COVID-19 Plan for Therapists: Questions, Answers, and Guidelines
Last updated 4/6/2021
Throughout the months of March and April, we collected questions and resources about COVID-19, coronavirus, therapy, telehealth, and psychotherapy. We didn’t want to come to you with an empty message that everything will be alright and to just wash your hands. We wanted to ensure that we were only coming to you with information that was needed and that we could be as thorough as possible.
Because we wanted to prioritize getting this information out to you as quickly as possible, this blog post is not super clean or well-formatted. BUT, we have since transferred all of the content you’ll find below into a cleaner, more organized format inside of our free Private Practice Community.
Additional updates and resources are being added over there.
We’ve added a collection of resources and information about returning to the office (if you choose to do so) and more.
COVID-19 is a type of virus that spreads quickly and puts certain populations such as the elderly or those with breathing or immune issues at heightened risk. Currently as of March 11, 2020, the World Health Organization (WHO) has declared this a pandemic.
Whether you are currently in an area where more stringent guidelines have been set by your local government or not, there are real questions coming up for therapists in private practice related to being prepared if:
A client has returned from a high risk area
A client comes in sick
If you have a client who tells you that they’ve tested positive for COVID-19
A client has a family member who has tested positive for COVID-19
You or one of your staff are in a high-risk population
Your local government puts restrictions or bans on leaving the house
If your client, or their child is quarantined
Local school closures for your clients or your children
While some of you have created plans for snow days, hurricanes, illness, etc. I don’t think I know anyone who had a pandemic plan as part of their business plan. I’ve been providing consultation and coaching for therapists in private practice since 2007.
But, in 2009, when the last pandemic struck, it somehow missed all of our awareness and it had never occurred to us to include pandemic as a part of a planning protocol. We’ve concentrated on illness, injuries, weather related issues, and other crisis situations.
The good news is this. The plans and processes for pandemics are extensions of weather and illness policies. If you do have those in place, we get to expand those to be more thorough, and if you don’t have weather and illness policies in place, this will help you get those in place for the future.
Below you will find answers to COVID-19 frequently asked questions, guidelines, and links to resources.
Updated 4/6/21
One of the most frequent questions and concerns we are hearing is therapists who are concerned that the phone isn’t ringing, or that they are fearful that their income and practices are going to drop. Here’s a post about the topic: What to Do When the Phone Calls Slow Down
Updated 4/13/20
Telehealth & Insurance Reimbursement: Resources to help you and your client get paid by insurance companies for the telehealth sessions you are providing. SimplePractice developed an awesome resource here.
Updated 4/5/20
COVID-19 Office Lease Options: Q & A with a Real Estate Attorney.
Updates 4/2/20:
Application for Small Business Funding here.
Small business owner’s guide to the CARE Act. There are resources and programs to help therapists in private practice during COVID-19. Learn more here.
We are scheduling a Free Q & A about the help programs that impact therapists next week. Follow us on Facebook to get notified of the Facebook lives and bring your questions.
Things you can do in your practice now
Physical steps to take in your office
Resources & Freebies for Therapists
FAQs: Ethics & Options for Your Unique Practice
FAQs: Compliance and How to Transition to Telehealth
FAQs: Policies, Systems, and Client Resources
FAQs: Insurance and Finances
FAQs: Health and Exposure
FAQs: Scheduling and Lifestyle Changes
FAQs: Information and Preparedness for COVID-19
If there are topics we did not cover, if you have additional resources to add, or if you have further questions, please comment below and we will continue to update this document.
This is not the most well-formatted document at the moment. Please understand that we are attempting to get information out quickly and will work on getting things better organized and formatted as we move into the coming weeks and days. We are choosing progress over perfection, and we know that we have a duty as leaders who reach tens of thousands of therapists.
Let’s review some guidelines and then jump into common questions.
Things you can do in your practice now:
This is definitely going to come up with your clients in session. Taking care of yourself and your business through this is important. Remember our clients need us now more than ever. Let’s discuss what’s happening with our clients and come up with a plan. Let them know what you are doing - it’s a way you take care of your clients.
