NIH Research Grant and Pilot Program using new NODA Telehealth

Through a new NIH Small Business Innovation Phase IIb Commercialization (5R44MH112470) grant, we are enhancing NODA(tm) to be the market’s first hybrid telehealth platform, ie. an integrated use of synchronous AND asynchronous telehealth technologies tailored to autism assessment.

This grant will help NODA develop and test a new system of care to accelerate autism evaluations remotely to assist all stakeholders (diagnostic clinics, referring primary care providers and affected families) as shown in the following video (1 minute):

Project will connect Primary Care providers with referring diagnostic clinics electronically, through our collaboration with Total Child Health, Inc. and its popular CHADIS (chadis.comPediatric Autism Screening Software Platform. CHADIS is used by > 3,000 pediatricians to help them screen young children for autism during the family’s well-child visits.

BIS engineers have invented and are introducing BI LIVE(tm) in this project – a unique realtime telehealth tool that gives clinicians better clinical documentation during a video consult. Look more for this innovation in future posts.

Starting Summer 2021, a validation study began throughout Georgia (led by Emory Autism Center), and a multi-region comparative study to research time-savings and clinician confidence of diagnostic clinics using NODA Enhanced(tm) compared to conventional InPerson assessments. Research sites will be in California (Children’s Hospital of Los Angeles), Arizona (Southwest Autism Research and Resource Center), and Idaho via University of Idaho’s Center for Disability and Human Development, and Northwest Neurobehavioral Health.

For more information about this project, please reach out to PI Ron Oberleitner at ron@behaviorimaging.com.

NODA Enhanced Pilot Program Invitation to New & Existing Clinics
We are ready to expand the availability of NODA Enhanced’s hybrid telehealth platform to a few clinics outside of the above structured clinical research studies. Clinics we’re looking to partner with would ideally be in newer geographical areas and:

  • Would like to work with clinical groups who are using & interested in telehealth for autism assessment
  • Who feel that the implementation and use of NODA would benefit their practice
  • Have the time to implement, use and provide feedback to us for further enhancement and experience assurance
  • Participation in feedback sessions bi-weekly
  • Can make a 90 day commitment to try NODA
  • Current NODA users are welcome
  • If interested, please apply here: https://behaviorimaging.com/contactsupport/  (choose product category ‘NODA’)

Other Use Cases: If you like to see additional videos, go here  Video Gallery

Original Song Aims to Shine a Light on Telehealth and Autism

To raise awareness of the potential of telehealth to improve autism care — even during a pandemic, Behavior Imaging has partnered with musician Ned Evett to release an original song and video, “If You Shine a Light on Me.” The song is available on iTunes, and proceeds from downloads will be donated to Autism Speaks, to continue their advocacy and support for individuals with autism and their families. You can also watch the video below.

Download on iTunes HERE or Download on Amazon HERE

Telehealth and Autism

Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care. Telehealth technology can help overcome the obstacles of distance, access to specialists, and cost, so families and autism experts can work together to greatest success. The song and video are launching on World Autism Awareness Day 2018 to raise awareness not only for autism itself but also for a potential avenue of vastly improving autism care in the near future.

 

We have always been passionate that telehealth could help our kids be diagnosed earlier and help families access treatment easier.

 

“We have always been passionate that telehealth could help our kids be diagnosed earlier and help families access treatment easier,” said Ron Oberleitner, CEO and Founder of Behavior Imaging. “I believe Ned’s beautiful song will help shine a light on the health needs and the special gifts of children with autism and their amazing caregivers and experts.”

 

About Ned Evett

Ned Evett is a singer, songwriter, and one of the world’s foremost fretless guitarists. He has toured the United States, Europe, Canada, England, Ireland, Mexico, and Australia including a world tour with Grammy-nominated artist Joe Satriani. Also an illustrator and animator, Ned chose to apply his unique set of skills to this project because of his belief in the potential of telehealth to improve autism care.

“We all have a smartphone in our pocket that is capable of fantastic feats,” said Evett. “It seems clear that we must harness that technology to help individuals with autism and their families. Once I knew about the need for telehealth solutions, I knew I wanted to help spread the word.”

Learn more about autism and telehealth with Behavior Imaging’s remote autism diagnosis tool, NODA.

COVID-19 Leads to Telemedicine Expansion

The COVID-19 pandemic has changed every industry worldwide. While some industries are struggling to regain a sense of normalcy four months into the pandemic, the current state of the world could be a tipping point for the use of telemedicine. 

