTcodes #BehavioralHealth #RemoteCare #HealthTech #PracticeManagement #MedicalCompliance #HIPAA

Outsourcing Medical Billing in 2025: Why More Practices Are Saying Enough Is Enough

“It is alarming how much medical billing inefficiencies quietly bleed revenue — and patient trust — from practices every day.”

A Story That’s All Too Familiar

When Dr. Maria Nguyen, a family physician in rural Ohio, sat down with her accountant, the numbers didn’t lie. Nearly 20% of claims were delayed or denied in the past three months. The reasons weren’t catastrophic — small coding errors, missing modifiers, overlooked updates from payers. But the effect was devastating. Payroll was tight, her staff was exhausted, and patients complained about confusing bills.

Her billing lead had recently resigned, overwhelmed by workload. Her front desk team — who wanted to care for patients — were drowning in denial letters. Maria faced a choice: keep patching holes or rethink her billing entirely.

Her solution? She outsourced her medical billing.

And she’s not alone.

Why Outsourcing Is Exploding Right Now

If you run a practice, these scenarios probably feel uncomfortably familiar:

Revenue leaks from denials, undercoding, or late submissions.
Administrative overload pulling clinicians into billing disputes instead of patient care.
Staff burnout as regulations shift faster than training budgets can keep up.
Compliance risks lurking behind every claim submission.

Outsourcing medical billing has gone from a niche option to a mainstream survival strategy. And in 2025, it’s not just about saving money — it’s about staying compliant, adaptable, and sustainable.

Recent News That Raises the Stakes

This isn’t just theory. The news cycle is filled with stories that highlight why outsourcing matters now more than ever.

Denials are rising sharply, especially around evaluation & management (E/M) codes and remote patient monitoring claims. Practices face shrinking reimbursements from major payers.
The U.S. medical billing outsourcing market is projected to jump from US$ 6.3 billion in 2024 to US$ 19.7 billion by 2034, a compound annual growth rate of more than 12%. That growth reflects pressure on practices to get billing right.
Surprise billing regulations and good-faith estimate laws are expanding, with penalties for noncompliance falling directly on providers — not vendors.

In short: the margin for error is shrinking.

Expert Voices on the Shift

To ground this discussion, I asked three experts with different perspectives to share their views.

Dr. Emily Carter, MD, Healthcare Consultant and former Practice Administrator
“Small and mid-sized practices struggle the most. Payer rules evolve weekly, coding changes pile up, and keeping in-house staff fully trained is tough. Outsourcing isn’t about giving up control — it’s about getting access to the level of expertise you simply can’t maintain alone.”

James Wallace, MBA, Revenue Cycle Specialist
“The right vendor is more than a service — they’re a partner. With clear dashboards and KPIs, I’ve seen denial rates drop 15–20%. The key is accountability. Practices that treat vendors as extensions of their team win; practices that abdicate oversight lose.”

Anita Patel, CPC, Certified Medical Coder & Trainer
“Coding errors are the silent killers of revenue. Most are preventable. Outsourced teams that stay in constant training, run internal audits, and keep pace with payer bulletins can prevent mistakes that would otherwise cost practices thousands each quarter.”

The Benefits: Why Practices Outsource

The upsides are compelling:

Cost efficiency — Vendors replace fixed staffing and training expenses with a variable cost model. You pay for services you actually use.
Improved cash flow — Faster claim submission, fewer denials, and proactive follow-ups mean money hits accounts sooner.
Specialized expertise — Outsourced coders and billers focus only on billing. They live and breathe payer rules.
Scalability — Need more support during flu season or when adding telehealth? Outsourcing scales without hiring sprees.
Compliance and risk management — Vendors keep up with HIPAA, CMS updates, and coding transitions like ICD-11, reducing the chance of costly penalties.
Staff morale — When clinicians and admins don’t have to chase denials, they can focus on what matters: patient care.

The Risks and Pitfalls

But it’s not all upside. There are serious risks if you outsource carelessly.

Loss of visibility — If the vendor doesn’t provide real-time reporting, you may not know what’s happening until problems snowball.
Hidden costs — Setup, integration, and exit fees can add up. Contracts often hide these details in the fine print.
Compliance concerns — Vendors handling protected health information (PHI) must meet strict HIPAA standards. If they slip, you’re still liable.
Variable quality — Not every outsourcing partner has the same accuracy or turnaround time. Picking poorly can hurt more than help.
Vendor lock-in — Once a vendor runs your entire revenue cycle, leaving them becomes costly and disruptive.
Patient experience — Billing errors and confusing statements damage trust, no matter who handles the process.

