| Course | NU 715 Telehealth to Expand Health Care Access and Delivery |
|---|---|
| Unit | Unit 5 |
| Paper type | Coverage and payment assessment |
| Length | About 1,030 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU 715 Unit 5
Can the Rural Heart Failure Telehealth Program Be Paid For? A Payer-by-Payer Assessment of Video Visits and Remote Monitoring
Student Name
Department of Nursing, Herzing University
NU 715: Telehealth to Expand Health Care Access and Delivery
Instructor Name
February 18, 2026
Can the Rural Heart Failure Telehealth Program Be Paid For? A Payer-by-Payer Assessment of Video Visits and Remote Monitoring
The Proposed Service
The composite rural Kansas health system proposes, for adults discharged with heart failure: a video follow-up visit within seven days of discharge, delivered either to the patient's home or to one of four outlying clinics with a nurse present; a month of home readings from a scale, cuff, and pulse oximeter, which a nurse reviews each day, with nurse practitioner oversight and monthly interactive calls; and telephone visits for patients who cannot use video. About 180 patients a year are expected. The payer mix of the hospital's heart failure discharges is about 70% traditional Medicare or Medicare Advantage, 15% the state Medicaid program, and 15% commercial insurance. This assessment asks, for each payer, which parts of the service are covered, from where, in which modality, and at what cost to the patient. Rules change frequently; everything below must be confirmed at launch.
Traditional Medicare: Video Visits
Under the Social Security Act, Medicare pays for telehealth visits only when statutory conditions are met, including that the patient is at an eligible originating site, such as a clinic or hospital, in a qualifying rural area (Social Security Act § 1834(m), 42 U.S.C. § 1395m). Since 2020, Congress has repeatedly extended temporary flexibilities that allow the patient's home to serve as the originating site for many services, but these have depended on short-term extensions, and the service cannot assume they will be in place.
Implication: video visits to a Medicare patient at one of the system's four outlying rural clinics are covered under the permanent rules, and the clinic may bill an originating site facility fee. Video visits to a Medicare patient's home are covered only while a temporary extension is in force. The service should therefore design the seven-day visit to work from the outlying clinics, with home video as an addition whose payment status is checked at launch and each year. The clinic-based design also recovers part of the physical examination, since a nurse is present.
Traditional Medicare: Remote Monitoring
Remote physiologic monitoring is paid under separate codes that are not subject to the telehealth originating site rules, because the patient is not receiving a visit: a one-time setup and education code, a monthly device supply code that requires readings on at least 16 days in a 30-day period, and codes for each 20 minutes of treatment management time in a month that include interactive communication with the patient (Centers for Medicare & Medicaid Services [CMS], 2025). The service meets these requirements if patients transmit daily and the nurse and nurse practitioner document their management time.
Cost to the patient: Part B coinsurance of 20% applies to each monitoring code. For a patient without supplemental coverage, that coinsurance each month may be enough to make some decline. The service should check each patient's secondary coverage before enrollment and discuss the cost openly. Use of remote monitoring in Medicare has grown rapidly and is concentrated among a small number of practices (Tang et al., 2022), which has drawn scrutiny; careful documentation of the 16-day requirement and of management time is essential.
Operational Requirements for Monitoring to Be Paid
Coverage on paper becomes payment only if the service can show that each requirement was met. For remote monitoring, that means: documented patient consent before enrollment, including that coinsurance may apply; devices that meet the federal definition of a medical device and transmit data automatically, rather than readings typed in by the patient; a count of days with readings for each patient each month, so that months with fewer than 16 days are not billed for device supply; a log of management time by the nurse and nurse practitioner, with the interactive communication documented; and a rule that only one practitioner bills the monitoring codes for a patient in a given month, since patients may also be followed by a cardiologist who might bill the same codes. The service's billing office will audit the first three months of claims before the program scales up. Each of these requirements has a staffing cost, which the program plan must include.
Medicare Advantage
Medicare Advantage plans must cover what traditional Medicare covers and may cover more, including home telehealth, as a supplemental benefit. The two plans that cover most of the system's Medicare Advantage patients were contacted; both cover home video visits for their members, and both cover remote monitoring with prior enrollment. Cost-sharing varies by plan and will be quoted to each patient.
State Medicaid
Kansas law requires the state Medicaid program and state-regulated health plans to cover services delivered by telemedicine on the same basis as in-person services, with details set by each plan. The Medicaid managed care plans in the state cover video visits to home and to clinics. Coverage of remote monitoring varies by plan and requires prior authorization in one; the service will confirm for each patient. Medicaid patients have little or no cost-sharing.
Commercial Insurance
The same state law applies to state-regulated commercial plans, but self-insured employer plans are governed by federal law and are not bound by it. Each patient's plan will be checked. The two commercial insurers most common locally cover video visits; one covers remote monitoring only with a cardiologist's order.
Telephone Visits
Payment for audio-only visits for medical care, as opposed to behavioral health, has depended on the same temporary Medicare extensions and on individual plan policies. The service should budget telephone visits as partly unpaid care, justified by their role in reaching patients who cannot use video.
Summary for the Finance Director
The service can be paid for, with three conditions. Build the seven-day visit around the outlying clinics, which Medicare covers under permanent rules. Fund remote monitoring through the monitoring codes, with rigorous documentation and upfront discussion of coinsurance. And treat home video for traditional Medicare patients and telephone visits as additions whose payment may change, budgeting for some unpaid care. The main financial case also depends on avoided readmissions, which affect the hospital's penalties and capacity; that case belongs in the program plan rather than in this coverage assessment.