In March of 2020, all 50 states passed temporary actions of some kind to remove barriers to telehealth access. According to research done by Knowable Magazine, telemedicine usage jumped by nearly 20% between February and May of 2020. As state governors, insurance companies, doctors, and patients realize that telemedicine is here to stay, many are making efforts to make those temporary laws more permanent. 

Past, Present, and Future of Parity Laws

Telehealth parity laws have been a major barrier in the struggle for broad usage of telemedicine. These laws allow for reimbursement of telehealth services at the same rate of in-person care. As of 2019, 34 states had parity laws in place, 4 had proposed parity laws within the house or senate, and 11 states had no parity laws whatsoeverEven in states with parity, each set of laws is different, and parity does not always equal pay equity, which limits accessibility for patients on Medicare. (For more information on state-by-state parity, read our blog discussing pre-COVID laws here.)  

Telehealth Parity COVID-19

Telehealth Parity by State, image courtesy visuwell.io

In an article for Smithsonian Magazine, doctors and telehealth providers discuss what a post-COVID world means for telehealth. One of the doctors interviewed is Joe Smith, cardiologist, and coauthor of an overview of telemedicine in the Annual Review of Biomedical Engineering. 

“I don’t think we go back,” Smith stated in Smithsonian. “For a long time, hospitals have been the cathedrals of health care where patients have to come. But people are now seeing that they can get their health care in the safety and comfort of their own home.”  

Telehealth Taskforce

In late June, once it became clear the COVID-19 pandemic was far from over, a coalition of 340 organizations sent a letter to Congress urging leaders to make telehealth reform permanent. The letter asks Congressional leaders to focus on these priorities: 

  1. Remove obsolete restrictions on the location of the patient 
  2. Maintain and enhance the Department of Health and Human Services’ (HHS) authority to determine appropriate providers and services for telehealth 
  3. Ensure Federally Qualified Health Centers and rural health clinics can furnish telehealth services after the public health emergency ends 
  4. Permanently authorize HHS to issue temporary waivers during public health emergencies 

If passed, these reforms could increase access to telehealth care for millions of Americans.  

States Making Progress

In the meantime, a number of states are making advances on their own to make temporary policy changes permanent. 

Idaho & Colorado

On June 22, Idaho governor Brad Little signed an executive order to make the state’s temporarily loosened restrictions around telehealth permanent.  

“Our loosening of health care rules since March helped to increase the use of telehealth services, made licensing easier, and strengthened the capacity of our health care workforce, all necessary to help our citizens during the global pandemic,” Little said. “We proved we could do it without compromising safety. Now it’s time to make those health care advances permanent moving forward.” 

COVID-19 Telehealth

Idaho Governor Brad Little makes COVID-19 Telehealth laws permanent.

Idaho is still one of the 11 states still without telehealth parity, but this new executive order could lead to greater progress down the road. 

On July 6, Colorado also passed a permanent bill that expands Medicaid coverage for telehealth services, in a huge victory for rural health clinics and patients. This coverage will include speech therapy, physical therapy, occupational therapy, and pediatric behavioral health care.   

Tennessee & New Hampshire

In Tennessee, a state with parity laws but not “true parity”, Governor Bill Lee eased telehealth restrictions in March. Now, State Representative Robin Smith is attempting to pass a bill to make those measures permanent. Pay equity is the central dispute between the state House and Senate, which have yet to agree on the bill. 

New Hampshire is also attempting to make Governor Chris Sununu’s emergency telehealth order, which allowed all health care providers to offer services remotely and required insurers to cover them, permanent. The bill has passed the House and is now waiting to be endorsed by a Senate committee. 

The Future of Telehealth

In a time where the only thing known for certain is that nothing is certain, an expansion of telehealth laws nationwide could bring a bit of certainty to millions of Americans. Now that decision-makers are more fully realizing the benefits of telemedicine and engaging in previously un-had conversations about these benefits, we are hopeful telehealth parity could become law nationwide.  

