It goes without saying that the CPT system of payments and coding is both complex and detailed. It involves payer codes, categories, circumstances of use, and time. This system came from a 1985 Harvard study that created the resource-based relative value scale. This 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. 

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 management. These 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. 

 

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 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

Telehealth has been expanding for years. We’re seeing more and more primary care providers, hospitals, and medical researchers embracing the option of treating patients remotely. Now, the next generation of telehealth is bringing Artificial Intelligence to the table to help advance healthcare options in a variety of ways. We’re rounding up the latest news in AI and three main advantages are emerging.

• Accessibility
• Cost Reduction
• Long Term Management

Accessibility

The most obvious advantage to Artificial Intelligence in telehealth is the level of accessibility it allows. Patients living in rural areas or those without reliable transportation are lucky to see a doctor once a year. That is hardly the amount of care it takes to treat a short term or long term chronic condition. A recent article from Electronic Component News features a simple observation from primary care physician Lyle Berkowitz,

 

“Many patients do not have easy access to a brick and mortar facility, but they all have access to a computer or mobile device, so we make it easy for them to use either to connect with us.”

Chatbots help connect doctors and patients.

 

Dr. Berkowitz is part of the MDLIVE Medical Group. The practice is one of the few in the nation handling patients across all 50 states, 24/7, year-round. They’ve developed an AI Chatbot called Sophie that can help register and connect patients with their doctor. MDLIVE is hopeful that in the future Sophie will also be able to help with diagnosis and treatment options. Some practices are even predicting that Artificial Intelligence will bring care and treatment options to developing countries with little to no access to healthcare at all.

Cost Reduction

Health care spending in the U.S. is a major concern. Evidence shows the U.S. spends more on healthcare than other countries, yet our nation’s health outcomes are often worse. This is largely due to administrative costs and slow intake processes. With AI the future does not have to be so sluggish. Chatbots like Sophie can not only guide new members through the registration process but also help users to recover usernames and passwords. Better yet, Bots can analyze patients’ insurance offerings and make recommendations to suit their needs and coverage.

 

These are examples of what is called Robotic Process Automation or RPA. This model helps put healthcare organizations’ focus back on patients, enabling them to navigate the intense healthcare ecosystem and find the best possible care options.

 

Long Term Management

Perhaps one of the most promising areas of development in Artificial Intelligence is analysis of long-term diagnoses. With the use of algorithms and predictive analytics, AI can alert clinicians to problems more quickly. Certain algorithms may even be right at our fingertips. Smartphone selfies have become powerful diagnostic tools. We generate millions of terabytes of data every day by simply taking selfies. AI can use that data to provide personalized, faster, and smarter services. A smart phone tool in the UK can identify developmental diseases by analyzing images of a child’s face. It can then match these images to more than 90 disorders to provide clinical decision support. AI makes it easier to sort through all the data. As Brandon Westover, Director of the MGH Clinical Data Animation Center, states:

 

“…if you have an AI algorithm and lots and lots of data from many patients, it’s easier to match up what you’re seeing to long-term patterns and maybe detect subtle improvements that would impact your decisions around care.”

 

From chatbots to genomics to remote sensors, we’re getting a sense of what to expect from the future of AI in telehealth.

 

At Behavior Imaging, we are all too familiar with the autism care gap and the long wait times most families face during or before diagnosis. Lack of brick and mortar facilities contributes to these issues. We’re constantly searching for innovative ways to shorten the gap and limit the wait time. AI’s promise of reduced spending, a focus on the patient, and a streamlined process can mean the world to those families. Especially to a family discovering the complexities of autism and the many care options available. The prospect of adding AI to streamline the process of connecting families with clinicians is incredibly exciting.

 

We hope to offer our own AI developments in the future

 

 

Sources:

https://www.ecnmag.com/article/2018/11/breaking-borders-patient-centric-medicine

https://jamanetwork.com/journals/jama/article-abstract/2674671?redirect=true

https://www.healthcareitnews.com/news/where-ai-has-most-promise-reducing-healthcare-costs

https://hitconsultant.net/2018/02/05/artificial-intelligence-focusing-on-care-not-cost/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298703/

https://www.genome.gov/27552451/what-is-genomic-medicine/

https://medicalfuturist.com/top-12-health-chatbots

https://behaviorimaging.com/2018/08/05/autisms-care-gap-when-resources-dont-meet-demand/

https://healthitanalytics.com/news/top-12-ways-artificial-intelligence-will-impact-healthcare

Though we have seen a rapid increase in autism diagnoses in recent years, dozens of children are still falling through the cracks and a pronounced racial disparity in autism diagnosis has emerged. A recent study from the Centers for Disease Control and Prevention (CDC) identifies 1 in 59 children as having Autism Spectrum Disorder (ASD). However, despite a 15 percent increase in prevalence, more research shows that less than half the children identified with autism (43 percent) have received comprehensive developmental evaluations by the age of three. Now, research shows even more startling statistics amongst black and Hispanic children.  

 

White children are consistently diagnosed earlier and more often than children in minority households. This blatant racial disparity directly affects a child’s future when living with ASD. With access to the right resources, clinical professionals can diagnose a child living with autism as early as the age of two. This kind of early detection is key for a child’s treatment and development moving forward. Behavior Imaging is using Telemedicine to prevent these kinds of discrepancies. Learn more about how the numbers really break down and how telemedicine and technology can help us move forward here. 

Contributing Factors  

In a perfect world no child living with autism would go undiagnosed. With access to the right information, parents and clinical professionals can recognize signs of autism in a child’s development. Cognitive delays can surface as early as 12 to 18 months. So, why is this information available to only some families? There are several contributing factors leading to racial disparity in autism diagnoses: 

• Prohibitive costs 
• Healthcare accessibility 
• Lack of dialogue between doctor and patient  
• Implicit medical bias  

In a recent interview with NPR, Sherry Alvarez spoke out about this kind of implicit bias after her son went undiagnosed for a significant amount of time, “We have to retrain ourselves. It’s not OK to hide our kids.” 

