Frequently Asked Questions about Telepsychiatry for Psychiatrists
Q: What is Telemedicine?
A: Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through the phone or the Internet and sometimes other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.
Q: What is Telepsychiatry (or e-psychiatry, telemental health, telebehavioral health)?
A: Telepsychiatry, also known as e-psychiatry, is the application of telemedicine to the specialty field of psychiatry. As of 2011, it has been the most successful of all the telemedicine applications to date, as it typically only needs adequate videotelephony service between the patient and the psychiatrist, especially for follow-up treatments.
Q: What telepsychiatry services do you provide?
A: e-Psychiatry partners with CMHC, FQHC, mental health clinics, hospitals, jails, schools, institutions, etc�. We work with providing telemental health care to patients at these facilities where psychiatrists are limited and in high demand.
Q: What type care do you provide patients with?
A: We provide both Outpatient and Emergency Care.
Q: I have a busy schedule. Will I have to provide Emergency Care for patients?
A: No, you may choose whether or not to provide emergency care to patients.
Q: Will I receive benefits?
A: No, you will be under contract with e-Psychiatry which would classify you as a contractor.
Q: Will you provide malpractice insurance?
A: Yes, we do provide malpractice for all our psychiatrists.
Q: Do you provide any equipment?
A: No, we do not pay for any of the equipment needed to practice telepsychiatry. All the equipment you will need come standard on most PC�s and Mac�s.
Q: What equipment is required?
A: You need a desktop or laptop (minimum core-2 duo), a high-speed DSL or cable internet connection (satellite or 3G not acceptable, 4G and 4G LTE are acceptable in some instances and a minimum 2 Mb upload & 2 Mb download speed), and the following equipment:
1. Web Cam (approximately $20 to $50 although web cams usually come standard with most PC�s and Mac�s)
2. Microphone and Speakers (Microphone approx. $10 to $40, Speakers approx. $10 to $40, these items usually come standard with most computers.)
1. Video Conferencing Software (We provide all software free of charge)
2. EHR (Electronic Health Record) (Typically, we use the EHR provided by thehealth care facility we contract with but we also provide a EHR custom built for use with telepsychiatry)
Q: How many hours per week can I work?
A: Our current payment model is based on an hourly rate and you can pick the hours you work. For work in contracted facilities, their hours are usually between 8:00 AM to 5:00 PM local time. This will be discussed with you prior to the agreement with the contracted facilities.
Q: Will there be cross coverage?
A: Yes, we can arrange coverage for a physician to cover you when you are ill, on vacation or have an emergency.
Q: Am I expected to provide cross coverage?
A: We ask all physicians to provide cross coverage at times when their schedule allows it.
Q: Am I expected to be on call?
A: No, not unless you agree to be.
Q: How will I be compensated for my services?
A: If you are contracted to work at mental health clinic, hospital, institutions, etc� then your compensation will be established during contract negotiations at an hourly rate. It depends on the entity we are contracted with and the work you will be providing. We will discuss compensation with you prior to any agreement that is settled with the facility. When we launch our in-home service you will be able to set your own rates.
You will be paid by Direct Deposit or Check. Your first payment will be 30 days after your first patient contact for fee-for-service patients and 30 to 45 days after work done at a contracted facility depending on the agreement. After the initial grace period, then you will be paid the 1st and 15th each month.
Q: Why does it take so long for the initial paycheck?
A: Once a provider starts work, it takes us 30 to 45 days to establish the initial payment infrastructure and get a steady stream of revenue from patients and contracted facilities.
Q: Can I take vacations?
A: Yes but they are unpaid. We do ask for as much advance notice as possible so we can find cross coverage before you go on a vacation.
Q: Do I get sick leave?
A: Yes, You can take leave if you are sick but we do not provide paid leave.
Q: Why do you use Independent Contractors?
A: We want to provide the best possible service for the lowest possible price. Therefore, we have concluded the best solution is to use Independent Contractors.
Q: Will I receive IT support?
A: Yes, We have On-Call IT support (via phone or email).
Q: Who are the mental health facility's contracts with?
