Telehealth best practices for video visits

A good video visit is mostly decided before the call starts. Practices that run telehealth well prepare the patient and the technology ahead of time, confirm who and where the patient is in the first minute, use a platform covered by a business associate agreement, plan for interpreters and audio-only fallbacks, and document modality and patient location so the claim matches the care. They also agree in advance on when a video visit should become an in-person one.

This guide covers each step and ends with where Medicare telehealth rules stand as of October 2026. The short version: Medicare's expanded telehealth flexibilities currently run through December 31, 2027, according to the CMS telehealth FAQ updated in October 2026, but these dates have moved several times, so treat the official page as the source of truth rather than any article, including this one.

Before the visit: preparation and tech checks

Most failed video visits fail for avoidable reasons: a lost link, a blocked camera, a phone at low battery. A short pre-visit routine catches these while there is still time to switch to a phone call or reschedule.

• Send the link with plain instructions a day or two ahead and again on the day.
• Offer a test link or a two-minute tech check by a staff member for first-time video patients.
• Ask the patient to join from a private, quiet, well-lit spot, with the device charged or plugged in.
• Confirm a callback number in the chart in case the video fails mid-visit.
• Collect intake forms, medication lists, and any home readings before the visit so the clinician is not reading them aloud.

Our piece on patient engagement strategies covers how reminders and outreach fit into this kind of routine.

Opening the visit: identity, location, and consent

Start every video visit with the same three checks, in the same order, so they are never skipped.

Step 1: Confirm identity with two identifiers, such as full name and date of birth. If someone else is on the call, ask who they are and whether the patient wants them present.

Step 2: Confirm the patient's physical location at that moment, including the state. Location affects which state's licensure rules apply, where to send emergency help, and how the claim is coded.

Step 3: Confirm consent to be seen by video. Telehealth consent requirements come mostly from state law and individual payers, and they differ, so your compliance lead should set the exact wording and how often it is renewed. Whatever the rule, record that consent was obtained and by whom.

Then confirm the patient can see and hear you, say what happens if the call drops, and give a one-sentence agenda.

Privacy and HIPAA-appropriate platforms

During the COVID-19 public health emergency, the HHS Office for Civil Rights said it would not impose HIPAA penalties for good-faith telehealth on non-public-facing tools. That enforcement discretion expired with the public health emergency at 11:59 p.m. on May 11, 2023, followed by a 90-calendar-day transition that ended at 11:59 p.m. on August 9, 2023, as set out in the OCR notice in the Federal Register. Since then, the HIPAA Rules apply to telehealth in full.

In practice that means using a video platform from a vendor that will sign a business associate agreement, since a vendor that creates, receives, maintains, or transmits protected health information on your behalf is a business associate under the HIPAA definitions. Consumer video apps that will not sign one are not appropriate for routine care. Beyond the contract, look for unique visit links or waiting rooms, recording off by default, and audit logging.

Privacy also depends on the room. Clinicians should work from a closed space, use a headset, and keep other patients' information off screen. Ask the patient whether they can speak freely; if not, offer yes-or-no questions or a later call.

Clinician setup: camera, lighting, audio, and eye contact

Patients judge attentiveness by what they see and hear.

• Camera at eye level and about an arm's length away, framing head and shoulders. A laptop on a stand or a separate webcam fixes the upward angle.
• Light from in front of you, such as a window or a lamp behind the screen. A bright window behind you turns you into a silhouette.
• A wired headset or a good external microphone. Audio problems end visits faster than video problems.
• A plain background and a wired or strong Wi-Fi connection.
• The video window placed directly under the camera so that looking at the patient's face is close to looking at the lens.

Narrate what you are doing when you look away, because silence plus a sideways glance reads as distraction. For patient-assisted exam steps, give one instruction at a time and say what you are looking for.

Accessibility: interpreters, captions, and audio-only

Plan for these needs at scheduling, not at the start of the call.

• Interpreters: use a qualified medical interpreter joined to the same call, not a family member, and confirm the platform supports a three-way connection.
• Deaf and hard-of-hearing patients: offer live captioning or a sign language interpreter on video, and test that the interpreter's video is large enough to read.
• Low vision, limited dexterity, or caregivers: keep join steps minimal, let staff walk the patient in by phone, and allow a second participant when the patient wants one.
• Limited bandwidth or no camera: have a clear audio-only path.

