6/17/2015 1 Wayne Roffer, Psy.D. Pennsylvania Psychological Association June 17, 2015 Harrisburg, PA Essentials of Telepsychology: Advanced Topics Disclaimer Dr. Roffer, while employed by the Department of Veterans Affairs, has not been asked to speak today on their behalf or on behalf of any other federal agency. The information presented and discussed herein is the opinion of Dr. Roffer and is not to be considered an official policy, statement, or position of the federal government or any associated agencies. Disclaimer Dr. Roffer is not an attorney. All information presented is for educational and informational purposes only. You should always consult with a attorney, preferably one specializing in medicine / health care, before implementing any suggestions mentioned today into your practice. Dr. Roffer has no financial interests / conflicts to disclose.
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6/17/2015
1
Wayne Roffer, Psy.D.Pennsylvania Psychological
AssociationJune 17, 2015Harrisburg, PA
Essentials of Telepsychology: Advanced Topics
Disclaimer
Dr. Roffer, while employed by the Department of Veterans Affairs, has not been asked to speak today on their behalf or on behalf of any other federal agency.
The information presented and discussed herein is the opinion of Dr. Roffer and is not to be considered an official policy, statement, or position of the federal government or any associated agencies.
Disclaimer
Dr. Roffer is not an attorney. All information presented is for educational and informational purposes only. You should always consult with a attorney, preferably one specializing in medicine / health care, before implementing any suggestions mentioned today into your practice.
Dr. Roffer has no financial interests / conflicts to disclose.
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Learning Objectives
1) Identify 5 emergency situations and develop an
emergency plan that addresses these crises
2) Describe how HIPAA, HITECH, and Omnibus affects
telepsychology practice
3) Describe the research in the efficacy of smartphone
applications for the treatment of behavioral health
disorders
4) Identify 2 issues related to the reimbursement of
telepsychology sessions
5) Identify at least 2 jurisdictional issues and describe
best practices for addressing inter-state behavioral health
t l h l ti
Case Example 1
A patient you have been seeing for over a year due to cutting and other chronic self-injurious behaviors tells you they are moving to another state. Due to a strong therapeutic relationship, they request to continue working with you. You offer to provide email therapy sessions weekly and video calls once a month.
Case Example 2
In an attempt to expand your practice and become more competitive, you begin to advertise your services to include telemental health. Your state of practice does not mandate reimbursement of 3rd party insurers for this service. To offset the cost of the equipment and other TMH overhead, you begin to charge an additional $35 to those paying out of pocket for this service and file claims to private insurers using standard CPT codes.
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Telepsychology
Walker, J., Roffer, W., & Tennyson, M. (2013, August)
“Telepsychology is defined, for the purpose of theseguidelines, as the provision of psychological services
Decreased travel timeIncreased productivity (fewer “no shows”)Increased access to mental health services /
decreased barriers to treatmentFlexibility in schedulingLess stigmaPatients less guardedIncreased frequency of visits = shorter length of
treatment
Dangers
Variation in state guidelinesCompetence of providerStandard of CareRisksAuthentication of patient/providerJurisdictionEmergencies
Guidelines
• APA
• ATA
• APA (psychiatric)
• American Counseling Association
• Federation of State Medical Boards
• American College of Physicians
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APA Telepsychology Guidelines
1.Competence of the Psychologist2.Standards of Care3.Informed Consent4.Confidentiality of Data5.Security of Data6.Disposal of Data and Technologies7.Testing and Assessment8.Interjurisdictional Practice
New rules / modifications effective March 26, 2013
Compliance required by September 23, 2013
Omnibus Final Rule
Consumers can request their electronic medical (in electronic format)
Privacy for out-of-pocket payees (including Medicare)
Marketing rules and sale of PHIIncreased penalties for negligenceAmendment to breach notification ruleRequired update to Notice of Privacy PracticeUpdate to Business Associate Agreements
HIPAA: Business Associate Agreements
Persons or companies who provide services on your behalf
Handle PHIOmnibus Rile provided greater responsibility to
BAsConduit exception
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HIPAA: Encryption
“Protected health information (PHI) is rendered unusable, unreadable, or indecipherable to
PTSD Family CoachCBT-I (self-administered)Trauma Recovery Coach
Smartphone Apps: Digital Prescription
Assess clinical competencePresent rationaleDemonstrate in sessionDownload in sessionReview usage regularly
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Smartphone Apps: Additional Issues
Security Don’t download / exchange digital clinical data Encourage use of passwords / screen lock / etc
HIPAA Not applicable if no transmission of data
Privacy GPS? Data collected?
Inter-Jurisdictional Issues
If a licensed health care provider electronically interacts with a patient in another state, the provider must be licensed or registered (but verify State-specific regulations) in each state in which he or she electronically practices.
No guarantee of 3rd party reimbursement unless mandated by state law
Requirements for billing may vary from state to state
Reimbursement: ICD-10
October 1 2015September 1 2015Be prepared to not get paidCheck ICD website for which codes are covered ICD Tabular Index
(ie www.cdc.gov/nchs/icd/icd10cm.htm DSM5 is a mistake
Effect of “other” or “unspecified”?
Reimbursement: Miscellaneous
Charges for service interruptionsOverage charges data plansOther costs (emailing, texting, etc)Value Based Modifier Program
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Resources
APA Telepsychology GuidelinesAmerican Telemedicine AssociationTelemental Health InstituteOnline Therapy InstituteThe Zur InstitutePerson-Centered TechCenter for Connected Health PolicyNational Center for Telehealth & TechnologyTelehealth Resource Centers
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