 

 

 

SOURCES: 

https://visuwell.io/telemedicine-reimbursement/
https://mhealthintelligence.com/news/idaho-governor-makes-covid-19-telehealth-expansion-permanent
https://www.idahopress.com/eyeonboise/governor-makes-eased-telehealth-regulations-permanent-signs-executive-order/article_904d315f-eb64-5076-b98a-e51630e30b66.html
https://www.govtech.com/policy/Tennessee-State-Lawmakers-Debate-Telemedicine-Bill.html
https://www.nashuatelegraph.com/news/coronavirus/2020/06/06/telehealth-expansion-in-new-hampshire-could-become-permanent-after-pandemic/
https://www.businessinsider.com/new-bill-asks-congress-make-telehealth-coverage-permanent-2020-6
https://mhealthintelligence.com/news/fcc-boosts-rural-health-program-funding-to-support-telehealth-expansion
https://www.healthleadersmedia.com/innovation/340-organizations-plead-congress-permanent-telehealth-reform
https://mhealthintelligence.com/news/telehealth-advocates-launch-task-force-to-lobby-for-permanent-policy-changes
https://www.smithsonianmag.com/innovation/is-covid-19-tipping-point-for-telemedicine-180975131/ 

Telehealth Reimbursement Progress by State

UPDATED 6/11/2020

In response to the COVID-19 pandemic that has swept the nation, many states have taken action to remove policy barriers to telehealth utilization. These policies include waiving of licensure requirements for telehealth and temporary expansion of telehealth Medicaid coverage.

The Center for Connected Health Policy has compiled a list of actions that each state has taken, which can be accessed at this link – COVID-19 Related State Actions. 

Already, several states are hoping to make this temporary expansion permanent.

**

3/5/2020

Everywhere you look, there is progress towards telehealth reimbursement. New bills are being introduced, debated, and signed into law or vetoed. (But even the vetoed bills have a way of coming back around next session.Forty-two states and the District of Columbia have telehealth laws already on the books, but inconsistencies from state-to-state can still create challenges in reimbursement for services. 

Currently, 16 states maintain laws expressly addressing reimbursement of telehealth services, but only 10 of them offer true “payment parity,” meaning that providers outside those states may still have an uphill battle when seeking similar reimbursement rates for in-person and telehealth services. 

Source: 50-State Survey of Telehealth Commercial Payer Statutes 

These inconsistencies create extra work for providers to understand the rapidly shifting landscape. The good news, however, is that nationwide coverage of (and even parity for) telehealth services is no longer a distant possibility. 

Researchers at Foley & Lardner LLP released their 50-State Survey of Telehealth Commercial Payer Statutes in December 2019. According to Eric Wicklund, Senior Editor at mHealthIntelligence, the survey shows a surge of commercial payers jumping on the “telehealth bandwagon.” More from Wicklund: 

Among the bright notes, some 34 states now mandate coverage for asynchronous (store-and-forward) telehealth services, an up-and-coming platform that enables patients and providers to connect online at the time and place of their choice, free of the challenges of real-time audio-video. 

In this article we will summarize some of the most notable efforts to expand telehealth access and coverage by state. Some of these stories specifically involve reimbursement progress, while others show expanding acceptance for, and investment in, telehealth services. For a deeper dive on the status of telehealth reimbursement in your state, we recommend checking out the full survey.   

Please note, this blog was made possible, in part, by the tireless reporting of Eric Wicklund. We highly recommend following his work at mHealthIntelligence. 

 

Behavior Imaging Telehealth Reimbursement by State

More and more states are making efforts to expand telehealth coverage.

California 

The California State Assembly will consider two bills this session that could drastically expand telehealth services. The first billAB 2007, pertains to federally qualified health centers (FQHC) and rural health centers (RHC). The legislative council’s digest described the bill:  

This bill would provide that an FQHC or RHC “visit” includes an encounter between an FQHC or RHC patient and a health care provider using telehealth by synchronous real time or asynchronous store and forward. 

The second bill, introduced on February 19th by Assemblymember Cecilia Aguiar-Curry, would establish a grant program for the purpose of establishing a statewide pediatric behavioral telehealth network. AB 2464 will likely be heard in committee next month. 

Colorado 

The Colorado General Assembly will consider a bill aimed at improving access and outcomes for underserved populations by allowing FQHC to be reimbursed through Medicaid for telehealth services. HB 20-1092 is very similar to California’s AB 2007. 

Maryland 

Maryland Health Care Commission (MHCC) is seeking grant applications for a telehealth system to improve care in nursing homes across the state. The announcement from MHCC requests applications that include a “clinical workflow redesign to ensure that telehealth becomes part of the standard of care.” The two-year $750,000 grant is not intended to fund technology development, but to creatively “pioneer the use of telehealth by nursing homes across the state.”  

