In the year 2021, we observed increased use of telehealth services as patients look for ways to continue their treatment while following physical distancing guidelines. This also created unique scenarios including patients and providers in different states during telepsychiatry sessions. When engaging in interstate practice, psychologists should comply with all relevant laws and regulations, both in the psychologist’s own state and where the patient is located. In this article, we shared, scenarios while billing telepsychiatry for interstate.
Scenarios of Billing Telepsychiatry for Interstate.
Scenario 1: Patient temporarily visiting another state
You should be licensed or legally permitted to practice in the states where you and your patient are physically located when services are provided. If your patient is temporarily in another state, you may be legally permitted to practice there under temporary practice laws. Temporary practice laws allow psychologists licensed in one state to practice for a limited amount of time in another state (e.g., 20 days per year) and may specify additional requirements such as obtaining a temporary permit or license. However, not all states allow for temporary practice. For information about another state’s temporary practice laws, you can refer to the website of the state’s board of psychology.
Scenario 2: Patient moved to another state permanently
The interstate practice rules will apply whether your patient is out of state temporarily or permanently. The clinical issues, however, may be different. If a patient is moving permanently out of state, they may benefit from transitioning their care to a psychologist in their new state of residence.
Scenario 3: Provider is temporarily in a different state
You should be licensed or legally permitted to practice both where you and where your patient is physically located when services are provided because you are arguably practicing psychology in both of those places. Most states clearly consider you to be practicing psychology where the patient is located. Some states also consider you to be practicing psychology where you are located. Please check with the relevant state’s board of psychology to find out its rules in this situation.
Scenario 4: Provider is shifting to the new state permanently
The provider could be considered to be practicing psychology in the place where they are located, even if your patients are in a different state. If you are permanently living in a new state, it will likely be worthwhile to get licensed in that state. Licensure in your new state gives you clear authority to practice there. It also allows you to treat patients who live in your new state.
Scenario 5: New patient from another state wants to initiate treatment
Most states do not have a specific requirement that care must be initiated in person or must be initiated in the same state where their psychologist is located. Your expertise may be an important clinical reason for initiating treatment with a patient in another state. However, practitioners should consider the patient’s best interests. If appropriate services are available, a patient may benefit from working with a local psychologist who would be able to provide in-person care.
Scenario 6: Patient moved to another country (temporarily or permanently)
You should be licensed or legally permitted to practice both where you and where your patient is located, including internationally. It can be challenging, however, to determine the licensing laws (if any) in some foreign countries. Checking with the relevant national psychology association is a good place to start. Clinical issues and patient welfare should also be considered. For example, will the time difference make treatment inconvenient? Will cultural issues be an important factor? Are there skilled therapists in the country where the patient is living? What are the local resources available if the patient were to be in crisis and need emergency services? In addition, there may be specific patient data privacy requirements that must be followed in that country.
Scenario 7: Emergency
If a patient contacts you with a clinical emergency, your professional and ethical duties to protect the patient from harm are paramount. Prompt action to address the emergency comes first. Reasonable steps to comply with jurisdictional rules should then be taken as appropriate.
Video-based Billing Telepsychiatry allows patients to benefit from convenient, affordable and readily-accessible mental health services.
The Psychology Interjurisdictional Compact (PSYPACT)
The Psychology Interjurisdictional Compact (PSYPACT) is a multi-state licensing compact allowing a psychologist licensed in a state that has joined PSYPACT to provide Telepsychiatry services or temporary in-person services to patients in other PSYPACT states. A licensed psychologist in a PSYPACT state would need to obtain authority to practice through the compact by either applying for an E-Passport for telepsychology practice or an Interjurisdictional Practice Certification (IPC) for temporary, in-person practice. The psychologist would also need to abide by the regulations set by the PSYPACT Commission.
The risks of engaging in temporary interstate practice may be low, especially when such services are brief and are clinically indicated such as when an ongoing patient who is temporarily located out of state requests a telehealth session. However, if there is a complaint and you have not complied with the relevant interstate practice rules, you could be accused of practicing psychology without a license. Some states have temporarily relaxed their rules about interstate practice during the pandemic. For information, please check our telehealth guidance by the state during COVID-19 and confirm current rules with the relevant board of psychology.
Just as Medicare does, most commercial payers have also updated their policies to include telehealth visits through the duration of the public health emergency. Partnering with an expert medical billing service can help providers navigate the complexities of coding and billing telepsychiatry services in these challenging times.