A: The clinic�s contract is with us, and we contract with telepsychiatrists to see their patients. If you decide to leave our company, then we assign another psychiatrist.
Q: Why contract with e-Psychiatry instead of another telepsychiatry company?
A: We have had a very successful marketing campaign and, due to the demand, we have many different mental health facilities seeking out our services.
Q: What if I have to cancel an appointment?
A: If you are working with a contracted facility, you would contact them and let them know you need to cancel.
Q: Do patients get my cell phone number?
A: No, if the patient has an emergency they will contact the clinic.
Q: Do you only work with board certified psychiatrists?
A: No, We work with board certified and board eligible psychiatrists.
Q: Which states will I be able to with a contracted facility?
A: Only in the states you are licensed.
Q: Can I be overseas when a consultation is performed?
A: Yes, It doesn't matter where you are physically. It only matters where you are actively licensed and where the clinic is located.
Q: Can I prescribe Schedule III, IV, and V medications?
A: Yes, you can fax or call the prescription into the patient's local pharmacy. In certain states some Sch III medications require a paper prescription on state specific security paper with an original signature and date. In the event that is the case, a paper script will be mailed to the patient�s address. We are currently working on an e-Rx program where the prescription is directly faxed to the patient�s pharmacy.
Q: Can I prescribe Schedule II medications?
A: Yes, you can for contracted mental health facilities since the patient will be monitored by the facility providing treatment. No, you can�t for individual in-home patients because of the potential for abuse. Some services do allow it but since telepsychiatry is fairly new and the laws are not completely clear on the subject, we ask our physicians to refrain from rx�ing Sch II medications. You can for contracted facilities since the patient will be monitored by the facility providing treatment. No, you can�t for individual patients because of the potential for abuse. Some services do allow it but since telepsychiatry is fairly new and the laws are not completely clear on the subject, we ask our physicians to refrain from rx�ing Sch II medications.
Q: How can I do a physical exam?
A: At a mental health clinics and hospital-based assignments, we may have a difficult time establishing contact with the patient�s PCP. Patients with Medicaid, Medicare, and Indigent have no assigned single PCP. Patients often can't even tell you who their PCP is because the public clinics rotate physicians and they are seen by a different doctor each visit. We will get the name and phone number of the clinic so you may call and speak with staff there to help coordinate whatever your concern may be. We will work to improve this system.
If you are seeing individual patients, as part of their contract they must agree to have a PCP that we can contact, they must provide that PCP's contact information when they initially sign up for our services and they must sign a release of information allowing the free exchange of information between e-Psychiatry staff/physicians and the PCP. Before the initial appointment, we have our physician call the PCP and establish a professional relationship. You would make certain that the PCP understands that you are going to see the patient via telepsychiatry and that you are not going to, in most cases, be available to perform a physical exam and that you need to have the PCPs assurance that they will be available to see the patient locally at your request and to be available in medical emergencies as that patients primary care physician. If the PCP is available to help with treatment then the initial intake evaluation appointment can be scheduled.
Q: How do I interact with the patient's PCP?
A: For contracted mental health facilities there will be someone in the room (often a nurse, and if not a nurse, then a nurse will be made available upon request). You will quickly become adept at using other people's
hands and ears to provide you with the information that you need. You can also work with the patient's local PCP to coordinate a physical exam to address whatever issue you feel needs to be addressed. If you are working with our individual in-home patients, and you have an office where the patient is close enough to visit, you can have our administrative staff coordinate an appointment. If the patient is under contract with us then you are required to only schedule face to face meetings through us. We would collect payment for the appointment in advance as well. If the patient is not in your area or you do not have an office, you can request the patient see his/her PCP and have the records from the exam faxed to us. We will then upload the patient�s records where you can view them on our EMR.
Q: Are there therapists at e-Psychiatry available for patients?
A: No, at the present time, we do not have any independent contractors for therapists. e-Psychiatry will open recruiting for therapists, psychologists, etc� once we have finished recruiting psychiatrists. Until then, you can have your patients utilize local therapy clinics, and with a signed release of information from the patient you can choose to have a professional relationship with the patient's therapist.
Q: What resources are available to me through e-Psychiatry?