New legislation will help providers serve underserved populations.

Pennsylvania 

This session, the Pennsylvania General Assembly is considering SB 857, a bill to authorize the regulation of telemedicine and provide for insurance coverage. The bill was referred to the Rules & Executive Nominations Committee on November 21st, and it has seen no movement since then.  

Washington 

The State of Washington has a telehealth champion in Republican State Senator Randi Becker. In 2020, she plans to resubmit telehealth bills mandating payer parity for telehealth services.  

Wisconsin 

At the end of November, Wisconsin Governor Tony Evers signed a law that requires Medicaid to reimburse for a host of telemedicine services, including store-and-forward applications. The final bill did not include a mandate for payment parity, but it still represented a significant expansion in telehealth access. 

National Signs of Progress

At the national level, there are more encouraging signs of telehealth advancementCongress is considering creating an Office for the Advancement of Telehealth to consolidate its federal telehealth efforts. As recently as last week, federal officials announced that the Department of Health and Human Services will be awarding grants to rural healthcare providers who seek to use telehealth to improve emergency services. 

As the creators of an asynchronous telehealth platform, we are encouraged by all of these signs of progress. As more states require telehealth coverage and increase the breadth of services covered, more patients will experience the benefits of seeing healthcare professionals remotely. For patients in rural and underserved areas, these policy changes could become an improvement in quality of life.  

For providers who need help seeking reimbursement for telehealth services, the Center for Connected Health Policy released a telehealth billing guide in January 2020. 

Behavior Imaging Named Among Most Promising Telehealth Solution Providers of 2019

At the end of 2019, Insights Care, a digital and print publication for the healthcare industry, recognized Behavior Imaging as one of the Most Promising Telehealth Solution Providers of the year. In the magazine feature about the award, Insights Care wrote about the importance of increasing patient access to the care of expert clinicians, especially for patients in underserved areas.

telehealth, early diagnosis, autism, solution, telemedicine

The telehealth solution is a useful alternative for early diagnosis.

Behavior Imaging’s remote behavioral assessments live on HIPAA-compliant, cloud-based platform. The technology is an example of asynchronous telemedicine. While synchronous telemedicine is the delivery of health information in real-time, asynchronous telemedicine creates more flexibility around the timing of care.

“Asynchronous telemedicine refers to the ‘store-and-forward’ technique, whereas a patient or physician collects medical history, images, and pathology reports and then sends it to a specialist physician for diagnostic and treatment expertise.”
– Oren J. Mechanic and Alexa B. Kimball

Behavior Imaging was recognized alongside other telehealth innovators including TeleDentists and General Devices, a telehealth service connecting EMS and hospitals. The leadership team at Behavior Imaging is honored to be named among other companies that increase access to care through telehealth.

The Importance of Early Autism Diagnosis

Research shows that symptoms of autism spectrum disorder, or ASD, can appear as early as the first two years of a child’s life. Extensive neurological research has also demonstrated the importance of early childhood development. During the postnatal period, when a child starts to interact with the world around them, they start to form bonds with their environment and people close to them. These bonds, as well as their first learning experiences, deeply affect their future physical, cognitive, emotional and social development. There is no question that these early years are incredibly important for any child, and perhaps doubly so for a child living with autism. Unfortunately, many families face barriers to early diagnosis and potential treatment for a myriad of reasons. The ability to bypass these barriers and obtain an early diagnosis can provide a greater likelihood of an improved developmental trajectory in individuals living with autism. We’ll explore both the aforementioned barriers families face, as well as several differences early diagnosis can make.

The Barriers to Early Diagnosis Treatment

Families living in rural areas experience one of the biggest barriers to early diagnosis due to lack of access to proper diagnostic tools. Jeremy Hsu, a science and technology journalist for Spectrum News, estimated that for more than 1 million autistic children in the United States, there only about 8,300 child psychiatrists, 1,500 child neurologists and 1,000 developmental-behavioral pediatricians. Families without access to these clinicians are often cut off from important information about their early development and treatment options. Furthermore, a joint article by Eliza Gordon-Lipkin, MD, Jessica Foster, MD, MDH, and Georgina Peacock, MD, MDH for Pediatric Clinics of North America, states that a backlog of patients can cause wait times for families that can range anywhere between 3 months to 2 years. The importance of early childhood development can make any lag in care potentially harmful for families.

early childhood, development, early diagnosis, children, autism, telehealth

Early development milestones are key for children living with autism.

