Objective: To characterize organizational and financial factors associated with hospital telemedicine utilization reporting. Methods: We used an explanatory sequential mixed methods design to quantitatively analyze hospital-level data from Medicare Cost Reports (2017-2021) and the American Hospital Association Annual Survey (AHAAS) (2020-2021) to assess telemedicine utilization reporting. Semistructured interviews were conducted with key informants from various health care sectors to contextualize quantitative findings. Results: Among 4,224 nonfederal acute care hospitals in our sample, most were urban (50.7%), not-for-profit (60.3%), and nonteaching hospitals (91.4%). For-profit, southern, and western hospitals were more likely to report telemedicine utilization data to the AHAAS compared to other ownership status and region categories. Qualitative interviews identified six domains that support enhanced telemedicine reporting: (1) resource and infrastructure availability, (2) organizational reporting issues, (3) survey design, (4) reconcilable vendor documentation, (5) lack of reporting requirements, and (6) lack of standardized definitions of telemedicine and telemedicine utilization. Conclusions: Addressing telemedicine reporting barriers is essential for accurate telemedicine utilization measurement and improved health care delivery. Future research should advance robust methodologies for capturing telemedicine utilization and explore the impact of reporting incentives and mandates on data completeness.