A: We provide a professional website homepage, On-Call IT tech support, EMR, corporate secure email, training, scheduling, billing/collection, phone and fax, administrative support, marketing and call center.
We also have various resources for patients to utilize.
Q: How do I maintain patient records?
A: You can fax or scan records with the contracted mental health facility. For individual in-home patients, we will use electronic medical records (EMR) software which holds the patient�s entire information. Any additional records are scanned and uploaded to our telepsychiatry EMR.
Q: Will patient be able to see his/her medical records?
A: No, In psychiatry, the ability to view your full medical record is at the discretion of the treating physician. Patients will be able to log into the EMR and to see their basic info, appointments and their list of medications, but individual progress notes will not be viewable. A patient would have to request the records, and the individual physician would have to approve or deny access. If denied, the doctor can opt to provide a written summary of the progress notes. This is all set up in the best interest of the patient. If you as a physician feel that access to the information in a progress note could potentially be harmful , then your first duty is to protect the patient.
Q: How will the patient communicate with me?
A: If at a contracted mental health facility then usually the communication comes first to staff that in turn will call or email you. Individual in-home patients can also contact you, through us, by phone. You can at your own discretion also give out your direct contact information to the patients although we don�t recommend it.
Q: How will I communicate with the patient?
A: You would have access to contact information and would be able to connect with the patient directly via phone, email or messaging via the telepsychiatry EMR.
Q: What teleconferencing system do you use?
A: For individual in-home patients, you can use multiple systems depending on the situation and patient�s preference. All of them are secure, HIPAA compliant and safe systems with the highest quality video and audio available.
Here is a list of current teleconferencing systems that we use:
A: We request that you use Cable or DSL internet connections with at least 2 Mbs upload and download speeds. (The faster the better)
Q: Will I be able to use WIFI?
A: Yes, but avoid it if possible. It�s best to have an Ethernet cable connected to your modem or router.
Q: Can I use a satellite internet service provider?
A: Yes, but some satellite internet service providers do not have sufficent bandwidth. Please check with us before using it.
Q: Can I use a 3G, 4G or 4G LTE connections?
A: Yes, but use it only as an emergency backup connection. 4G or 4G LTE is a better solution if available.
Q: Can I record patient consultations?
A: No, under no circumstances will you be able to record patients. That is against HIPAA regulations regarding confidentiality.
Q: Can patients or contracted facilities record consultations?
A: No, the patient and contracted facility sign an agreement that they will not record any session. In the contract, they are informed that recording a doctor/patient interaction in any way is against the law and punishable by fine and imprisonment and that e-Psychiatry will pursue legal action to the fullest extent of the law.
Q: Is there interaction available between your psychiatrists/admin (peer support)?
A: Yes, You may contact other psychiatrists and staff via videoconferencing, phone, email and instant messaging.
Q: Do you work with Psychiatric Nurse Practitioners or Physician Assistants?
A: Yes, we do have some contracted mental health facilities that specifically request the services of an NP or PA.
Q: Are hours available on night and weekends?
A: Yes, We do contract with hospitals and other facilities that provide around the clock services. When we begin our in-home telepsychiatry program you can work any hours provided there are patients to fill the time.
Q: I have multiple licenses, can I see patients or work with contracted facilities in those states?
A: Yes, we will make sure that any services you provide are within the legal requirements of each state and locality.
Q: Will I be able to see individual patients that are out of the country?
A: Yes, as long as the patient is a legal resident in the state you are licensed.
Q: How do I prescribe medication to a person who is not in a state or country where I'm licensed?
A: If you have an established a doctor/patient relationship and that patient is temporarily out of the state, then you can prescribe to a local pharmacy for a one-time courtesy or emergency fill or refill. However, it would be up to the local pharmacy in that state or country as to whether or not it would fill a courtesy or emergency fill or refill.
Q: How will I know that the patient I'm seeing is really who he/she says he/she is?
A: Individual in-home patients at first encounter, in order to get an initial appointment, he/she must first fax us a government issued photo ID and evidence of current legal residence address. At contracted mental health facilities, the staff will verify the patients identity.
Q: Will I be able to bill insurance?