The Difference Early Identification Can Make

A child can miss out on several milestones, including a regular sleep schedule and consistently responding to questions, in as little time as a year from age one to two. Because autism can potentially affect a person’s interactions socially, at school, at work, or in other areas of life, some clinicians are of the opinion that early treatment options are more cost and time efficient than a “wait and see” approach. According to a 2013 article by Robert L. Koegel, Kristin Ashbaugh, and Jessica Bradshaw for the International Journal of Speech and Language Pathology, researchers also see the potential for secondary symptoms, such as aggression or self-harm, to arise in cases where primary symptoms are not addressed early on. Telehealth is now a widely recognized option for early diagnosis. Behavior Imaging tools like Behavior Connect and NODA can provide remote diagnostic options for clinicians and families to ensure these milestones aren’t missed.

The Fiscal Difference

fiscal difference, save money, early diagnosis, telehealth, savings

Early diagnosis has the potential to save families money.

Beyond the behavioral differences of early identification, there is also evidence to support a fiscal difference. Early diagnosis has the potential to save money for both those in need of care and medical providers. Some people individuals with autism desire and need long term support while others need very little at all. Every process is unique. People who require support well into adulthood are often faced with mounting prohibitive costs later in life. In a cost-benefit model from 1998, researchers attempted to predict cost savings by introducing early treatment to children living with autism for 3 years from the time they were 2 years old to school entry. Cost savings were estimated in the range of $187,000–$203,000 for children aged 3–22 years and between $656,000–$1,082,000 for those aged 3–55 years. Whether a family’s needs are short or long term, prohibitive costs shouldn’t stand in the way of support and treatment.

The Telehealth Solution for Early Diagnosis

telehealth, early diagnosis, autism, solution, telemedicine

The telehealth solution is a useful alternative for early diagnosis.

Telehealth tools like NODA and Behavior Connect are an incredibly useful alternative to traditional diagnostic tools. By capturing their child’s behavior using smart phone technology and sending data directly to a clinician, families can bypass exorbitant wait times. Multiple visits to a brick and mortar medical facility can also lead to mounting costs that can ultimately prohibit families from receiving a final diagnosis. We’re hopeful that telehealth can provide a step in the right direction by providing a cost effective option for early diagnosis by reducing these high cost visits. It’s our mission to ensure healthy early development for children living with autism by providing diagnostic options through telehealth.

 

 

 

 

 

 

 

Sources:

http://www.child-encyclopedia.com/importance-early-childhood-development   

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576710/

https://www.ncbi.nlm.nih.gov/pubmed/27070190

https://www.spectrumnews.org/features/deep-dive/why-are-there-so-few-autism-specialists/

https://pathways.org/growth-development/toddler/milestones/

https://www.tandfonline.com/doi/full/10.3109/17549507.2013.861511?src=recsys 

https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1099-078X(199811)13:4%3C201::AID-BIN17%3E3.0.CO;2-R    

https://www.sciencedirect.com/science/article/pii/S0031395516410308?via%3Dihub

ascend, behavior, partners, families, first, NODA, telehealth, improved, solutions

Ascend Behavior Partners Puts Families First With NODA

When Jonathan Mueller, a founding owner of Ascend Behavior Partners, thinks about how to improve services to children with autism, he starts with a basic observation.

“Parents want the best for their kids. When they realize that their child has a developmental concern, panic can set in,” says Mueller. “We see a lot of parents incredibly hungry for answers and information.”

But far too many of these families will have to wait for the information they so fervently desire.

“It can take two years from when a parent has concerns to when they get the actual diagnosis,” Mueller points out. “That is exacerbated for families who have Medicaid.”

Delayed Assessment = Delayed Intervention

developmental, trajectory, early, intervention, autism, NODA, behavior

Improved developmental trajectory depends on early intervention.

Experts agree that an improved developmental trajectory depends on early intervention. Knowing this, providers like Ascend aim to identify — and eliminate — the reasons for such long delays. 

“When a family decides to seek help, it’s hard to navigate the system and access the resources. The healthcare world is complex,” Mueller points out. “A major cause of diagnosing delays for families is the shortage of providers – both licensed psychologists and developmental pediatricians.”

