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Telehealth, ABA Therapy, and Insurance Coverage

aba-teletherapyWith the numbers of individuals affected by autism spectrum disorders (ASD) increasing, the demand for professionals with experience in applied behavior analysis (ABA) also grows.

This is especially true for states with large rural populations that face challenges in obtaining ABA services. Thankfully, however, access to ABA therapy and services is growing through the use of technology.

Telehealth has emerged as a cost-effective system of delivery for ABA providers and patients who cannot meet in the traditional face-to-face consultations or examinations. Telehealth has been defined as seeking “to improve a patient’s health by permitting two-way, real-time, interactive communication between the patients, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

Telehealth may be referred to in a number of terms including:

  • Telebehavior analysis therapy
  • Telepractice
  • Telemedicine
  • Teleconference
  • Teleconsultation
  • Videoconferencing
  • Teletherapy

There are several forms of telehealth application including real-time communication, store-and-forward, and remote patient monitoring.

Real-time communication allows for the communication between patients and providers via video conference, telephone, or a home health monitoring device.

Store-and-forward refers to the transmission of data, images, sound, or video from one care site to another for evaluation.

Remote patient monitoring is the process in which a patient’s vital signs and other health data are collected while the patient is at home or at another site, and the data is transferred to a remote provider for observation and action as needed.

Advantages

Telehealth offers accessibility and flexibility for all patients, but can be truly life changing for individuals with ASD who are limited due to the lack of experts located within their geographical area. Considering that over 85% of the American population has internet access as of 2016, the feasibility of telehealth has become  even more obtainable as access to technology continues to explode amongst the nation’s population.

Alongside accessibility is the flexibility in which teletherapy can be conducted. The therapist is readily able to connect with the patient or patient’s parents via devices with built-in webcams and microphones, making the ability to deliver a session easier on both the therapist’s and family’s schedules. Both of these facets of teleconsultation can improve on the amount of individuals with ASD who are receiving high-quality services.

Telehealth Insurance Coverage

Thus far, the most common measure taken by states to cover telehealth services has been by way of the Medicaid program. States are moving quickly to establish standards, with 48 states and the District of Columbia now providing some form of Medicaid reimbursement for telepractice.

Aside from Medicaid, states are also working to create requirements for private insurers in relation to telehealth. The statutes vary by state, but the broad mandate is for commercial insurers to cover such services. Currently 32 states, and DC, have some kind of private payer policy in order.

It is vital to recognize as an ABA provider however that covered services are defined by state law, and even when a private plan covers telehealth, coverage may be limited. There are also variations in reimbursement, although insurers in 23 states with stricter telehealth parity laws have to cover telehealth services at rates equivalent to in-person visits.

Some of the more frequently covered teletherapy services are diagnostic intake, psychotherapy, individual and group health and behavior assessment and intervention, neurobehavioral status exams,  pharmacologic management, smoking cessation, and alcohol aftercare.

Insurance plans may also require the client to be at a healthcare facility, at a school, or live in a rural area.

Medicaid’s coverage tends to be aligned with private payers, as the Center of Medicare and Medicaid Services allows states to dictate a large portion of their own laws in reference to healthcare coverage. Generally speaking, live video telehealth services are covered. The majority of Medicaid programs tend to not have geographical restrictions, while some insurances may.

Tips for Ensuring Telehealth Service Insurance Coverage

In order to understand eligibility as a provider for telehealth insurance coverage, there are a number of criteria and information you should have in place, including:

  • Contact your client’s insurer prior to providing services. Have CPT codes ready, which will be the same as for in-person care, but with the proper modifiers to indicate that it is a telehealth session. Ask if your license is covered for telehealth and understand limitations such as client location.
  • Ask which modifiers should be used on the claim and if the Place of Service Code is necessary (invoicing teletherapy sessions as if they took place in person is insurance fraud).
  • Complete the Autism/ABA Remote Supervision Compliance Attestation form and fax it to your Regional ABA Network Manager.
  • Ensure that your videoconferencing technology is HIPAA compliant and meets current American Telemedicine Association minimum standards (Skype is not considered an acceptable HIPAA technology).
  • After you receive approval from your Regional ABA Network Manager, you must indicate on each applicable treatment plan that ABA remote supervision will be utilized.

Additional tips for providing telehealth services:

  • You must be licensed in the state where the client is when you have contact, not where the client resides. Ignoring this could cost you your license and your malpractice may not cover you.
  • Telehealth is not the same as in-person therapy, so understand practice guidelines.
  • Be selective of patients and plan for face-to-face sessions at intervals.
  • Your therapy is still subject to “medical necessity” review.

Not sure if you can provide teletherapy services? Amvik Solutions can help.

Amvik Solutions can help you get credentialed today and starting your telebehavior analysis therapy tomorrow. By collecting all the necessary information through a “Provider Enrollment Questionnaire” and filtering all relevant data and required documents, we’re able to help you get on the road to being credentialed—and reducing time and stress.

Taking certain business responsibilities into your own hands can work for numerous tasks, but credentialing should not be one of them. By helping your ABA agency get credentialed, Amvik Solutions will increase your reach and ability to provide the best quality mental healthcare to those who need it most.

Need help getting started with the credentialing process? Contact us today at 805-277-3392.