Telehealth: The Revolution of Therapy
Jessica K. Lynn Hatfield, MS, OTR/L, SIPT, CKTP
The current circumstances in our communities, states and globally have called for us to revolutionize the way we provide therapy. It is uncertain exactly how long these circumstances will last. We do know that when patients do not receive the services they need, it is likely they’ll regress. Although there are circumstances that we cannot change, we can take action to deliver therapy services remotely for appropriate settings. We are fortunate to be standing on the shoulders of all the researchers and pioneers of telehealth.
Know the Laws
Understand your state’s laws specific to telehealth as it applies to your profession. Each state is different, and each profession has different laws. Look at your profession’s licensing statutes and regulations first. Your state may or may not have specific rules about which providers are permitted to provide telehealth services. Your state may have specific guidelines for informed consent, confirming patient identity, and providing alternate means of communication. There have also been rapid changes to these laws. Look for memorandum updates from your licensure board, as many have relaxed their previously established regulations. For example, some states previously did not identify therapy assistants as telehealth providers. Some states required an in-person visit before therapy could be provided through telehealth. If you can’t find these resources for your state, consult your profession’s state association. This is one of many great examples of why it’s important to be a member of your state’s professional association!
Synchronous vs. Asynchronous Services
Telehealth is divided into two modes. Synchronous telehealth is live interactive audio and visual communication, usually achieved through videoconferencing. Synchronous telehealth is most commonly reimbursed for therapy. Asynchronous telehealth includes “store-and-forward” communication, in which videos, images and/or data may be recorded, then electronically transmitted between the provider and patient. Asynchronous telehealth results in a delay and a less interactive experience compared to synchronous telehealth. Due to the urgent adaptations to accommodate telehealth, some states have temporarily approved telephone conversation as acceptable for synchronous telehealth to patients who do not have internet or device access.
Choose a Platform
HIPAA-compliant telehealth platforms include, but are not limited to, Zoom for Healthcare, Doxy.me and thera-LINK. Because so many HIPAA-compliant programs are now being used at levels higher than ever before, many platforms are experiencing lagging and connectivity challenges. It’s advised to pick a backup platform if your “Plan A” experiences issues. The Department of Health and Human Services has relaxed many of its HIPAA requirements about the type of platform providers may use for telehealth. Platforms such as Zoom (free), Skype (free), FaceTime and others are permitted by HHS. Identify whether your state licensing bodies and/or reimbursement sources are aligned with utilizing these less secure platforms. Also, consider that with the increased remote work for everyone, there have been increased incidents of ZoomBombing. This is where uninvited hackers interrupt your meeting with potentially inappropriate content. Zoom has increased its security measures effective April 5, 2020, but these are ongoing challenges with unsecured videoconferencing platforms.
Create your informed telehealth consent document by identifying required content from your licensing bodies. Whether you’re maintaining current patients or accepting new patients, it’s likely you’ll need people to sign documents remotely. Identify what method of obtaining signatures will work for you. Some options are IntakeQ, Adobe PDF and DocuSign. Remember to train your families on how to sign these documents electronically before services can begin.
There has been a dramatic push in many states for reimbursement sources to include telehealth. Some states have been primed and are already using telehealth. Identify if your state has a telehealth parity law. Telehealth parity laws typically state that private insurance companies must reimburse for telehealth the same as they do for in-person care. Even in states with parity laws, some insurance companies have been contradictory. You might have to hold insurance companies accountable through skillful communication with the decision-makers of the organization. Be in excellent communication with your state professional association and their lobbyist to facilitate this. More and more insurance companies are conceding that telehealth is a needed delivery model for healthcare, especially during this time. Therapy providers will continue to bill their CPT codes based on their therapeutic interventions. However, there are other billing coding considerations for telehealth. The place of service on the CMS 1500 form will need to be the telehealth location of 02. Many insurance companies prefer the newer 95 modifier added to claims, while some request the older GT modifiers. You will need to identify modifier preference with your insurance company representatives.
Once you have the above ducks in a row, you can implement telehealth (the topic of our next article). Providing services through telehealth may not be in your comfort zone yet. However, your mindset matters. Think of this as a brand-new adventure. You get to help families maintain and gain skills in a whole new way! Families are dealing with a new set of circumstances, just as we are. As you begin to implement, you’ll start to get a grasp of what they’re now facing. You get to be their lifeline.
Be willing to try something new.
Next article: Transitioning Patients to Telehealth