The facts bear out Mueller’s conclusion. Autism diagnoses have increased over recent years. In 2012, the prevalence of ASD was one in 68 children; by 2014, it was one in 59. Yet, at the end of 2016, there were only 800 board-certified developmental-behavioral pediatricians. To put it another way, the demand for autism diagnostic services is 18 times the number of providers. To make matters worse, where a family lives can greatly limit their access to providers, and consequently, their treatment options.

“We knew we needed a more efficient way,” says Mueller.

Telehealth: A More Efficient Way

The practice at Ascend Behavior Partners consists mainly of home-based ABA services. Ascend also provides diagnostic evaluations for children with concerns for autism when diagnostic wait-times are a potential barrier to accessing treatment. That practice is led by a licensed psychologist.

“Our goal was to reduce the time from when a parent has a concern to when they have resolution down to 2 months,” says Mueller.

To help them achieve this ambition, Ascend Behavior Partners turned to NODA, Naturalistic Observation Diagnostic Assessment. NODA expedites the assessment process by enabling families to gather behavioral data at home using mobile technology.

From ADOS to NODA

“If our psychologists cannot observe the child, they cannot make a diagnosis. They need those behavioral observations,” says Mueller. “And every family – literally everyone – is on smart phones. There’s no reason that everything that we do with doctors cannot be enabled with smart phones and mobile devices.”

By empowering families, NODA gathers observations more efficiently than in-person visits only. And because the observations are acquired in a child’s everyday settings, they are more representative and accurate.

NODA, families, clinicians, assessment, diagnosis, autism

NODA expedites the assessment process by empowering families and clinicians

“If you bring a 2-year-old child into a doctors office, is the psychologist going to see the same behaviors as at home? That’s not the child’s natural environment. The child might have a bad day on testing or not act the same way,” says Mueller. “NODA helps our team see the child in their natural environment.”

Mueller’s experience has convinced him of the potential of NODA.

“We believe NODA plays such a critical role in behavioral observation; it can be done instead of the ADOS.”

Telehealth and the Status Quo

Mueller sees new technologies addressing real problems in a system often resistant to change.

“Let’s put ourselves in our families’ shoes,” says Mueller. “There are outdated health care systems that don’t jive with our 2019 world. For instance, most referrals are still coming in via fax.”

Then there’s the issue of new technologies being embraced by current compliance structures.

HIPAA compliance is a big concern with new technologies. For small practices, that has to be a really well-considered question,” says Mueller.

And as always, there’s the matter of payment through insurance.

“This is a big barrier to a lot of psychologists. At Ascend Behavior Partners, we view NODA as part of the cost of an assessment. Even though insurance does not pay for N

ODA, we think it would be beneficial for insurance companies to include it as a reimbursable expense in provider contracts.”

But despite the barriers to adopting new technologies, Mueller sees great promise.

Telehealth is in the first inning of the ball game. There are great technologies out there. There’s a lot of tools to create a compliance eco-system that’s leveraged by tech,” observes Mueller. “Artificial Intelligence is going to help significantly. We should absolutely use AI applications with text and video recognition.”

However, Mueller is always careful to see new technology as a means to an end.

“Technologies empower providers to make better, more informed decisions that lead to better patient outcomes,” asserts Mueller. “Technology will not replace providers. Doctors and psychologists will always be important.”

Guiding the Journey

Ultimately, technology empowers the families he serves.

“Families with autism are on a journey. They have to advocate for themselves and stay in the driver seat. It can be exhausting,” says Mueller.

For Mueller, technological solutions can make that journey easier for children with autism and their families.

technological, solutions, NODA, diagnosis, autism, families

Technological solutions can make a family’s journey easier.

“Technology can help guide them. It can facilitate follow-up and provide digestible information on what to do next.  It helps us check in on how families are doing,” says Mueller. “Families can take care of themselves better and ameliorate caregiver fatigue.”

For Ascend Behavior Partners, technologies like NODA will help give families the choices they want and deserve.

Provider Reimbursement Progress for Telehealth

It goes without saying that the CPT system of payments and coding is both complex and detailedIt involves payer codes, categories, circumstances of use, and time. This system came from a 1985 Harvard study that created the resource-based relative value scaleThis scale deployed an ongoing method of calculating relative value units for physician services. Many practices utilize a third-party medical billing service to stay compliant and keep up with CMS changes that cycle every two years. 