Offering Telehealth Options:
Quickly get ready for telehealth a 15-minute video training with Roy Huggins of Person Centered Tech:
Check for telehealth guidelines with your professional organization. APA, AAMFT, CAMFT
Add to your informed consent that you offer telehealth sessions along with the software that you use: Here is a sample telehealth informed consent from NAADAC. Katia of Insight Maryland a group counseling practice in Maryland is also sharing her group’s consent form here, telepsychology consent form here,
Discuss telemental health options as a way of increasing access. Your clients need support through this.
Sign up for a Telehealth platform. Options are listed below.
Prepare your clients for how telehealth sessions might be different. If possible, they need to create privacy on their end. This won’t necessarily be a long term solution for your clients
If you work with children, you may be switching the work to be with the parents virtually, helping them navigate helping their child if the child can’t come into session
You can conduct couples sessions with the online platforms as well as group therapy if those are things you offer in your services
Send an email to your clients with your plans and move them to telehealth
All new client calls offer telehealth sessions
Take this FREE CE course about the psychological impact of the pandemic on your clients.
Physical steps to take in your office:
You still may be in your office or have recently seen clients. This is what is being recommended.
Remove non-essentials from the waiting areas- magazines, books, etc. give individual packages of tissues.
Make hand sanitizer available to all staff, clients, and yourself
Wash hands after each session
Make a checklist of surfaces to wipe down at the end of the day and beginning of the day
Consider single package tissues during times of high risk.
Post a hand washing policy
Post an illness policy for your practice on the front door
Send your illness policy to your clients
Check in on high-risk past clients
Consider outdoor sessions
Avoid high fives, hand-shaking or hugs
Record a video for your clients about the changes in your practice
Record a video for your clients about how to manage the current stress
Consider offering virtual support groups as a way to meet the needs of your clients
Utilize video training with loom.com to onboard your clinicians and clients onto how to utilize the software for telehealth sessions
Resources & Free Stuff for Therapists:
Resource of the Day 3/19/20: How do I market ethically during Coronavirus? Check out this training from 3/19/20 from three very different therapists talking about what does and doesn’t work in marketing and what has changed for them since the start of the pandemic.
Resource of the Day 3/21/20: Is your therapy practice an essential service? Check out this free video response from Roy Huggins.
Resource of the Day 3/22/20: Reality Check: Telehealth standards during this time of emergency. Free webinar (and it will be recorded Wednesday 3/25/20. Learn more and register here.
Resource of the Day 3/23/20: Live Webinar Launch Party for Business School for Therapists. Do you need expert week by week guidance NOW on what to do with your practice? Join us for the Business School launch party for support, encouragement, and options during this time of crisis. (And you could win an entry to Business School or a ticket to the alumni retreat once the crisis is over! Click here to attend live or watch the recording.
Loom is one of our favorite resources for creating trainings for clinicians and working with our virtual assistants. They have cut their prices and extended their free plan and trial period. Check out Loom as a resource if you want to create video trainings for your staff on doing virtual work, or anything else.
SBA Emergency Loan information, and where to apply.
Headspace Plus free membership for therapists.
MyOutcomes has also agreed to extend it’s free trial period from one month to two, and is offering this as free service with no strings attached. When everything gets back to normal, you are free to export your client's reports and raw data at no charge.
Netflix Party! Free streaming movie night with friends virtually- you can even chat back and forth!
The New York Public Library has over 300k books available for free download!
Ethics and Options for Your Unique Practice:
Should I see clients in my office? Or should I move to telehealth?
Everyone’s situation is different. Please realize that everyone is doing the best that they can, in their unique situation, with the information they have. This is NOT a time to judge people’s well researched decisions. Some therapists are having to making the decision to offer no therapy, or to offer teletherapy. Some therapists have already been exposed and are trying to stop the spread. Some therapists are more at risk of death, or are caring for family members at home who are more at risk for death. Some therapists have researched what is happening in other countries and feel like it is a social responsibility to everything they can to stop the spread. Making decisions to see, or not see clients in the office is a personal one. We encourage you to do your own research (turn off the news and the media), be thoughtful and do what makes sense for you and YOUR clients.
