Telepractice has transformed the way speech-language pathologists deliver services. Whether you are adding telehealth to an existing practice or building a fully remote caseload, setting up a compliant, effective telepractice service requires careful planning — but the investment is absolutely worth it.
Step 1: Understand Your State's Telepractice Laws
Telepractice regulations vary by state and are updated frequently. Before seeing your first remote client, verify your state's licensure requirements, whether you can treat clients located in other states (and if so, whether you need licensure in those states), and any specific telepractice regulations from your state licensing board. ASHA maintains a state-by-state telepractice resource that is a good starting point.
Step 2: Choose a HIPAA-Compliant Platform
Not all video conferencing platforms are HIPAA-compliant. You must choose a platform that offers a Business Associate Agreement (BAA) and has appropriate security features including end-to-end encryption. Popular options include SimplePractice, Zoom for Healthcare, Doxy.me, and TheraPlatform. Standard Zoom, FaceTime, and Google Meet are not HIPAA-compliant for clinical use.
Important: Get the BAA in writing before your first session. Verbal agreements are not sufficient for HIPAA compliance purposes.
Step 3: Set Up Your Clinical Space
Your telepractice space should have good lighting (light source in front of you, not behind), minimal background distractions, and reliable internet connectivity. A wired ethernet connection is significantly more reliable than WiFi for video sessions. Invest in a quality external webcam and microphone — your clients need to see and hear you clearly for effective therapy.
Step 4: Billing and Documentation
Telepractice billing varies significantly by payer. Verify coverage with each payer before initiating services — do not assume that because one payer covers telehealth, all payers do. Document the modality (telehealth), the platform used, and the patient's location in your clinical notes. Many payers require specific place-of-service codes and modifiers for telehealth claims.
Step 5: Informed Consent
Obtain written informed consent for telepractice services that covers the nature of telehealth, privacy considerations, technical requirements, emergency procedures, and the limitations of remote service delivery. This consent should be separate from your standard practice consent and should be updated whenever your telepractice policies change.
Telepractice is not simply in-person therapy delivered through a screen. The most effective telepractice SLPs adapt their materials, pacing, and engagement strategies for the remote environment. Invest in digital therapy materials, learn to use screen sharing effectively, and build in extra time for technical troubleshooting — especially with new clients.