A: No, you personally can not receive reimbursement from insurance companies.Individual in-home patients would seek reimbursement for services rendered. Contracted mental health facilities can be reimbursed for services rendered in certain states.
Q: Is it legal to see patients this through telepsychiatry?
A: Yes, some states do require that the initial visit face-to-face be done with the patient to establish doctor/patient relationship. We will let you know what your particular state(s) require.
Q: How do I conduct an AIMS test?
A: The majority of the AIMS test is based on your visual observation and on asking the patient questions. At a contracted mental health facility, you can have local staff help you during the AIMS exam. For individual in-home patients you can conduct a majority of the exam and if it makes you suspicious that cogwheel rigidity is present, then you can have the patient seen by their local PCP.
Q: What do I do if I can't hear and/or see a patient via telepsychiatry?
A: A requirement of telepsychiatry is that you can see and hear the patient and the patient can see and hear you in real time. If the teleconferencing sound or video is off for either party, then you cannot bill for a typical appointment. You could reschedule the appointment for another time, or if the need is to do something clinical right then, you could, as long as you have an established professional relationship with the patient, call them and conduct a telephone appointment (if state law allows).
Telephone services are typically billed using two sets of codes added to the CPT index in 2008: codes 99441 - 99443 are for phone services by physicians, while 98966 - 98968 are for services by "qualified non-physician healthcare professionals." None of these codes are covered by Medicare but more and more private payers are starting to reimburse for this code so it is certainly worth checking with them to see if they will pay.
If you do decide to bill patients for these codes, here are five things you must know about these codes:
They may be billed only for "medical discussion" that IS NOT related to an E&M service that was provided within the last seven days and DOES NOT lead to an in-office visit within the next 24 hours or earliest possible date.
The phone conversation must be documented by the provider that took the call.
Though Medicare does not pay for these codes, both sets of codes have relative value units (RVU's) assigned to them that you can use to help determine what fee you will charge your patients for these codes.
The patient must initiate the call in order for you to bill the service.
The codes are valid for established patients ONLY, according to the CPT guidelines.
Q: What if I have problems with the website, computer, camera, speakerphone, billing, staff at a contracted facilities, etc...
A: With any problem, please contact our administration. We will do our best to assist you with any proble you are having. If it's something that falls under your own business expense, then we'll let you know. We provide a significant amount of support to make sure that our program works exceptionally well. However, if you need a new web cam, microphone, to renew your medical license or DEA certificate, Suboxone License, etc., these are the kinds of expenses that fall to you.
Q: How do you oversee quality assurance over your psychiatrists?
A: The contract mandates adherence to specific Standards of Practice. We will routinely survey patients and contracted facilities regarding the satisfaction they or their patients are provided.
Q: Do you reimburse me for my office expenses?
A: No, but you can write them off as a business expense.
Q: Is there any online telepsychiatry training websites for psychiatrists?
A: Yes, there are many training resources on the internet we can provide you with.
Q: What type of marketing do you do?
A: We spend a significant amount of money on marketing online and print media.
Q: Does working with your service preclude my participation in other telepsychiatry services?
A: No, you can be contracted with as many telepsychiatry companies as you like.
Q: Can you guarantee a steady source of income?
A: Yes, we will negotiate your hours per week with our contracted mental health facilities. When we begin our in-home telepsychiatry program it will be a fee-for-service. It will be a matter of building up your telepsychiatry practice in the same way you build up your office-based practice. However, we will advertise heavily for you, and it is clear that the telepsychiatry idea is catching on quickly. We strongly believe that in five years a great number of mental health patients will prefer telepsychiatry over office-based psychiatry because of the convenience.
Q: Is there a demand is out there for telepsychiatry?
A: Yes, there is a great demand for both clinics and patients due to the lack of psychiatrists in the US.
Q: Can I refer individual patients to other providers if needed?
A: Yes, but please to refer them to someone in our network first.
Q: How can I see if my services are needed at e-Psychiatry?
A: Please email us at email@example.com. Please include your CV, the hours your willing to work and what states you are licensed in. We hope that you join us and become a part of the e-Psychiatry Team!