In a recent conversation with the Office of Mental Health and Substance Abuse Services (OMHSAS) it was stated that audio-only services for telehealth should only be used when the individual does not have access to technology such as a smart phone, tablet, or computer that would allow real time audio-visual communication. Additional requirements for audio-only services include the following: payers are allowed to require a signature after each encounter, providers are still required to fill out service verification (encounter forms), and providers can send a form in the mail to patients with a pre-paid return envelope or utilize a HIPAA compliant system that captures an electronic signature in a manner that is auditable. If you have questions about obtaining a signature from your patients, please contact your payer.