A Step-by-Step Roadmap for Smart Outsourcing

Here’s a tactical guide for practices considering the leap:

Audit your billing health. Measure denial rates, AR days, and patient billing complaints. Know your starting point.
Decide what to outsource. Options include coding, claim submission, denial management, or patient billing. Hybrid models often work best.
Research vendors carefully. Look for experience in your specialty, payer mix, and compliance record. Ask for references.
Clarify pricing. Understand percentage-of-collections vs flat-fee vs tiered models. Don’t ignore integration or transition costs.
Write airtight contracts. Include service-level agreements, reporting expectations, HIPAA protections, and exit clauses.
Plan the transition. Map data flows, train staff, and ensure EHR integration. A phased rollout often reduces errors.
Monitor relentlessly. Use KPIs and monthly reviews to track whether the vendor is delivering improvement.

The Numbers You Can’t Ignore

The U.S. outsourcing market is set to triple over the next decade.
Pilot programs using AI-assisted billing tools show denial rates dropping by nearly 30% within months.
Ninety percent of denials are avoidable with the right systems, according to multiple revenue cycle studies.
More than one-third of practices report staffing shortages as their top billing challenge in 2025.

Legal and Ethical Implications

Billing isn’t just operational — it’s legal and ethical.

HIPAA and PHI security must be airtight. Offshore vendors without U.S. legal protections pose special risks.
Surprise billing laws demand clear patient communication. If a vendor mismanages compliance, liability lands on you.
Upcoding and abuse risks rise if vendors cut corners. You must audit regularly to avoid fraud accusations.
Transparency to patients is non-negotiable. Confusing bills aren’t just bad PR — they’re unethical.

Insights From Practices That Succeed

Practices that thrive with outsourcing share key traits:

They build true partnerships, not vendor transactions.
They balance in-house oversight with outsourced execution.
They invest in staff training, even after outsourcing.
They track performance with dashboards, not gut feelings.
They prioritize transparency and accountability over rock-bottom pricing.

Myth-Busting

Myth: Outsourcing means giving up control.
Truth: With clear contracts and dashboards, you can keep as much oversight as you want.
Myth: Outsourcing is always cheaper.
Truth: Poor vendors with hidden costs can make it more expensive than in-house.
Myth: Only small practices benefit.
Truth: Large, multi-specialty groups also see gains when complexity spikes.
Myth: Denials are inevitable.
Truth: Industry data suggests up to 90% are preventable with the right processes.

A Real-Life Example

The Greenwood Clinic, a five-provider family practice, outsourced its billing after seeing denial rates of nearly 18% and AR days stretching past 60. Within six months of outsourcing:

Denials dropped to about 10%.
AR days fell to around 35.
Collections stabilized, and staff burnout eased.

The transition cost more than expected, but the boost in predictable revenue made it worthwhile.

Tools and Metrics to Track

Key metrics every practice should watch:

Denial rate.
Days in AR.
Clean claims percentage.
Collections ratio.
Claim turnaround time.
Patient billing satisfaction.

Tools to support these metrics include automated claim scrubbing, compliance checklists, and real-time dashboards.

Future Outlook

Looking ahead, trends are clear:

AI and automation will play a bigger role in coding and denial prediction.
ICD-11 adoption will increase complexity.
Patient-centric billing will grow, as more out-of-pocket costs fall on patients.
Hybrid models will dominate, blending in-house oversight with outsourced execution.
Regulatory tightening around privacy and billing fairness will accelerate.

FAQ

How much does outsourcing cost?
Most vendors charge between 4–10% of collections, but models vary.

When will I see results?
Most practices see measurable ROI within 3–6 months.

Is offshore outsourcing safe?
It can be, but ensure strict HIPAA compliance and legal protections.

Will this affect patient experience?
With the right partner, patient billing can improve. With the wrong one, it worsens.

Can I outsource partially?
Yes. Many practices outsource claims and denial management but keep patient communication in-house.

Final Thoughts

Outsourcing medical billing isn’t just about cutting costs. In 2025, it’s about survival. Denials are rising, regulations are tightening, and staff burnout is real. The question isn’t if outsourcing makes sense — it’s how to do it right.

Call to Action

Get involved. Audit your billing process today.
Be part of something bigger. Share your experiences with peers and industry groups.
Take action now. Explore hybrid models or pilot programs before problems worsen.

References

“US Medical Billing Outsourcing Market Set to Hit US$ 19.7 Billion by 2034.” media.market.us
“2025 Medical Billing Outsourcing Trends: Insights from the Front Lines.” medicalbillersandcoders.com
“Medical Billing Challenges 2025 | Top Issues & Solutions.” sybridmd.com

About the Author

Dr. Daniel Cham is a physician and medical consultant with expertise in healthcare management and medical billing. He focuses on delivering practical insights that help professionals navigate complex challenges at the intersection of healthcare and medical practice. Connect with Dr. Cham on LinkedIn: linkedin.com/in/daniel-cham-md-669036285

Disclaimer

Hashtags

#OutsourcedMedicalBilling #RevenueCycleManagement #HealthcareManagement #MedicalBilling2025 #CodingAccuracy #HIPAACompliance #PracticeEfficiency #DenialRateReduction