Telehealth ABA

Plutus Health has been at the fore front of providing Revenue Cycle Management services to ABA organizations across the US.  As a part of our service delivery for several ABA Customers, we have been billing for Telehealth for the past 2-3 years, even before this COVID-19 pandemic and change in rules of reimbursement.

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Telehealth for Applied Behavior Analysis (ABA)

Plutus Health offers Billing & Collection to Telehealth ABA Customers

Telehealth in ABA: Successfully Breaching a New Frontier

Telehealth – variously known as telebehavioral health, teletherapy or telemedicine – is a concept that has been in use in many other healthcare specialties such as dermatology, psychiatry and surgery for decades.And now it is finally taking off as a genuine delivery modality in Applied Behavior Analysis (ABA) Therapy as well.

The results so far have been quite promising. That’s why more and more licensed clinical practitioners in the U.S. are turning to telehealth in order to maximize the services provided to ABA therapy clients. Through connectivity and communication technologies like the Internet and videoconferencing, behavioral experts are providing ongoing therapeutic care to clients in an effective and affordable way.

Why Telehealth?

Telehealth is able to address the need for specialized, high-quality behavioral health services in areas where there may be a lack of qualified behavioral health professionals By allowing behavioral experts to provide the same kind of real-time therapeutic interventions from a remote location that they would from their office, this healthcare model offers a powerful means to extend the reach of behavioral healthcare in meaningful ways.

Other benefits of telehealth include:

  •  Greater and more timely access to clinical ABA services
  • Better communication between clients’ parents or guardians and ABA providers
  • Reduced wait time and lower costs associated with travel
  • A better-coordinated behavioral healthcare system that ensures continuity of care

The evidence speaks for itself

The global telehealth market – of which North America alone accounts for more than 40% – is expected to touch $34 billion by the end of 2020, according to market research done by Mordor Intelligence. Many factors are driving this growth, including:

  • More payers (Medicaid programs in many States and private insurers) now recognizing it as a genuine, reimbursable form of treatment
  • Guidelines for practice and delivery are now available from the American Psychological Association, the American Psychiatric Association and the Tele mental Health Institute
  • Over 70% of America’s population reportedly owns a computer or iPad and has Internet access
  • Aging population of parents or guardians

Growth spurt is only one of the reasons (albeit a very powerful one) why ABA providers who have not yet embraced telehealth should consider it as a legitimate means to deliver treatment to clients who really need it. Another reason is that telehealth in the ABA milieu really does work. And the evidence in favor of this statement is mounting. A study conducted by the University of Iowa found that telehealth helps parents of children with autism communicate better with their child, implement a few modalities on their own and lower their treatment costs. More such studies are expected to be published in the near future.

Telehealth and Insurance

As already seen, more and more Payers cover and reimburse for telehealth services.

Payers that cover telehealth for ABA include:

  • Anthem/BCBS GA: Will allow telehealth for any ABA codes, as long as it is within the scope of the provider’s practice and is allowed under state law
  • BCBS IL & TX:  To pursue approval/authorization for ABA telehealth supervision, the member MUST have: 1) tele health benefit coverage; and 2) ABA benefit coverage, then subsequently be approved for ABA treatment as medically necessary
  • Cigna: Behavioral telehealth sessions are available to all Cigna customers and administered in accordance with the customer’s benefit plan
  • United/Optum: Patient must have the approval for group or individual therapy sessions.
  • Washington State Health Care Authority (HCA): Reimburses providers for telemedicine services
  • Almost all Payers in CA cover telehealth services for ABA, including Medical

Plutus Health’s expertise with Telehealth in ABA

Plutus Health has been at the fore front of providing Revenue Cycle Management services to ABA organizations across the US.  As a part of our service delivery for several ABA Customers, we have been billing for Telehealth for the past 2-3 years, even before this COVID-19 pandemic and change in rules of reimbursement.

Some of the advantages of working with Plutus Health include:

  • Scalability – immediate access to qualified ABA Billers & Collectors
  • Domain Knowledge – As a group, we have been servicing several large and small ABA organizations and understand the nuances including expertise on software like Central Reach, Total ABA, Code Metro, Practice Suite, etc.
  • ABA specific nuances – Eligibility and Prior Authorizations are crucial for payment by Insurance
  • Increased Bandwidth – Ability to meet and sustain larger revenue cycle volumes
  • Cost savings – Our combination of technology and global delivery can reduce overall costs
  • Fewer operational and HR obstacles: Your HR teams can concentrate on hiring BCBA’s and RBT’s, while we take care of the Billing staff needs
  • Patient e-Statements – For better and faster collections from Parents/Guardians

Telehealth for ABA during COVID-19 :Possible Action Steps for Providers

Providers should contact funders to clarify the latter’s position on reimbursing for telehealth services during the COVID-19 pandemic. They should send in forms, make online applications and follow any other requirements to meet the funder’s telehealth requirements.

Providers should also ask the following questions:

  • What is needed to be able to provide telehealth services?
  • What specific equipment or software is required to be used by the funder?
  • What are the billing modifier and place of service (POS) codes for each funder?
  • Which HCPCS and CPT codes apply to telemedicine reimbursement?
  • Is a GT, GQ or 95 modifiers needed for reimbursement?
  • Are there location restrictions by patient or provider?
  • Which Provider types are eligible for reimbursement?
  • Will the reimbursement rate for telehealth match the rate for in-person visits?
  • Are there any specific details that need to be documented for reimbursement?

Are you looking to provide telehealth services but you’re not sure how? We can help.

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Increased revenue and clean claims due to certified coders and claim scrubbing process
Faster reversals by team working on denied or rejected claims
Advanced automation and technological advantages that speed up the process without risk of error
Reduced debt, denials, operational costs, and expenditure
Round-the-clock services and excellent TAT delivery
Advanced automation and technological advantages that speed up the process without risk of error

Increased revenue and clean claims due to certified coders and claim scrubbing process

Faster reversals by team working on denied or rejected claims

Maximized revenue flow due to cost-effective nature of outsourcing

Reduced debt, denials, operational costs, and expenditure

Round-the-clock services and excellent TAT delivery

Advanced automation and technological advantages that speed up the process without risk of error

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