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Getting Paid
It should go without saying, but many of us in the mental health biz forget this part: don’t downplay your need to get paid efficiently and without too much hassle.
The classic piecemeal approach is to use online payment services like PayPal or Square, where clients can send money to you over the Internet. This works professionally because HIPAA provides a narrow, but powerful, exemption for financial institutions.
The difficulty is that HIPAA’s financial exception doesn’t apply when you go beyond simply accepting payments, and you start using value-added services like invoicing (you can read more about that here.)
Automated billing and payment services are golden for the telemental health pro. We can’t collect payment at the office, so we need to manage it by some other means. This is one reason why a HIPAA-secure platform that includes billing services, e.g. invoicing, can be highly valuable to us.
If you are comfortable managing payment without automated billing features, or you have another HIPAA-secure solution already, piecemeal could be the right way for you.
Client Contact
Video calls aren’t the only contact we have with clients. We also communicate in between sessions. To protect client confidentiality and to maintain the sanctity of the private space that you provide for your clients online, you need a secure tool for that communication.
The piecemeal approach is to subscribe to a secure email, or “encrypted email,” service. Many secure email services exist out there — and we’re not just talking about the services that will do a HIPAA Business Associate Agreement with you. Secure email is a tool that ensures that your communications with clients are never exposed on the open Internet at all under any reasonable circumstances.
Many platform services will provide a feature called a “client portal.” These are web pages where a client can log in to your platform service and securely interact with you in certain ways.
At minimum, client portals provide that same secure messaging functionality that secure email services provide. Some client portals also allow clinicians to give clients access to portions of their records (assuming the platform does record-keeping), produce superbills, or perform other tasks that assist with HIPAA compliance and client service. This helps simplify your workflow when you’re doing a lot of these activities.
If your need for those client communication services are lite, however, then a standalone secure email service may be just right.
Record-Keeping
In my consulting work, I have found that most telemental health providers keep their records electronically. The sessions are done that way, and we often find it’s better to have your records in the same place where you provide services.
If you prefer paper records, and you do your sessions in the same place where you keep the file cabinet, you may be all set. There isn’t always a need for electronic records – not even in telemental health.
You can also keep records directly on your computer. Many therapists are comfortable with the various policies and procedures needed for HIPAA compliance and client safety in this case.
More and more professionals are turning to the cloud (aka “The Internet”), however, for electronic record keeping. If cloud records are the choice for you, then you may want to consider choosing a cloud system that also incorporates telemental health features, e.g. video calling.
If your record-keeping needs are lite, then there may be no significant value in switching to the cloud for record keeping. The same goes if you are having no logistical trouble with paper records. If you are using the cloud (or considering it) for record keeping, however, then consider finding a platform that is a good fit for you and that provides your record keeping and telemental health software services in one place.
Where to Find Platforms
A “platform” could be a practice management system or a certified EHR system that happens to also include secure video calling. It could be a secure video calling service that has incrementally added practice management or EHR functions. Neither one is necessarily superior to the other, in my opinion.
You can, of course, compare platform options at telementalhealthcomparisons.com. You can also find some excellent reviews of numerous practice management systems at Tame Your Practice, although those reviews are not limited to systems that act as telemental health platforms.
If you’re not sure what’s the best choice for you, or you want more information about the issues touched on in this article, you’re in luck! Coming up soon is a FREE, live (to be recorded) 1 hour event: What’s Coming and What’s Here in Online Therapy. This is an educational webinar presented by telemental health mega-expert Jay Ostrowski, NCC LPC-S and therapy tech expert Roy Huggins, LPC NCC. CE credit will be available for an additional fee to those who need it.
The event will be 1 hour and will be recorded. If you missed it, click here anyways to see the recording. It will be always be there and available for free!
Telemental Health Regulation, Certification and Training
There are more than 45 terms used in the marketplace and professional literature related to the mode of tenement all health. Mental health and behavioral health license boards use 26 terms. At least thirty-eight (38) state counseling boards now have policy regulating online counseling for the citizens of their state. Most state counseling licensing boards include the requirement that the counselor is licensed in the state in which the client resides. Arkansas has gone a step further in requiring a special license. Additionally, all major counseling, psychology and social work associations have endorsed telemental health services. Certification for online counseling is available through ReadyMinds.com. They offer training in the legal and ethical practices of online therapy which leads to the Distance Credentialed Counselor (DCC) certification. If you need help with service set up, the Telehealth Resource Centers can help you choose a system, set up HIPAA and HITECH policies and protocols and provide expertise in marketing and business development in order to establish you online clientele. Additional training and support for online therapy can be found through the Online Therapy Institute, Telemental Health Institute and the Zur Institute. The American Telemedicine Association and Hands On Telehealth both provide great insights and resources for the telehealth industry.