Experience Proves Positive 

Behavior Imaging has been fortunate to be funded by research grants from the National Institute of Health to test if technology can bridge this gap in earlier diagnostic assessment for underserved populations. Our recent study on NODA Autism Diagnosis for rural areas. One native American family who heard about potential warning signs entered the study. Their ability to securely share behavior samples on video clips captured in their home confirmed indicators for autism to a trained diagnostician who was hundreds of miles away.  The family’s diagnosis was expedited as a result.  Witnessing tears of joy after starting helpful early intervention exercises that had almost an immediate positive impact, the grandmother assured us that, without the remote diagnosis tool, they would have been struggling without answers to help her grandchild for years to come.  

We shared this, and 57 other cases involving underserved ‘rural’ families, in a research poster presentation at the annual Telemedicine Service Provider conference in Glendale, AZ in October 2018.  

A Cultural Overhaul

There is more to this issue than cases simply falling through the cracks. It permeates on a deeper, cultural level. In 2007, a study by a team at the Center for Autism and Developmental Disabilities Research and Epidemiology found that African-American children were 5.1 times more likely to be misdiagnosed with various conduct disorders before being diagnosed with autism. Thankfully some clinics are starting to take note of this disparity. Westside Regional Center in Culver City is taking advantage of a grant to investigate their intake and treatment patterns.  

“We’ve implemented a series of trainings with intake counselors on cultural awareness and sensitivity, and we’re starting to have a lot of conversations about biases,” says Tom Kelly, Westside’s chief psychologist.  

However, not all families have access to clinics such as Westside Regional. Options are already limited and, though ASD affects all races and ethnicities, black and Hispanic families seem to experience even more limitations. For these families especially, there is a need for an innovative and accessible answer that helps put an end to racial disparity once and for all.  

 

Sources:  

https://behaviorimaging.com/noda/  

https://www.helpguide.org/articles/autism-learning-disabilities/does-my-child-have-autism.htm 

 https://www.autismspeaks.org/news/news-item/cdc-update-autism-shows-gap-between-early-concerns-and-evaluation 

https://en.wikipedia.org/wiki/Epidemiology_of_autism#Frequency 

https://www.jaacap.org/article/S0890-8567(09)60739-5/abstract 

https://www.npr.org/sections/health-shots/2018/03/19/587249339/black-and-latino-children-are-often-overlooked-when-it-comes-to-autism

For families of children diagnosed with Autism, choosing the right treatment option can be daunting. For many families, however, the choice is made for them due to limited resources and high demand for care in many areas. For these families, new telehealth technology can help provide access and options they may not otherwise have in their region.

A 15% Increase in Diagnosis

This year, the CDC reported a 15% increase in the prevalence of autism diagnosis from 1 in 68 to 1 in 59 children. Compare this number to data from the American Board of Pediatrics that recognized only 800 board-certified Developmental-Behavioral pediatricians at the end of 2016. That’s out of 118,200 pediatricians nationwide. While the increase in diagnoses most likely reflects an increase in awareness and better diagnosis tools, it doesn’t change the fact that more children are in need of autism diagnosis and treatment than ever before, and there are few specialists to assist them.

The Link Between Treatment Options and Geography

A recent study found a significant correlation between autism treatments used and where a family lives. Researchers from University of Houston and Baylor College of Medicine collected data from 2,647 families across the United States and in Montreal, Quebec. Children living in the Northeast and Western regions of the United States are more likely to have tried a variety of therapies, compared to children in the South or Midwest who are more likely to be taking medication as treatment. Families reporting use of no treatment came primarily from the South and Montreal.

This information correlates to a Stanford University School of Medicine study regarding access to diagnoses and treatment centers around the country. The study found that 70% of people live within 30 miles of an autism diagnostic center, but the average distance traveled to a center is 50 miles. Once diagnosed, access to therapists is similarly limited, with the demand for treatment 18 times larger than the available supply of caregivers.

This lack of access is even more stark in low-income areas where families on Medicaid face year-long waits to see providers, generally due to low Medicaid reimbursement rates, with South Carolina paying ABA technicians only $17 per hour.

Lack of Access = Lack of Choice

It comes as little surprise, then, that families in Midwest and Southern states would turn to medication over various forms of therapy, because they simply don’t have access to therapists. While there are certainly advantages and disadvantages to all treatment options, in an ideal world, each family would have the full realm of options available to them and the freedom to choose what is best for their child. 

Telehealth Technology Can Help Bridge the Gap

At Behavior Imaging, we hope that emerging advances in telehealth technology will help bridge the gap and increase access to autism diagnosis and treatment options. With the NODA diagnosis app, families can skip the months-long wait and long travel times to visit a diagnosis center. Instead, smart phone technology empowers families to send video to trained clinicians and receive a diagnosis within weeks instead of months. Recent research conducted by the Behavior Imaging team found that the average total time associated with obtaining an ASD assessment in person was 118 days, while that time was cut in half to 59 days using the NODA program.

After diagnosis, telemedicine can become a valuable resource for families creating a treatment plan. Behavior Connect is an online portal that connects families and specialists, allowing them to remotely capture, assess, and analyze behavior. Behavior Connect makes it easy to remotely perform world class Functional Behavior Assessments (FBA) and track and manage medication.

Families Deserve Access and Options

Raising a child with autism comes with enough challenges as it is. Having access to care shouldn’t be one of them. Through telehealth technology, we hope that eventually families in all regions of the United States will have access to the care that best suits the needs of their children.