5 Things Every Mental Health Provider Needs to Know About Telehealth During COVID-19

It’s mental health reimagined. During times of social distancing, sitting directly across from clients in a comfortable therapy office is no longer possible. Instead, clients sit at home and talk to their therapist using a computer or mobile device. As with any major transition, though, this monumental shift requires stepping out of one’s comfort zone.

Now more than ever, mental health providers must master new technology and adapt existing treatment modalities to a new medium—all while continuing to provide high-quality care during a time of incredible uncertainty. “This care approach takes some getting used to from both the provider and patient’s perspective,” says Toni Elhoms, CCS, CPC, CRC, CEO of Alpha Coding Experts. “It takes providers a few days before they typically develop a rhythm.”

In honor of National Mental Health Awareness week, we are providing five things every mental health provider should know as they ramp up telehealth services during COVID-19 and beyond:

1. Beware of non-HIPAA compliant solutions.

Although Medicare permits providers to temporarily use popular applications that allow for video chats (e.g., Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, the free version of Zoom, or Skype), it’s important to note that these tools are not HIPAA-compliant, says Elhoms. Note that Medicare does not permit Facebook Live, Twitch, and TikTok. Also note that commercial payer requirements may differ.

Best practice is to choose a telehealth vendor that ensures privacy and security of protected health information and is willing to sign a business associate agreement in connection with the provision of its video communication products. Another reason to choose a HIPAA-compliant vendor? If and when payers eventually move away from HIPAA flexibility and reinstitute more stringent requirements, mental health providers who already use compliant solutions will be ahead of the game, says Don Self, CMCS, CPC, CASA, consultant at Don Self & Associates, Inc. They will not need to find a new solution, and their clients won’t need to adapt to new technology, he adds.

2. No two commercial payers are alike. 

In addition, commercial payers may or may not follow Medicare, says Elhoms. “I think the biggest challenge right now is navigating all of the reimbursement changes that have occurred over the past eight weeks.” Best practice is to contact each commercial payer individually and inquire about telehealth coding and billing requirements—or, better yet, partner with a telehealth vendor that includes state-specific reimbursement mandates, payer-specific nuances, and artificial intelligence-driven rules to prevent denials. When providing telehealth to patients with Medicare, mental health providers should report place of service code 11 and append modifier -95 to the CPT code for the service furnished via telehealth, says Self. Medicare will pay the same amount for telehealth services as it would if the service were furnished in person if the service was provided via an audio-video platform.

Also create a backup plan to call the patient directly when audio-visual technology fails—but know that there could be reimbursement consequences for patients with Medicare, says Self. If most of the visit is conducted via audio/visual technology, providers can still bill telehealth, he says. However, if most of the visit is via audio only, they must report a telephone services code. For example, a therapist spends five minutes out of a 30-minute appointment using Skype but then switches to the phone due to technical difficulties. Because most of the visit is conducted by phone, they must bill CPT code 99443 (which pays $41.14) instead of CPT code 90832 (which pays $71.10). Note that commercial payers may allow it and cover telehealth rendered via phone only, he adds.

3. Patients may need coaching.

Preparing patients for telehealth is critical. Ask the practice manager to call patients a day or two in advance and walk them through how to download and navigate any necessary apps. Providers can also send written instructions in advance to make it a smoother transition for clients.

4. It’s important to think outside the box. 

There are a whole host of telehealth services that Medicare has agreed to cover temporarily during COVID-19 such as group psychotherapy, psychological testing, and neuropsychological testing. Commercial payers may cover these as well. “Make sure you take advantage of these services while you can,” says Self. These are in addition to various telehealth services that Medicare previously covered. Dr. Huling Xu of Wholehealth PLLC, for example, uses telehealth to treat patients with agoraphobia and paranoia, disorders that can often cause individuals to feel uncomfortable commuting to a doctor’s office, let alone sit in a waiting room. Dr. Xu found telehealth to be a perfect solution to solve this prominent patient issue.

Wholehealth also has a subset of clients who have a difficult time finding childcare or who travel often for business and are unable to make it into the office for appointments.“One possible silver lining to the entire pandemic may be that Medicare and commercial insurance carriers may continue to pay for telehealth after all of this is over,” says Self. “We will have to wait and see.”

5. Time-saving features make a huge difference.

In the middle of a public health emergency, mental health providers want to focus on their clients—not administrative tasks that take time and zap their energy. “Integration between the telehealth platform and practice management systems is important for revenue cycle management,” says Elhoms.

It is important to look for a practice management system that offers time-saving features such as online patient intakes, automated appointment reminders, and online patient scheduling. “Kareo’s intake process has streamlined everything. New patient visits take a full 30 minutes less than before,” says Dr. Rusha Butler of Wellness Integrative Medical Centers. “That’s time we can spend with patients, rather than wasting on paperwork. We can now actually do our jobs and provide optimal care.”

For more information on how Kareo can utilize technology to optimize your mental health clinic, click here and to download our guide to Modernizing Your Mental Health Clinic to Save Time and Improve Care Delivery, click here.

About the Author

Lisa A. Eramo, BA, MA is a freelance writer specializing in health information management, medical coding, and regulatory topics. She began her healthcare career as a...

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