The COVID-19 (coronavirus) pandemic has been declared to be a national emergency. Many of your clients/patients are wisely limiting their travel and contact with others, and thus may be reluctant to come to your office for appointments. This can impact the financial health of your practice, as well as the mental health of your clients/patients. An alternative to face-to-face psychotherapy is Teletherapy, also known as TeleHealth. Almost all modern Teletherapy is provided over the Internet using a secure, encrypted video chat service.
TherapyAppointment offers a HIPAA-compliant "plug-in" for both the Legacy system and the new TherapyAppointment 2.0 system. By using our secure C3Now video chat service, your clients can get the support they need during these uncertain times. You may not be fully familiar with the mechanics of Teletherapy, the legal requirements for this service, or the recommendations for conducting effective online sessions. Keep reading to learn some valuable considerations regarding Telehealth.
Protecting Your Practice
Here are several key areas to be aware of when incorporating Telehealth into your growing practice.
- Legal and Ethical Issues
- We urge you to check with your state licensing organization to fully understand your state's requirements regarding practicing Teletherapy.
- Research the Interstate Medical Licensing Compact for information on conducting Teletherapy across a state line.
- Malpractice Insurance - this link by a for-profit insurance carrier suggests the best ways to conduct Teletherapy ethically.
- Click here for direct access to a map and search options that cover current laws and regulations for all fifty states and the District of Columbia. If there are other questions, contact your insurance carriers to ensure that they cover Teletherapy services.
- Under HIPAA, you MAY NOT use a public service such as Skype, GoToMeeting, or Zoom for Teletherapy. The service that you use must follow strict security requirements, including encrypting the data in transit. In addition, you must have signed a Business Associate Agreement with the service.
- Billing & Insurance
- In many cases, the CPT codes used for Teletherapy differ from the codes used for face-to-face encounters. They can vary from state to state and from insurance company to insurance company. For example, some carriers want you to use a “modifier code” while others want an “add-on code” to identify the session as Teletherapy. Due to this nuance, TherapyAppointment cannot direct users on how to bill for Telehealth sessions (such as specific CPT codes, modifiers, etc).
- Before billing for a service you may want to consult with a billing professional, the CPT code manual, and/or the insurance providers you are billing. Insurance providers may have special requirements or proof of training; this is especially true for Medicare and Medicaid.
Inform Clients about Teletherapy
Your clients may need some reassurance that social distancing does not have to mean a reduction in their therapy sessions. Most clients and therapists adapt to Teletherapy easily. Here are some points to convey to your clients about transitioning to Teletherapy:
📄 Download - Teletherapy Consent Form Template
- Inform clients of what can be expected when using Teletherapy and how to access the session. Be able to explain how the technology and process is going to work. (*See additional resources on using Teletherapy below).
- Client intake forms for Teletherapy should include the same information that non-telehealth client forms contain. You will also want your client to sign an additional consent form specific to Teletherapy.
- Distractions can increase when the environment shifts to an in-home setting. Remind clients of the importance of confidentiality during the session (no recording), as well as being in a safe and quiet environment (not driving, not in a cafe, etc).
- Adjust your seating so that your facial expressions are easily seen, and suggest that your client sit close to the camera, as well.
- Though it is a difficult habit to establish, try to look at the camera rather than directly at the screen. Looking at the screen may appear to your client like you are looking down or avoiding eye contact, which can unconsciously dilute your client’s sense that you are “present” in the session.
- Though Teletherapy works with a computer or a phone, some clients dislike using a phone because it is tiring to hold it for an hour, the video image is small, and battery life may be limited. Others prefer a phone for its portability and familiarity. If possible, you will want to use a computer, or at least plug in your phone and put it in a stand.
Legacy CPT Modifier Codes
2.0 CPT Modifier Codes
American Psychological Association: Medicare Telethealth Psychotherapy Coverage
American Psychological Association: Psychotherapy Coding Clarifications
American Psychological Association: Legal and Ethical Guidelines for Telehealth
CDC Cases & Latest Updates for Coronavirus
Symptoms of Coronavirus Disease (pdf)