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Teleassessment

The provision of remote services has expanded greatly since the beginning of the COVID-19 pandemic. Teleassessment refers to the evaluation between clinician and patient through a technology interface rather than both people being together in the same location. The goal of teleassessment is to determine a diagnosis and create a viable treatment plan. The information below addresses key points for the successful use of teleassessment in both audiology and speech-language pathology. Follow associated links for more in-depth information.

On this page:

Licensure and Reimbursement

Considerations Resources

In-state service provision:

  • Does the state have specific telepractice laws for audiologists and SLPs?
  • Are you licensed in the state where you provide services?

Out-of-state service provision:

  • Are you licensed in the state where you provide services?
  • Are you licensed in the state where the client receives services? Are there temporary practice provisions for out-of-state practitioners?

International service provision:

  • Are you appropriately credentialed to provide services in that country?
  • Are you licensed in the state where you provide services?

Reimbursement:

  • What kind of insurance does the client have (if any)?
  • Does the payer reimburse for telepractice services?
  • What CPT codes do you use? Are modifiers required?

Reimbursement of Telepractice Services: Considerations for Audiologists and Speech-Language Pathologists

Technology and Access for the Clinician and Client During Teleassessment

Does the client have the necessary...

  • equipment?
  • private space?
  • adequate broadband speed?
  • apps?

Does the clinician have the necessary...

  • equipment?
  • private space?
  • adequate broadband speed?
  • apps?
  • video platform that is FERPA and HIPAA compliant?

Does the client need...

  • closed captioning?
  • facilitator due to cognitive, hearing, motor, and vision needs?
  • interpreter due to language needs?

Resources

Teleassessment Considerations for Audiology

Create a Plan

  • What type of teleaudiology services will you provide (i.e., screening, diagnostics, hearing aid fittings and/or follow up)?
  • Will you utilize a technician or an audiology assistant?
  • Synchronous (in real time) or asynchronous (pre-recorded) appointments?
  • High-speed Internet considerations for the clinician, patient, and the remote site?

Patient Selection

Some patients may happily welcome teleuaudiology services into their plan of care. Keep in mind: Not every patient will be a good fit for teleaudiology services.

Factors to consider for teleaudiology services:

  • cognitive ability
  • family or caretaker involvement
  • comfort level with technology, and access to technology, such as smartphones, tablets, or computers

Equipment

Technology considerations will vary depending on practice setting.

Hardware

  • video camera
  • laptop or computer
  • extra external monitor
  • PC-based audiometer and other diagnostic equipment
  • video otoscope

Software

  • videoconferencing platform
  • hearing aid manufacturer-specific software

You will also need support for troubleshooting if problems arise.

Other Factors to Consider

  • Optimize sound quality—turn off any radios or televisions in the background. Consider using a headset.
  • Set up your physical surroundings so that your back is to a bare wall, or use a backdrop.
  • Keep your space clear of clutter: If there are too many items in the background behind you, clients may find it visually distracting.
  • Implement privacy considerations while an appointment is in progress, such as hanging a “do not disturb” sign near your workspace.

Resource

Audiology Service Delivery Considerations in Health Care During COVID-19 [ASHA web resource]

Teleassessment Considerations for Speech-Language Pathology

If you use a standardized test, remember...

Document the interpreted scores the same way as you would for in-person administration.

Contact the test publisher for questions about reporting scores using remote administration.

If you modify a standardized tool, remember...

Obtain publisher permission if you copy, scan, or modify test materials. This is required by law. On the publisher's website, look for a link (usually on the homepage) called "Permissions" (or similar) and follow the steps listed there.

Include modifications in an evaluation report, which documents the following information:

  • test materials used
  • administration procedures followed
  • an acknowledgment that you used a facilitator

Note: Using a test in a non-standardized manner will invalidate standard scores and may also impact billing of standardized assessment codes.

If you include informal measures, think about...

  • dynamic assessment
  • spoken and written language samples
  • speech sound productions and intelligibility during conversation
  • teacher and caregiver report and questionnaire
  • observation

For feeding and swallowing:

  • observations at mealtime(s)
  • use of any previously prescribed compensatory strategies for swallowing
  • use of food samples that are culturally relevant to the person and their family
  • use of (any) adaptive feeding equipment previously prescribed

If you're relying on caregivers to help with the assessment, remember to...

  • utilize scripts and visual aids to follow during the session
  • discuss roles, expectations, and the importance of neutral feedback
  • maintain a positive attitude when interacting with the caregiver
  • arrange with caregiver to have potential positive reinforcers on hand
  • offer movement or stretch breaks

For feeding and swallowing:

  • ensure that the caregiver has all required tools/stimuli for cranial nerve assessments and trial oral feeds
  • familiarize the caregiver with emergency contacts and safety protocols that are in place at the patient’s/client’s/student’s location

Resources

Considerations for Speech, Language, and Cognitive Assessment via Telepractice [ASHA web resource]

Dysphagia and Telepractice During COVID-19 and Beyond [live web discussion by ASHA Health Care Services]

ASHA Corporate Partners