I don’t want to do video sessions, it isn’t in the best interest of my clients, what can I do?
Every situation is different. Your employer may ask you to work from home, your clients may request telehealth, or your employer may require you to be in the office. You may also work with populations or a treatment modality that does not seem to immediately gel with telehealth. We will share resources below for doing telehealth with some of these populations, as well as alternatives. To start, you can continue to see clients in person if it is safe and legal to do so. You can move to phone sessions. You can move to secure text based therapy. You can terminate therapy for the time being if it is clinically appropriate. You can seek out consultation and make a clinical plan for each of your unique clients based on their unique needs.
Do I move my practice online for the time being?
Many are choosing to do video or phone sessions as a collective effort to practice social distancing. This isn’t something you will be doing forever, remember this will end eventually. But this is a great way to do your part while continuing to provide access to care. Every practice and situation are unique.
Can I do telehealth or play therapy with young children and adolescents?
The real answer is, it depends. In some cases working with the parent providing direction and coaching makes the most sense, in other cases working with the child via telehealth could be beneficial. Here is a review of research and literature related to working with children and adolescents using telehealth: Remember, you are doing the best you can during this situation to provide for the needs of your clients and their families.
Depending on where you live in the country or the world, your situation, and how to respond best to your unique clients may be quite different. Just make sure to get clinical consultation from someone you trust and document the options, what you chose, and WHY you chose it. Here is an article from NAMI on children and telehealth. With school districts closing, many kids are going to need more support not less to manage their lives at home.
What ideas do you have to keep from losing out on the majority of your business if your practice is primarily play therapy and families won't come in? (Can't really do telehealth with a 4-year-old, lol!)
Right now focusing on parent coaching via telehealth as an alternative and reported lower impact of this virus on kids, but that's as far as I've gotten.
What resources are there for me to connect with other therapists about ways to do teleplay therapy with children and teens?
There are some amazing resources and group available to bring therapists together during this time. Here are a few (feel free to share more in the comments section:
Tele-PLAY Therapy Resources and Support Facebook Group for teleplay with 19k members in the last few weeks. Great resources
I am looking for info about adapting sandplay therapies to telehealth
Check out the Teleplay group on Facebook we mention above to see if you can bring together a group of sandplay therapists to talk about what they are doing. We've seen sandplay work adapted in lots of ways over the years including using sand and a tote. It is possible you could put together a sandbox for $10 for each client and drop off sets in their homes. You may also be able to find therapists that are doing work with programs like this: https://www.sandtrayplay.com/ or that are using roadblox or other virtual games as a spot for virtual work in a different modality.
What about us as counselors doing telehealth within our home instead of going into the office setting?
Insurance may or may not cover reimbursements of telehealth if you are working out of your home. However, you may be private pay or that may be the only option, and that is ok. Here are some best practice guidelines to use:
Find a private place in your home free from distractions or interruptions.
Get a pair of headphones to preserve privacy.
Hardwire into the Internet if at all possible- yes, that could mean that you have a long cord going through your home for a bit of time.
Do your best to create a space where you are front-lit, and it is easy to see you and your expression.
Consider what is viewable behind you on screen and how it might impact the relationship and be ready to respond if it comes up, or adjust your setting as necessary.
As noted above, you may decide to do phone or text-based therapy for multiple reasons including lack of privacy within your home (if your kids are off of school for example).
What about telehealth with domestic violence clients?
Your clients may not have a safe space in their home for video sessions, so you may need to safety plan and be flexible about how you meet and continue support with your clients. Consult with other therapists to crowd source ideas for supporting this or any other population.
What about Online Therapy for EMDR?
There have been organizations and individuals providing online therapy and teletherapy for EMDR for some time. You can seek out consultation and research on this subject. There is also a therapist providing online trainings this week for $20 here.
What about Online Therapy for Somatic Work?
There are therapists out there providing somatic therapy online, one of note is Victoria in during virtual somatic therapy in Orange County. Now would be a great time to schedule consultation or get a group of therapists together for a consultation group.
