Although a cell phone can be used for appointments, it is preferable for the therapist to use a computer with a secure internet connection. If telehealth sessions are expected to Get a HIPAA-compliant program During the COVID-19 pandemic, meeting HIPAA guidelines may be more challenging than normal. But when arranging your telehealth setting, staying compliant should be at the top of your list of priorities. A HIPAA-compliant platform comes with built-in security. Some of the commercial programs offer free versions that are not HIPAA-compliant, but these versions are essentially Setting up the electronic medical record The first, and perhaps most important point in this section is that a separate, specific consent form is required for telehealth. Most patients are required to sign a consent form upon starting therapy, but this form doesn’t cover telehealth sessions. Thus, a specific form that covers matters such as access to video is needed. The patient must agree or disagree to this. Some states may say verbal consent is sufficient, but written consent is best. This may require you to mail the paperwork to the patient with a prepaid envelope for returning signed paperwork. Obviously, moving from regular sessions into telehealth requires a separate conversation to discuss the available options for treatment. Perhaps the patient works odd hours or lives far away from the clinic, making them reluctant to continue with therapy. Telehealth gives the patient an opportunity to continue making progress without inconvenience to the rest of their schedule. Payment options For cash payment practices, taking payment at the time the appointment is booked is always recommended. People tend to be less compliant with telehealth appointments than they are in person. Prepayment may help to reduce the number of no shows or last-minute cancellations. Medicare update and e-visits Due to the COVID-19 pandemic, The Centers for Medicare & Medicaid Services (CMS) is temporarily waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2), which specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services from a distant site. The waiver of these requirements expands the State rules and regulations As mentioned above, APTA and AOTA are working nationally to get approval for practitioners as telehealth providers. In the meantime, however, the same rules apply for in-person and telehealth visits regarding what you can do as a therapist, and what an assistant can or cannot do. Malpractice insurance Check to make sure your malpractice insurance coverage has telehealth provisions. Be sure there are no exclusions, and if necessary, request specific language covering virtual sessions. Conclusion The BPS model and pain science education can be used as guiding principles for evaluation and treatment in telehealth care. In the clinic, therapists have a responsibility to equip their patients for successful recovery. Helping patients to understand how pain works, how it affects them, and how they can use that knowledge to improve their individual situation can lead to successful gains and overall compliance on the road to recovery especially in the telehealth setting. Consistency of follow-up is equally important. Keeping the lines of communication open and checking in regularly between sessions are paramount to patient success. In the current climate, it is almost impossible to see the patient as regularly as would be
become a regular part of the therapy practice, it is important to invest in the needed technology.
the same as using Skype or FaceTime. To be HIPAA-compliant, a platform with built-in security is needed. There are many standalone options that function as an all-in-one solution and allow for complete integration including documentation on the same platform.
If the patient agrees to continue therapy via telehealth or incorporate telehealth sessions into their treatment program, the next step is sending a welcome email with specific instructions regarding what to expect and any equipment that may be needed. The email should be specific to the program, give appropriate log-in information, and offer a brief overview of what the platform looks like. Familiarizing the patient with the platform before the telehealth sessions begin will help make the sessions productive. Next, explain the importance of the camera in conducting the session. Many patients will need instructions on how to best position their camera. Lastly, explain how the session will proceed, while covering the reality that telehealth is not for everyone, and that continuing with in-office appointments is always a possibility. Finally, set your system to send email reminders to your patient before the appointment. A reminder 24 hours ahead of time and another one two hours before the start is typical without being intrusive. Billing at the time of the session is also an option, but reimbursement policies differ by state and by insurance company, and will depend on your business, your employer, and their policies. types of health care professionals that can furnish distant-site telehealth services to include all those that are eligible to bill Medicare for their professional services. As a result, a broader range of practitioners, such as physical therapists, occupational therapists, and speech language pathologists can use telehealth to provide many Medicare services (CMS, 2020).
Check state resources. In most places, a PTA can do follow-up sessions with an existing patient, but this varies by state.
If a patient sustains an injury during a virtual session, a therapist needs to know the extent of their liability and how to proceed. Do not practice telehealth without addressing this critical issue.
expected in the clinic setting. This makes regular check-ins that much more important to ensure compliance. Telehealth is a growing, evolving sector of physical and occupational therapy. It can be a valuable tool for both patient and therapist when extenuating circumstances such as the COVID-19 pandemic prevent in-person treatment. As a therapist it is crucial to understand the nuances associated with providing care via telehealth and the specific state and federal guidelines required to be compliant.
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