References
Centers for Medicare & Medicaid Services. (2025). Telehealth & remote patient monitoring (MLN Booklet MLN901705). U.S. Department of Health and Human Services.
Social Security Act § 1834(m), 42 U.S.C. § 1395m (2025).
Tang, M., Mehrotra, A., & Stern, A. D. (2022). Rapid growth of remote patient monitoring is driven by a small number of primary care providers. Health Affairs, 41(9), 1248-1254. https://doi.org/10.1377/hlthaff.2021.02026
What the NU 715 Unit 5 instructions ask for
In Unit 5 you assess whether a telehealth service can be reimbursed. Expect to describe the service, examine coverage rules for each major payer, such as Medicare, Medicare Advantage, Medicaid and commercial insurance, identify operational requirements for payment and summarize the financial viability. Many versions ask about temporary flexibilities and what happens if they end. Check whether your section wants a specific state. Cite the Social Security Act, CMS guidance and state telehealth parity laws. Payment rules change often, so date your sources and note which provisions are permanent. Coverage on paper is not the same as payment in practice, so explain the documentation and time thresholds a service must meet for each code it plans to bill.
How this NU 715 Unit 5 example is built
The assessment opens with the service described in billable terms: what is delivered, by whom and how often. Traditional Medicare is split into video visits and monitoring because different rules apply. The operational section is the most practical, listing documentation requirements that turn coverage into payment. Medicare Advantage is handled briefly as a plan-by-plan question. Kansas Medicaid and state-regulated commercial plans are covered by the state parity law, with the self-insured exception explained. Telephone visits get a short section on their uncertain status. The summary for the finance director gives a clear answer with three conditions, such as building the seven-day visit around eligible rural clinics. Every rule is cited with its source and year, which matters because these rules shift.
Reading the NU 715 Unit 5 rubric
Herzing's rubric for a payment assessment usually covers the service description, payer-specific analysis, operational requirements, accuracy and currency of sources, the conclusion and writing. Payer analysis usually counts most, with full credit only when each major payer's rules are applied to the specific service. Operational points reward documentation and time requirements stated for billing codes. Currency is checked carefully, since outdated flexibilities are a common error. The conclusion criterion looks for a clear answer with conditions. Financial modeling is usually not required, but realistic statements of what is billable earn credit. APA 7 with legal citations covers the statute, CMS sources and state law.
NU 715 Unit 5 help: mistakes that cost points
Unit 5 assessments commonly lose points by treating telehealth payment as one rule rather than a set of payer-specific rules. Another frequent error is relying on pandemic-era flexibilities without noting their expiration dates. Students often miss the originating site requirement for traditional Medicare. Remote monitoring is sometimes treated as a telehealth visit, though it is billed differently. Self-insured employer plans are rarely mentioned. Operational requirements are skipped, so the paper says services are covered without showing how they would be paid. Finally, date every payment source, because graders check whether your rules match the current year and a citation from three years ago may describe a rule that no longer applies.
Get a NU 715 Unit 5 example written to your instructions
Send the Unit 5 instructions and the rubric from your NU 715 classroom, plus the service you are assessing and the payers that dominate your area. We write a custom example with each payer worked separately, coverage kept apart from claim requirements, uncertainty marked and viability judged on the mix, returned in 24 to 48 hours. The first custom sample is free.
More NU 715 papers and MSN samples
- NU 715 Unit 1: Telehealth modality brief
- NU 715 Unit 2: Remote examination protocol
- NU 715 Unit 3: Encounter suitability criteria
- NU 715 Unit 4: State licensure and compact analysis
- NU 715 Unit 6: Digital access equity audit
- NU 715 Unit 7: Equipment and connectivity standard
- NU 715 Unit 8: Telehealth program plan
- NU 725 Unit 5: Usability review
- NU 726 Unit 5: Advocacy brief
- NU 730 Unit 5: Discussion post
- NU 760 Unit 5: Evidence translation plan
NU 715 Unit 5 questions, answered
Are the rules the same in every state?
No, and that is much of the point of this unit. Public program rules set a floor that state programs and commercial plans depart from in both directions, and state law on payment parity varies considerably. Write the assessment for the states your service would actually operate in, name the source of each rule, and confirm current terms with the payer, since published summaries fall behind quickly.
What if I cannot find a payer's telehealth policy?
Say so in the assessment and mark that position unconfirmed. Provider manuals and policy bulletins are usually the best available source, and where nothing is public, the honest entry is that the service would have to confirm with the plan before relying on the revenue. An assessment admitting two gaps is stronger than one that fills them with assumptions.
Should the assessment include a full financial model?
Follow the instructions, and in most sections a proportional estimate is enough: the expected mix, the share reliably payable, and what the gap means for staffing. Detailed projections usually belong in a finance course. What this deliverable is judged on is whether the payment conditions were understood correctly and then applied to a service somebody could actually run.
Where can I find a free NU 715 Unit 5 sample paper?
This page holds the full NU 715 Unit 5 payer-by-payer assessment at no cost, from Medicare rules to the finance director summary. A custom assessment can examine the payers and state for your own telehealth service.
Does Medicare pay for remote patient monitoring?
Yes, under separate codes that are not subject to the telehealth originating site rules. Payment requires documented device setup, a minimum number of days of readings in a period and clinician time, which this sample lists as operational requirements.