For 2019, CMS published ninety-nine CPT codes for telehealth services and specifically one new code that is exciting for us at Behavior Imaging in relation to our remote autism assessment tool, NODA (Naturalistic Observation Diagnostic Assessment). This article is an overview of those new codes and other emerging payment options that clinicians can use to expand telehealth services within their practice.  

Direct Pay for Telehealth Services 

One option for telehealth reimbursement is direct pay, wherein families pay the clinics directly for remote health assessment services. Families with health plan deductibles may be able to use the direct payment towards meeting their deductible. 

Behavior Imaging, Provider Reimbursement, telehealth, deductible

Families with deductibles may be able to use the direct payment toward meeting their deductible.

For example, if the family’s plan deductible is $500 and the clinic charges $400 for a NODA assessment, the family direct payment for $400 would apply and meet 80% of their health insurance deductible. This method would allow a clinic to collect the direct payment in full and report the service and billable amount to the family insurer for tracking deductible spending. Of course, this method depends on the individual health plan of the family, but it can be a valuable tool for provider reimbursement. 

Private Insurance Reimbursement

Private insurers follow CMS coding and payment schedules but can also incorporate their own payment schedules based upon needs and various state laws. The process varies by insurer and state. A few states and insurers have been open to emerging methods of evaluation and managementThese progressive thinkers realize the benefits of technology that reduces both costs and wait-times. We suggest checking with the insurance providers in your state about the new and exciting changes outlined in the section below. 

CMS Changes

In June 2017, the CPT Editorial Panel revised five existing codes, added 13 codes to provide better descriptions of psychological and neuropsychological testing, and deleted CPT codes 96101, 96102, 96103, 96111, 96118, 96119, and 96120. The RUC and HCPAC submitted recommendations for the 13 new codes and for the existing CPT codes 96105, 96110, 96116, 96125, and 96127. 

The new coding structure separates billing for the first hour from each additional hour as well as distinguishes between evaluation services and test administration/scoring as follows:  

  • 96101 for psychological testing by a psychologist or physician is replaced by 96130 (first hour) and 96131 (each additional hour) 
  • 96136 for psychological testing evaluation and scoring services (first 30 minutes) and 96137 for test administration and scoring (additional 30 minutes) 

Before the changes took effect on January 1, 2019, both CPT 96101 and CPT 96111 were used widely for Autism assessments.  

ABA Assessment Code

The new ABA CPT code 97151 includes 15-minute billing increments for non-face-to-face analyzing of data as part of the behavior identification assessment. NODA can be incorporated into this assessment method as one of the tools used for evaluation reporting. The above changes are positive changes toward including NODA as one of the tools a clinical professional can utilize and be compensated within their practice. 

 

provider reimbursement, insurance, telehealth, payment code, progress, telelmedicine

Clinicians can expand telehealth services in their practice.

New Exciting Reimbursement Code to Watch

For CY2019, CMS proposed to make separate payment for remote evaluation services when a physician uses pre-recorded video and/or images submitted by a patient in order to evaluate a patient’s condition through new HCPCS G-code G2010: 

Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with verbal follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment 

The new G2010 code was created with dermatology in mind, and although not specific to psychological testing, the fact that CMS considers this a viable and credible method of evaluation can only hold promise that NODA directly will correlate to expanding this service coverage for reimbursement in other categories.  We hope to establish a working group to share both experience and patient results to CMS resulting in the expansion of this procedure for FY2021. 

Increased Acceptance of Telehealth

New payer codes for telehealth services signal an increased acceptance of remote services and their benefits for both clinicians and patients. As clinics are able to treat more patients using cost-effective and evidence-based telehealth technology, we predict that it will become an essential part of every clinician’s toolkit. 

Behavior Imaging Tools for Training and Supervision

Since starting Behavior Imaging in 2005, our goal has always been to support families living with autism on their journey from diagnosis to care. As autism prevalence rises, the ability to quickly and accurately diagnose a child has become paramount. Families often wait months for an official diagnosis or struggle with lack of access to care. Behavior Imaging technology seeks to remove these barriers. As technology grows and improves, Behavior Imaging tools have developed other uses for training and supervision.

 

Improvements in the Training and Supervision Process:

    • Teachers and Supervisors can monitor and assess behavior remotely
    • Students and trainees can quickly receive feedback from multiple sources
    • Learning processes are expedited due to time saved

These applications allow supervisors and teachers to turn to technology like Behavior Connect and the Behavior Capture App to bring training and supervision of young clinicians to the next level.