What about blank way of working with clients online?
The power is in our community! Get a group of therapists together to consult and create something that works in these times and focus on what we CAN do, not what we can’t.
I’ve closed my Florida group practice, notifying clients that we will be available to meet by phone, as it is unethical to just shut down.
It is unethical to not contact your clients and provide alternatives and options for them moving forward. However, I don’t think it would be considered an ethical obligation to continue in-person treatment if there are medical concerns for you and your clients. You just need to provide referrals.
Should I become National Board Certified Telehealth Provider?
Video answer to this question here.
Marketing now, in the midst of COVID-19 seems like we're taking advantage of people's fears, how do we ensure we're not lumped into the group of 'scammers'?
Video answer to this question here.
People are really panicked and scared and I do want to help. But I do not want to sound opportunistic right now. I do not want my clients to think that I am pushing therapy for money, which I am not.
Video answer to this question here.
If a therapist insists on telehealth is it coercive or abandonment?
No. There are no ethical guidelines that require that we expose ourselves or our clients to a health risk as part of our ethical duty. Multiple studies have shown telehealth to be as effective as in-person treatment. So, even if you do not want to do telehealth as your ongoing intervention, it is not unethical to offer this as an alternative to terminating treatment. You can LOVE in-person care and still move to telehealth for a season based on the current recommendations. If you choose to keep seeing clients in person do document in your clinical record why, what you did to stop the spread, and contact your liability insurance to ensure that you will be covered if an issue does arise with clients testing positive from contact in your office.
I am overwhelmed and need support right now to transition
Virtual assistant offering packages to help transition to telehealth.
Compliance and How to Transition to Telehealth:
I need to get started with Telehealth and don’t know anything about it. What should I do?
Roy from Person Centered Tech even did a quick Facebook LIVE on the down and dirty of what you need to know. YOU CAN WATCH HERE. There is a FREE 30-minute training about transitioning to telehealth happening Tuesday you can learn more and register here. There is a 55 minute training for $5 about how to quickly transition to telehealth due to COVID-19 here. SimplePractice Learning has made their Legal and Ethical Issues of Telehealth on-demand course FREE until March 23rd. If you are in California, no laws or regulations have been lifted about telehealth. You can review what you can and cannot do here.
Can I use Facetime, Skype, or other non-HIPAA compliant software to contact my clients for therapy?
Therapists: Important updates: You can reach out and use discretion when working with clients- that could include Facetime, Skype, Zoom (without HIPAA), etc. See this notice for details.
What CPT code do I use for Telehealth services? AKA How do I bill for telehealth or virtual sessions?
The CPT codes are the same. The place of service code is 02. The modifier can vary depending on the insurance plan. Most require either modifier 95 or GT. Some insurance plans require one, the other, or will accept either. You will need to ask this question when you call insurance companies to determine if they will reimburse for telehealth sessions.
Here is a great training by SimplePractice called “Ask a biller” that answers questions about billing for telehealth.
If you are in California and billing Medicare, here is a document with information.
I'm in Seattle. I'm wondering if I should do all telehealth sessions now. I use VSee. I need to get a telehealth consent form in place. If clients don't want to meet virtually, and this goes on for a while, how many sessions can they cancel (with my 48-hour notice) before I need to offer the spot to someone else?
You have to use your best judgement, but Seattle is recommending social distancing so moving to virtual makes sense. I think it would depend on the individual situation. But, you can communicate to the client that if they miss more than two sessions you won’t be able to save their spot, and that you’ll do your best to work them when they return, but can’t guarantee availability will be immediate. To ensure that they get their needs met, you may need to refer them out if they prefer not to do telehealth sessions during the interim. Remember, it goes back ultimately to clinical judgement and ensuring you can keep the lights on.
I have decided to move my practice to virtual only for the time being, how do I communicate this with my clients?
In an ideal world when you need to make changes, you have a conversation in the therapy session. But in a circumstance like this, clinicians are needing to email all of their clients and then follow up with a phone call to work out a game plan based on the needs of the clients.