Technology Advancements in Online Counseling
Advances in encryption, video and cloud computing have created new possibilities for HIPAA compliant distance counseling. To date, there are over 100 mental-health-specific online counseling venues and over 40 online practice networks. Online counselors now have many inexpensive, HIPAA compliant options for video and text based counseling, even in low bandwidth areas. That makes it relatively simple to “Hang a shingle” online for a safe, ethical and legal online practice.
Government and Mental Health Industry Adoption of Online Therapy
As the industry continues to progress and become more widely accepted by clients and practitioners, online counseling is on course to become as mainstream as face-to-face counseling. The use of online counseling has been validated by the US Federal government and most states, as illustrated by the billions of dollars dedicated to setting up and delivering telemental health services through the DOD and the installment of the federal and regional offices advancing telehealth. https://www.telehealth.va.gov/, https://www.hrsa.gov/rural-health/about/telehealth/.
Reimbursement of Telemental Health
Reimbursement of online therapy has grown dramatically in the last few years as third party payers find it less expensive to provide outpatient video treatment services over even brief hospitalizations. In addition, 20 states now mandate reimbursement for video telemental health services at the same rate as face-to-face therapy and many more states have legislature moving toward a vote. Since the adoption of third party insurance payment is rapidly changing, counselors are advised to check regularly with insurance companies to see who is reimbursing for online therapy and at what rate.
Guess Blog: The Professional's Dilemma Do I Need a Whole Telemental "Platform?"
By Roy Huggins, LPC, NCC, Director, Person-Centered Tech
A current trend in telemental health is the use of “platforms” for delivering and managing services. Platforms are integrated services that include multiple features for telemental health pros besides just the basic video calling. The question is: do you need one for your telemental health practice? Or is a piecemeal approach to your tech the right path for you?
As we develop our telemental health practices, we discover that we need more than just a good, secure video service. We need payments, we need communications between sessions, we need record keeping, we need websites, and so on.
Here we’ll take a look at some benefits and challenges of obtaining those services piecemeal vs. getting them all in one place through a platform service.
Getting Paid
It should go without saying, but many of us in the mental health biz forget this part: don’t downplay your need to get paid efficiently and without too much hassle.
The classic piecemeal approach is to use online payment services like PayPal or Square, where clients can send money to you over the Internet. This works professionally because HIPAA provides a narrow, but powerful, exemption for financial institutions.
The difficulty is that HIPAA’s financial exception doesn’t apply when you go beyond simply accepting payments, and you start using value-added services like invoicing (you can read more about that here.)
Automated billing and payment services are golden for the telemental health pro. We can’t collect payment at the office, so we need to manage it by some other means. This is one reason why a HIPAA-secure platform that includes billing services, e.g. invoicing, can be highly valuable to us.
If you are comfortable managing payment without automated billing features, or you have another HIPAA-secure solution already, piecemeal could be the right way for you.
Client Contact
Video calls aren’t the only contact we have with clients. We also communicate in between sessions. To protect client confidentiality and to maintain the sanctity of the private space that you provide for your clients online, you need a secure tool for that communication.
The piecemeal approach is to subscribe to a secure email, or “encrypted email,” service. Many secure email services exist out there — and we’re not just talking about the services that will do a HIPAA Business Associate Agreement with you. Secure email is a tool that ensures that your communications with clients are never exposed on the open Internet at all under any reasonable circumstances.
Many platform services will provide a feature called a “client portal.” These are web pages where a client can log in to your platform service and securely interact with you in certain ways.
At minimum, client portals provide that same secure messaging functionality that secure email services provide. Some client portals also allow clinicians to give clients access to portions of their records (assuming the platform does record-keeping), produce superbills, or perform other tasks that assist with HIPAA compliance and client service. This helps simplify your workflow when you’re doing a lot of these activities.
If your need for those client communication services are lite, however, then a standalone secure email service may be just right.
Record-Keeping
In my consulting work, I have found that most telemental health providers keep their records electronically. The sessions are done that way, and we often find it’s better to have your records in the same place where you provide services.