 

Behavior Imaging Tools in Practice

training and supervision, behavior imaging, autism diagnosis, remote tools

Several military families participated in the study

A study conducted on behalf of the U.S. Air Force Medical Service gives context for how Behavior Imaging’s tools can improve training and supervision. Thirty-three military families with at least one autistic child assessed the effectiveness of the Behavior Imaging online consultation platform. These families used our diagnostic tools to capture behavior remotely. Applied Behavior Analysis supervisors then reviewed the captured footage. According to surveys completed by participating families, the benefits of Behavior Imaging technology included significant time and expense savings, as well as more relevant information communicated both to the caregiver and therapist. 

 

Technology Enhancing Supervision

While the above study focused on families capturing their children’s behavior, we’ve found that supervisors can just as easily turn the camera around and use these methods to assess clinicians in the field. Using the same tools that families used to document their child’s behavior, clinicians can record their own behavior during a routine procedure or consultation and send to their supervisors for immediate review.

Immediate Improvements for Supervision:

    • Better understanding of complex behaviors by the therapist supervisor
    • More accurate assessments of behavioral trends and progress
    • Multiple supervisors at once can review behavior in an expedited manner

We’re hopeful that supervisors can use Behavior Imaging’s technology to not only to help families, but also to supervise health professionals and help them optimally care for their patients. For a closer look into better therapeutic supervision with Behavior Imaging, we’ve included the video below for further viewing.

 

A Helpful Solution for Students

Behavior Imaging is a helpful tool for students.

As the healthcare landscape changes and grows, so does the training process for the next generation of medical professionals. Behavior Imaging video-capture technology has the potential to transform the student/teacher relationship in a similar way to the clinician/supervisor relationship. For example, nursing students carrying out protocols such as a routine influenza immunization can capture the procedure using the Behavior Connect platform. These students can then send their data to several different teachers at once who can evaluate the students’ proficiency in the procedure almost immediately. In this way, the learning process is expedited while maintaining the specificity needed to train capable medical professionals entering the field. 

 

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Sources:

https://www.healthcareitnews.com/news/air-force-encouraged-new-behavioral-telehealth-technology

NODA Smartphone-Based Assessment Expedites Autism Diagnosis

Behavior Imaging recently completed a National Institute of Health-funded research study to compare current in-person autism assessment practices with the NODA smartphone-based method. The research showed that the average total time associated with obtaining an autism spectrum disorder assessment using the in-person method was 118 days. With the NODA method, however, assessment took only 59 days. These research findings indicate that the NODA method decreases the overall time required to complete an assessment while providing acceptable levels of satisfaction for the families involved.

“We are immensely grateful to the experienced diagnosticians from participating sites who used their clinical experience to assess children earlier by the NODA method,” said Ron Oberleitner, CEO of Behavior Imaging and principal investigator of the study.

 

“Twenty years ago, our family faced a similar challenge. Long wait times at diagnostic clinics led to us going almost two years before confirming our son Robby’s diagnosis. This approach would have been invaluable to help us get an earlier start on Robby’s treatment.”

 

The NODA Study

From the beginning of January 2017 to the end of March 2018, three autism research sites participated in the project including Emory Autism Center (EAC), Southwest Autism Research and Resource Center (SARRC) and the University of Idaho. Each site invited families from surrounding rural and urban communities who were seeking a developmental evaluation for autism.

A total of 57 families were included in this research study, of which 11 were from rural communities. Traditional in-person assessment was used for 29 families and the NODA method of assessment for the other 28 families. Families filled out two questionnaires about their experience, one after the assessment data was collected and the other three months after receiving a diagnostic report. Survey results showed both assessment methods were comparable in supporting families to get treatment if results were positive for an autism diagnosis.

 

The Benefits of NODA Software for Autism Diagnosis

Developed by Behavior Imaging, NODA (Naturalistic Observation Diagnostic Assessment) is an evidence-supported autism diagnostic assessment tool available as a software service.  Experienced diagnostic clinicians can use NODA to enable remote autism assessments. The service was commercially developed through a NIMH-funded series of research studies. By expediting a potential autism diagnosis, families can move forward more quickly with their care plan. NODA technology has the ability to bring families closer to the options they need for their child’s development and future. 

 

 

Read the full report here.

Sources: www.behaviorimaging.com