Because of your life and your needs plus the needs of the client, your schedule will most likely need to shift and adjust. Again, it’s not ideal, this will pass but it’s about taking care of yourself while still providing access to mental health care.
You can create a loom.com video explaining the process and how you will be conducting sessions and add this link to your email. Sometimes seeing and hearing person is helpful when you are making a transition like this.
In your letter you can give encouragement and tips of how to cope with the changes as well. We want you to empower your clients to take care of themselves. Now more than ever we need support - you need it, your clients need it. It’s not about fear mongering, it’s about advocacy.
When planning with your clients:
Assess safety - what format of virtual therapy is safest for them if they are not safe in their home
Assess access - Do they have what is needed to conduct a session (headphones, phone, laptop or tablet)
Assess availability - What works for them to continue and what works for you
Strategize - you both may have children at home. How can you navigate this with the clients. Is it a session after the kids go to bed? It’s it text based therapy? Is it giving the kids an iPad and having the session via phone or video?
Here is a sample letter to send to your clients. Feel free to copy it and edit it for your needs.
Dear Client,
I know that each day we wake up to news updates and an ever growing list of changes we are making in our lives. It can bring up a lot of fear, anxiety and even grief as plans are cancelled, social distancing happens and daily routines are completely shifted. I truly value our relationship and have developed a plan so we can continue to take care of your mental health during this time. I want to be a place of support through what you are going through.
As of today, all sessions will be moved to virtual sessions. We will no longer meet in my office. This is a temporary measure as the CoVid-19 will one day pass. We have three options moving forward based on your needs, all of which are secure and encrypted. You can utilize video sessions, phone sessions or text based therapy. I am happy to discuss the option that is best for you. I also made a loom video that you can watch here explaining how the process works. Just click here
Research shows that virtual sessions is an effective form of psychotherapy. There are a few differences than what you experience in my office. You will need to find a space if at all possible that is quiet and where you feel comfortable to share. If you have a headset that will also help with reducing noise and distraction. Many people prefer video as we can see each other’s faces and expressions.
I also recognize that your schedule may look different, as does mine. While this is temporary, I want to discuss if our session time works for you or to explore how I can accommodate your needs. I want to be as flexible as possible as I know this is a crucial time for all of us to maintain some sense of normalcy, to get support when we are isolated and to continue working on our strengths to take care of our mental well being.
Please know, I am also doing things to care for myself so that I can be there for you fully. Please respond to this email with confirmation that you received it. Let me know if your session time still works for you and what form you prefer. Let me know if you need to hop on the phone to speak about a plan.
Once our plan is determined, I will send you a consent form via the EHR portal.
I look forward to seeing you this week.
Sincerely,
Therapist
During this Covid-19 time of concern. What do you feel it the best way to touch base with clients to let them know how you will be supporting them if office is closed. Text link to update page for them on my website? Call them? Email them? Contact when sending my reminders for next day session or send something to all at once today?
Video answer here.
I have a group practice and we are no longer going to be seeing clients in our brick and mortar offices for the time being. How do I transition my team to online sessions?
As a leader your job is to empower, provide boundaries and education and hold the vision moving forward through this pandemic. I recognize every group practice looks different. If you have contractors you cannot force them to see clients or have any control of how they handle this moving forward. You can share what you would like to happen, but they get to decide if they continue seeing clients. If you have employees you can be more directive however many group practice owners are working to be as flexible with client schedules and clinician schedules as possible.
Every clinician needs access and training for using the software tools to conduct telehealth sessions. Share this blog, Person Centered Tech’s trainings as listed above, or create a loom video showing how-tos.
Every clinician needs a telehealth consent form to be sent to the clients.
Send out an email, similar to the one written above for solo practices, modified for your group practice, to your clients as a whole with the plan. Each clinician will need to contact their clients after to get their schedules in order and to determine which method of session is best for them.
Empower your staff - this is about serving as best we can while still taking care of ourselves. It’s not ideal and it’s not what they wanted. There will be grief and frustration that comes up. Guide them through it. Discuss how having appointments can continue to give them something to focus on beyond the news. It can be helpful to stay present with our purpose, however imperfectly that might look.
