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Session 5: Virtual Counseling and Telehealth

Through technology, dietitians are no longer limited by location and have the ability to access prospective clients from near and far. Virtual counseling is allowing you to branch out from the traditional office or in-person setting through a variety of different platforms, ranging from a simple phone call to HIPAA-compliant video conferencing. So what does this all mean for you and your client?

 
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Convenience is a plus.

Virtual counseling is mutually beneficial because of the convenience factor for both you and the client, especially since counseling services primarily require spoken communication. This allows you to work from any location, and clients have the option of calling in from the comforts of their own home or at the workplace during a lunch break. It is especially helpful when all you need is a quick follow-up session: your clients will be more likely to oblige in continuing under your care when it can be done at their convenience.

 

But…let’s not put the cart before the horse!

One common misconception is that if you offer virtual sessions, the increased accessibility to your services will directly translate into more clients.  However, that is often not the case because you still need to focus first on finding a way to reach the right audience and market that will consider working with you, whether in-person OR virtually. Having a virtual option is definitely a value-add in working with you, but it will not likely be the determining factor of whether a client WILL work with you. The same determining factors will definitely still apply, such as whether you take insurance, or if you’re a health professional that they connect with and want to work with.

This is something to consider before dropping a hefty monthly subscription on investing in a telehealth platform, especially if you haven’t figured out a predictable client flow yet.  Clients will not magically appear because you have a virtual platform to connect with you, so it's important to ask yourself: do you have a means of obtaining a steady client flow to make it reasonable for you to invest in a platform?

The other question you need to ask yourself is: will your client will require a telehealth platform, especially one that has additional bells and whistles that your clients may not even use? For example, if you work with a senior clients who are older and are not tech-savvy, going the route of a platform where they need to access through a smart phone that integrates different apps and devices may be too confusing for them.  It’s possible all they want is a simple phone call! 

So this all goes back to knowing who your clients are and their needs before you decide to invest in a specialized virtual platform for your practice.

 

What about patient privacy?

Patient privacy and handling sensitive information is always something that needs to be top of mind when you are considering a virtual platform. Consumer-based video conferencing platforms, such as Skype or FaceTime, are not HIPAA-compliant, so be aware of what your notice of privacy practices state in how you’re protecting your patient’s information. If it’s in the contract, you are legally bound!

Phone is also considered HIPAA-compliant as long as you are holding the call with those privacy safeguards in mind.  In other words, having an open conversation in a coffee shop with a client is NOT private! 

Staying HIPAA-compliant in your communication does give both you and your client piece of mind, but if you decide to not follow exact HIPAA-compliant guidelines, your notice of privacy forms should appropriately reflect that to your clients.

It is absolutely required to be HIPAA-compliant if you are a covered entity (i.e. as an in-network insurance provider). When you are dealing with HIPAA-compliant virtual counseling, that is when the term ‘telehealth’ applies because it is a HIPAA-compliant health care service you are providing.

Here are a few HIPAA-compliant telehealth platform options that you can look into if you are considering moving forward in this area.

 

Do all states and insurance companies cover telehealth?

Unfortunately, telehealth coverage really is dependent on both your state as well as the different levels of health plans offered by the insurance company. Sometimes, the requirement may be that the initial visit must be in-person, while the follow-ups can be done virtually.

If you take insurance as an in-network provider, you will have to call the insurance company to verify whether virtual sessions will be covered.  If you are not contracted with insurance and want to provide a superbill to your patient for their out-of-pocket reimbursement, coverage again will vary. Here are some additional tips to consider if you are trying to determine eligibility for telehealth for a client.

The main takeaway: there is no general rule of thumb on telehealth insurance coverage, you will need to call the insurance companies because each patient’s insurance plan coverage will vary!

However, remember that telehealth is still changing as health care is catching up to technology. For some additional reading on telehealth in different states courtesy of Healthy Bytes:

 

How does virtual counseling or telehealth work across state borders?

In general, private pay client can request to work with you through virtual counseling across state lines, although there are some considerations to keep in mind. For those considering virtual counseling in private pay in other states, the broader rule is that you must be licensed in the state you are working in (if your state has licensure) specifically when providing medical nutrition therapy (MNT). However, health coaching and general education can be practiced by you (and anyone else) across state lines, so you may still be able to work with patients across state lines who are not requesting MNT. 

As you're well aware, dietitians have the option of becoming licensed in any/all states that have licensure IF your home state has licensure. So if you are getting many inquiries from patients of a neighboring state, getting licensed in that state would be a great option to work with more patients. This applies regardless if the patient pays out of pocket or uses insurance.

Also be aware that even if you accept insurance in a specific state, that may not mean you’re covered for a client in another state with the same insurance company.   In other words, even if you are part of insurance company X in State 1, you’re not necessarily considered "in-network" with the same insurance company X in State 2. Therefore, you still have to look into getting credentialed and contracted with insurance company X in both State 1 and State 2, if a state happens to have great telehealth coverage and there are clients who can potentially work with you.

Note: For Medicare patients, Medicare Part B will only cover telehealth under the following condition: “If patients are receiving counseling online, CMS requires that the "originating site be located in either a nonmetropolitan statistical area county or rural health professional shortage area, and can only include a physician's or practitioner's office, hospital, critical access hospital, rural health clinic, or Federally Qualified Health Center".

The virtual consulting world has been the source of some confusion right now because laws haven't caught up with technology yet. To be safe, dietitians should following the above mentioned protocol regarding licensure when counseling clients online.