For Medicare, audio-only is allowed in specific circumstances. Under the CY 2025 Physician Fee Schedule final rule, a telehealth service to a patient at home may use two-way, real-time audio-only technology when the practitioner is capable of video but the patient is not capable of, or does not consent to, using video, and the claim carries CPT modifier 93 (or modifier FQ for rural health clinics and federally qualified health centers). The CMS telehealth FAQ states that patients may continue to receive audio-only telehealth at home through December 31, 2027. Document why the visit was audio-only.

Documenting modality and patient location

Document a telehealth visit as you would an in-person encounter, then add a short, consistent telehealth block.

• Modality: audio-video or audio-only, and if audio-only, why video was not used.
• Patient location at the time of the visit, including state, and whether it was the patient's home.
• Who else participated, such as an interpreter or caregiver, and their role.
• Consent to telehealth, and who obtained it.
• Any limits the format placed on the exam, and how you addressed them.
• Follow-up plan, including any in-person visit or tests ordered.

For professional claims, the CMS FAQ directs practitioners to use place of service 02 for telehealth provided other than in the patient's home and place of service 10 for telehealth provided in the patient's home. Telehealth visits that land in the record the same way as in-person visits also make follow-up easier; see our EHR integration guide for how scheduling, notes, and orders should flow back to the chart.

When to convert to an in-person visit

Agree on conversion criteria as a team before they are needed. Common reasons to convert include:

• The assessment needs a hands-on exam, such as auscultation, abdominal palpation, or a neurological exam beyond what can be observed.
• New or worsening red-flag symptoms, such as chest pain, shortness of breath at rest, new weakness, or signs of sepsis.
• The patient cannot be seen or heard well enough to assess safely, even after troubleshooting.
• The patient seems unable to speak freely, or there are concerns about safety at home.
• The patient prefers to be seen in person.

For urgent symptoms, the location confirmed at the start lets staff direct emergency services. Otherwise, book the in-person visit before ending the call and note the reason. Questions that bring out what patients leave unsaid are covered in when patients say "I'm fine".

Medicare telehealth status as of October 2026

Congress has extended Medicare's pandemic-era telehealth flexibilities several times with short deadlines. The flexibilities lapsed temporarily from October 1, 2025, during a government shutdown, and CMS says claims from that period will be paid as if there had been no lapse. A CMS billing instruction identifies the Consolidated Appropriations Act, 2026 as the law that extended these flexibilities. According to the CMS telehealth FAQ updated in October 2026:

• Through December 31, 2027, Medicare patients can receive telehealth anywhere in the United States and its territories, including at home. Starting January 1, 2028, outside of behavioral health, patients will generally need to be in a medical facility in a rural area.
• Through December 31, 2027, an expanded range of practitioners can bill telehealth. From January 1, 2028, physical therapists, occupational therapists, speech-language pathologists, and audiologists can no longer furnish Medicare telehealth services.
• For mental health telehealth, the in-person visit requirement takes effect after December 31, 2027. Patients who began mental health telehealth before 2028 are treated as established and need an in-person visit at least every 12 months after that date.
• Geographic and location restrictions for behavioral health telehealth were removed permanently by the Consolidated Appropriations Act, 2021.
• Beginning January 1, 2026, virtual direct supervision through real-time audio and video is allowed for services without a 010 or 090 global surgery indicator.
• Telehealth modifiers BB and BC are required beginning January 1, 2027; CMS says they have no payment implications.

Two cautions. First, these dates come from law and can change again, so check the CMS telehealth FAQ linked above, which CMS updates as the law changes, before you plan schedules or staffing around them. Second, Medicare's rules do not set the rules for Medicaid or commercial plans, which have their own coverage, modifier, and documentation requirements. Services that are not face-to-face, such as chronic care management and remote monitoring, are not on the Medicare telehealth list and are not subject to these restrictions; our overview of Medicare care management in 2026 covers those programs.

Hoss Care runs video visits, follow-ups, and documentation in one place connected to your EHR, but the habits above matter more for visit quality than any single platform feature.