New Telehealth Code Gains Ground with Commercial Insurers and State Agencies

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Telehealth Code Gains GroundDuring a recent webinar conducted by Robert Bosch Healthcare, an audience of hospital executives, health plan executives, and ACO executives was asked how they are currently being reimbursed for telehealth services. Nineteen percent of participants said they are being reimbursed through fee for service, 6% through bundled payments, 7% through a grant, 12% through some source not listed—and a whopping 55% said they are not being reimbursed at all.

Home telehealth has certainly struggled with reimbursement issues, and it’s still not covered by Medicare Fee For Service. However, organizations are successfully using code S9110 to gain reimbursement from some commercial insurers and state Medicaid agencies.

The new code covers:

  • Telemonitoring of patients in their homes
  • Related computer systems
  • Related connections and software maintenance
  • Patient education and support

The code has been available since January and was implemented following CMS’s Medicare Management for High-Cost Beneficiaries Demonstration, which ran from 2006 to 2012 and concluded that an integrated telehealth and care management program can significantly reduce all-cause mortality in high-cost, high-risk Medicare beneficiaries with heart failure.

According to the Home Care Technology Report, the two clinics in the demonstration used Bosch’s Health Buddy to communicate with patients, monitor vital signs and support patient efforts to increase their knowledge about their chronic illness(es). Beneficiaries with heart failure who were offered the program saw a mortality reduction of 25%; beneficiaries who actively participated in the program saw mortality reduction of 57%.

While the code cannot be used for reimbursement for Medicare patients, some home health agencies may want to use the S code for all telehealth patients for tracking purposes. According to Bosch’s Bill Broderick, North American head of marketing and global outcomes research, many ACOs are doing just that—self-funding telehealth because it’s so effective in reducing costs and using the S code to track outcomes.

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