Prior to the COVID-19 pandemic, many mental health professionals had never practiced distance therapy with their patients. When social distancing and flattening the curve became nationwide-goals, the legislatures acted quickly to relax restrictions on providing teletherapy and many mental health professionals jumped into action. After all, isolation, financial pressures and the stress and anxiety brought on by the societal changes required by the pandemic created a high demand for mental health services. But how do we safely deliver quality services using the technology available to us? What extra documentation is necessary for compliance purposes? Let’s review some basics for the mental health providers who are new to teletherapy or are interested in adding the technology to their practice.
Where to Begin?
While you may have a well-established routine with your patients, there are some aspects of distance therapy that will require you to re-orient the patient to how the practice works. You may also need to complete some additional paperwork before you begin. While most insurers quickly changed policies to allow for distance therapy services temporarily during the pandemic, there are some private or employer panels that are not covering the service. It’s best to check each patient’s coverage to be sure they are covered. If your existing informed consent paperwork on file does not already include language referring to distance therapy, you will need to send each patient an informed consent form specific to distance therapy and have that in place before you begin.
Rule #1 – Have a Contingency Plan
What will you do if your internet freezes or you have connectivity issues? If your session is conducted over the phone, what will you do if the call is dropped? Most importantly, what will you do if your client is in crisis? Have a plan in place and at the beginning of every session explain what will happen should a problem arise.
The OCR will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. As long as you use a non-public facing remote communication product, many video applications and even telephone-only sessions will be allowed. While there are some great HIPAA-compliant technology platforms available, and it is always preferable if you can access them, it is permitted during the COVID-19 public health emergency to conduct sessions using FaceTime, Skype, etc., if necessary. Remember that public-facing applications, such as Facebook Live, are still strictly prohibited.
OCR has published a bulletin advising of flexibilities as well as obligations that remain in effect under HIPAA. That bulletin can be found here.
Verify with your patient that they are satisfied with the privacy on their end of the teletherapy session. Watch for body language that indicates that they are concerned someone may be listening to the session and ask questions if you feel that is the case. On your end, it is crucial if you are working from home that you are able to lock the door of your workspace and that anyone in the home is aware that they must not interrupt your sessions.
A statement should be included in each note that you are conducting the session via telehealth and you should identify the technology used. You may also include the phrase “Due to the COVID-19 public health emergency” when you document the session’s use of telehealth, especially if you are using a platform that is only temporarily permissible, such as a telephone-only session, Skype, or a Google Chat.
With regards to billing for telehealth, in general, the place of service (POS) code 02 is used for telehealth, although this depends on the payer. Modifiers may or may not be required by the payer, so it is important to know the rules before submitting your claims.
CMS is temporarily waiving requirements that out-of-state practitioners be licensed in the state where they are providing services when they are licensed in another state. There are four conditions of this waiver:
- The provider must be enrolled in the Medicare program.
- The provider must possess a valid license to practice in the state which relates to his or her Medicare enrollment.
- The provider is furnishing services - in person or via telehealth - in a state in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity.
- The provider is not affirmatively excluded from practice in the state or any other state that is part of the emergency area.
Conduct a professional session. Your camera view should be neat and free of personal objects. Remember that the patient can see you at all times. If you are taking notes or typing, the patient will see that you are looking down and you may appear to not be paying attention. Look at the camera and do not allow yourself to be distracted. If your telehealth session does not have a video component, think about how you will handle silences? Without being able to see the patient, you will have to use your intuition to acknowledge the silence and not lose momentum of the session.
There are many excellent resources for training, certification, and continuing education. No matter how experienced you are, telehealth is different. Be open to learning from others and do research into developing your skills as a distance therapy provider.
Remember that many of the restrictions on telehealth therapy services that have been lifted during the pandemic will be back in place at some point so it is crucial to check updated policies with your different insurance panels frequently. You should also verify with your patient that the distance therapy format is meeting their needs. Ask specific, open-ended questions. If this format does not best serve your client or makes them uncomfortable, find a better solution. With a little research and preparation, and perhaps some experimentation with new technologies, you can adapt your practice and continue to serve your patients’ mental health needs throughout the public health emergency.
For more specific information, AIHC offers a short course worth 2 CEU’s: COVID-19 Healthcare Ethics & HIPAA.
Written by: Amy Wagner, CPC, ICDCT-CM