If you prefer paper records, and you do your sessions in the same place where you keep the file cabinet, you may be all set. There isn’t always a need for electronic records – not even in telemental health.
You can also keep records directly on your computer. Many therapists are comfortable with the various policies and procedures needed for HIPAA compliance and client safety in this case.
More and more professionals are turning to the cloud (aka “The Internet”), however, for electronic record keeping. If cloud records are the choice for you, then you may want to consider choosing a cloud system that also incorporates telemental health features, e.g. video calling.
If your record-keeping needs are lite, then there may be no significant value in switching to the cloud for record keeping. The same goes if you are having no logistical trouble with paper records. If you are using the cloud (or considering it) for record keeping, however, then consider finding a platform that is a good fit for you and that provides your record keeping and telemental health software services in one place.
Where to Find Platforms
A “platform” could be a practice management system or a certified EHR system that happens to also include secure video calling. It could be a secure video calling service that has incrementally added practice management or EHR functions. Neither one is necessarily superior to the other, in my opinion.
You can, of course, compare platform options at telementalhealthcomparisons.com. You can also find some excellent reviews of numerous practice management systems at Tame Your Practice, although those reviews are not limited to systems that act as telemental health platforms.
If you’re not sure what’s the best choice for you, or you want more information about the issues touched on in this article, you’re in luck! Coming up soon is a FREE, live (to be recorded) 1 hour event: What’s Coming and What’s Here in Online Therapy. This is an educational webinar presented by telemental health mega-expert Jay Ostrowski, NCC LPC-S and therapy tech expert Roy Huggins, LPC NCC. CE credit will be available for an additional fee to those who need it.
The event will be 1 hour and will be recorded. If you missed it, click here anyways to see the recording. It will be always be there and available for free!
Telemental Health Regulation, Certification and Training
There are more than 45 terms used in the marketplace and professional literature related to the mode of tenement all health. Mental health and behavioral health license boards use 26 terms. At least thirty-eight (38) state counseling boards now have policy regulating online counseling for the citizens of their state. Most state counseling licensing boards include the requirement that the counselor is licensed in the state in which the client resides. Arkansas has gone a step further in requiring a special license. Additionally, all major counseling, psychology and social work associations have endorsed telemental health services. Certification for online counseling is available through ReadyMinds.com. They offer training in the legal and ethical practices of online therapy which leads to the Distance Credentialed Counselor (DCC) certification. If you need help with service set up, the Telehealth Resource Centers can help you choose a system, set up HIPAA and HITECH policies and protocols and provide expertise in marketing and business development in order to establish you online clientele. Additional training and support for online therapy can be found through the Online Therapy Institute, Telemental Health Institute and the Zur Institute. The American Telemedicine Association and Hands On Telehealth both provide great insights and resources for the telehealth industry.
Technology Advancements in Online Counseling
Advances in encryption, video and cloud computing have created new possibilities for HIPAA compliant distance counseling. To date, there are over 100 mental-health-specific online counseling venues and over 40 online practice networks. Online counselors now have many inexpensive, HIPAA compliant options for video and text based counseling, even in low bandwidth areas. That makes it relatively simple to “Hang a shingle” online for a safe, ethical and legal online practice.
Government and Mental Health Industry Adoption of Online Therapy
As the industry continues to progress and become more widely accepted by clients and practitioners, online counseling is on course to become as mainstream as face-to-face counseling. The use of online counseling has been validated by the US Federal government and most states, as illustrated by the billions of dollars dedicated to setting up and delivering telemental health services through the DOD and the installment of the federal and regional offices advancing telehealth. https://www.telehealth.va.gov/, https://www.hrsa.gov/rural-health/about/telehealth/.
Reimbursement of Telemental Health
Reimbursement of online therapy has grown dramatically in the last few years as third party payers find it less expensive to provide outpatient video treatment services over even brief hospitalizations. In addition, 20 states now mandate reimbursement for video telemental health services at the same rate as face-to-face therapy and many more states have legislature moving toward a vote. Since the adoption of third party insurance payment is rapidly changing, counselors are advised to check regularly with insurance companies to see who is reimbursing for online therapy and at what rate.
Behavioral Health Innovation is reliant upon public information and the feedback from the companies represented regarding these telemental health counseling products/services and cannot make any warranty regarding this information. This information has been compiled for educational purposes and attempts are made regularly to verify the accuracy of the information. Individuals are encouraged to verify the information represented prior to making a purchasing decision.
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