Telehealth technology has been on the rise for years, providing patients with quick and secure access to certified medical professionals to diagnose and treat a wide range of needs. As healthcare technologies continue to advance, ABA professionals have adapted to meet the ongoing needs of their clients. When unpredictable circumstances arise or families struggle to find accessible and cost-effective care, many seek remote ABA therapy to bridge the gap.
There are many considerations to take into account to ensure practices are set up correctly and securely to provide telehealth services. Let’s dig into these details to help you navigate the opportunities and challenges of adopting ABA telehealth to your practice.
Funding Source, Verification of Benefits, and Authorization Requirements
First, you must have approval from each of your funding sources to provide services via telehealth. Also, be sure to clearly understand your reimbursement rates, which in many cases are different for telehealth than in-person care.
Start by reviewing your payor contracts and contacting your payors directly to make any necessary adjustments, update fee schedules, and gain insights into any other pertinent information or specific requirements to consider. For example, you may need to document or collect certain information for your telehealth sessions that may not apply to face-to-face therapy sessions. There could also be specific systems or software solutions payors may require you to use. Going over these details will enable you to determine whether or not you can successfully bill and get paid for telehealth services and ensure that you don’t face recoupments during a payor-initiated audit.
Once you have approval from payors, the next step is to confirm your clients have the necessary coverage under their individual insurance policies. For this, you need to reverify the client's benefits and review their authorizations to ensure telehealth services are covered and the correct service codes and modifier details are included. Even if the payor has given you approval to provide ABA services via telehealth, this does not mean your clients are necessarily covered. Reverification of benefits and authorization updates will set you up for successful billing down the line.
Telehealth Software, Devices, & Security Considerations
As detailed above, payors may have specific platforms they want you to work with to deliver telehealth services. The key here is that the video-conferencing solution must be HIPAA-compliant. You can verify this by asking vendors to confirm or even share their Business Associate Agreement (BAA).
It’s important to note that devices are not HIPAA-compliant, but instead, the software solutions (video conferencing software, practice management software, etc.) used via those devices are the ones that have to adhere to compliance and regulations.
If you use an Applied Behavior Analysis practice management software or ABA electronic data collection, you may have an advantage in transitioning to telehealth because you likely already have video conferencing devices. Otherwise, you may need to supply reliable devices to your teams. Secure your investment by considering high-quality device manufacturers and warranties when coordinating these purchases. Your practice’s software company may even be able to provide you with a list of approved devices to aid you in your purchase decision. Consider engaging with mobile device management companies for more robust guidelines.
If you are using a tablet for electronic data collection, providers may have limitations for video conferencing, as it can be difficult to have more than one screen open at a time for the various systems needed to conduct the session. Using multiple monitors to have all the necessary screens open may be the most efficient way to conduct ABA via telehealth. Help your teams by supplying them with the equipment they need from the start for a successful rollout. Additionally, make sure you review your security policies and procedures to ensure that they are updated to reflect your use of this new clinical tool.
Care Delivery & Policies
Payor contracts should specify the billing codes, modifiers, and services approved for telehealth, but as a practitioner, you should consider which services are appropriate without in-person interaction based on each client’s specific circumstances and needs. You should review the Ethical Considerations in the Design and Implementation of a Telehealth Service Delivery Model and the Ethics Code for Behavior Analysts for specific protocols for behavior analysts to determine whether your clients are appropriate candidates for telehealth. Some clients may require a more hands-on approach and protocols that could not be performed using telehealth. As such, providers should analyze these factors in detail on a case-by-case basis. Before proceeding with telehealth services, be sure the client will have a Patient Support Person (PSP) who can be available to support the therapy session and acknowledge service disclaimers before the session begins.
To simplify the rollout of telehealth services, develop clear policies and checklists for your teams. Some items may include:
- Prohibit the remote clinician from participating in or conducting a telehealth session from a public area, such as restaurants, coffee shops, etc.
- To protect the client's confidentiality, the remote clinician should aim to be in a private office or room without any other participants. The client must disclose and acknowledge any exceptions before starting the session.
- Read service disclaimers to legal guardians before starting every session.
- Establish guidelines for crisis situations.
- Seek parental/guardian consent before starting every session, especially when exceptions are made.
- Prohibit public internet connections.
- Evaluate whether or not recording would be allowed.
- Establish how therapeutic materials will be supplied and used during sessions.
- Ensure the family has an electronic device and reliable internet access.
How CentralReach Solutions Can Help You Transition to Telehealth
CentralReach’s suite of software has many built-in features that will enable you to quickly and effectively transition and properly track and bill for telehealth services, including:
- Set up telehealth service codes and fee schedules based on your payor’s contracts.
- Quickly identify and track telehealth clients, appointments, providers, billing codes, and more for effective reporting and analysis using custom labeling functionality across the system.
- Collect data electronically and report it in real-time to all necessary stakeholders to keep clients progressing in their treatment plans.
- Comply with payors’ requirements by developing telehealth session notes for providers to complete upon every session to effectively track and record all necessary information and keep all documentation linked to the client's records.
- Continue billing processes by submitting all claims electronically and billing more frequently to improve cash flow.
- Continuously and securely communicate with legal guardians via the Client Portal.
- Develop a custom course to transition care delivery to telehealth through CR Institute to train and track learners' progress virtually.
Dr. Will Brandon, Ph.D., BCBA-D, LBA
Learning ARTS Corporate Officer-President and CEO
Dr. Will Brandon is the founder of Learning ARTS and has been working with children with autism and other developmental disabilities for the past 25+ years. In addition to a Board-Certified Behavior Analyst – Doctorate, Dr. Brandon has a Doctorate in Early Education (ABA Emphasis), dual Master’s degrees in Special Education and Psychology, and a Bachelor's degree in Psychology. He is also a Licensed Behavior Analyst in the State of Nevada, a Nationally Board-Certified Teacher in Special Education, and holds several California Teaching Credentials.
Dr. Brandon has been recognized for teaching excellence by the United States Congress and by the State of California. He has also sat on several state and local boards including the Superintendent's Autism Advisory Committee (Department of Education) that helped develop protocols for school based services for children with autism.
In addition to his work with Learning ARTS, Dr. Brandon has been an adjunct professor in Behavior Analysis and Assessment, Gifted Education, and Mathematics Instruction. Dr. Brandon additionally has done several presentations and publications; recently coauthoring the California Association of Behavior Analysis Practice Brief on Telehealth.