Consider check ins with your staff weekly, allowing them a space to strategize, process and get support from you and from each other as a team.
Billing and such may get disorganized. I personally take the stance that progress over perfection. Now is the time to just work to provide access to care. Some group practice owners are choosing to do the session and deal with the insurance as they are able. Some group practice owners are changing who handles the billing so that staff can just focus on their sessions and nothing else.
We don’t know how long this will go on for to be honest. We have talked to people in other countries and 2 to 3 months seems to be a rough estimate. As time progresses, we are hearing that in other countries people have more routines and structure in place so they can have their sessions more regularly. At this moment, it is more chaotic because of the school closures and rapidly changing rules. Remember you will refine this over time until this is over.
Policies, Systems, and Resources:
Should I draft a policy to my clients regarding illness and coming into the office?
You should already have an illness policy in place. If you do, it is time to review it. If you don’t it is time to develop one. Either way, you need to enforce the illness policy. I am hearing multiple reports of clients coming into therapist’s offices sick with fevers and coughing and therapists not sending them home. Here is a sample thing to say:
“I am concerned about you and I care. Our therapy appointments are important to both of us, but we can’t have them in person while you are sick. I can’t be here for you if I get sick, and I have to ensure that your fellow clients can come here without getting sick. For today, would you like to call or video conference me from your car, or would you like to reschedule? Open the door as you speak, and don’t be afraid to start walking towards an open area. Post your illness policy on the door to remind clients.
That said, many are practicing social distancing and are choosing to move all of their clients to telehealth sessions until more information is known about the virus coming to an end and the risk lowering. You do not have to wait until people are sick to enact this. It can be a protective measure for you, your clients and the community.
Does my liability insurance cover me providing telehealth?
It depends on your insurer. If you are using CPH, they report it is covered as long as you are legally providing the service based on your state and your license. Read more here.
I don’t have an illness policy for my counseling practice, where can I find one?
Here is a sample illness policy:
Therapy works best when it is regularly scheduled and attended. However, it is also important that you and your therapist remain healthy. If you have a fever, body aches, or chills in the last 48 hours, we can cancel, reschedule, or move to a virtual session. Do not come into the office or waiting room. This policy is to keep you, your community, and your therapist healthy.
What policy should I send out to my clients regarding telehealthcare?
Sample Texts to Clients:
If you’ve been exposed to anyone with the virus, been in an airport, or showing any symptoms of ANY illness including a fever, please wait 14 days after the fever has subsided before coming in for an in-person appointment. We can convert your appointment to a telehealth appointment. For young children, we will be meeting with parents in lieu of child or play therapy to give you strategies to practice with your unique kid during this unique time.
Alternate:
Your physical and emotional health are our greatest focus. Based on public health recommendations of social distancing, our practice will be moving to telehealth or phone sessions immediately to ensure you continue to have access to care, and that you don’t have to be concerned about possible exposure in waiting rooms, offices, etc. While your therapist has not been exposed, we are taking the utmost care. I will be calling you to talk over logistics. Here is a link to what to expect of a virtual session and how to prepare.
What software can I use individual telehealth sessions?
Check with your EHR, such as SimplePractice offers a telehealth capability. You can use VSee Clinic or Doxy.me is free.
What software can I use for couples or groups?
Here are the platforms you can use for more than 1 person, TheraPlatform, Regroup , Google Meet (If you have signed the BAA with google suite-note we link to the document that describes how to set this up properly), Zoom- call to negotiate BAA (Heard some therapists getting it down to $100 per month. SimplePractice does not publicize being able to be used with couples, but the link that is sent out to the “primary” client, can be copied and pasted and both parties can be present on the screen with the therapists.
Do you have a script to introduce telehealth to old school thinkers?
Clay Cockrell from Online Counselling did a great report with Joe Sanok from Practice of the practice. View it here.
I need some training on teletherapy. Which trainings do you recommend?
Person Centered Tech is offering a discount for people at 20% off
Telebehavioralhealth Institute has a training program as well.
You would need to update your consent forms.
Here is a sample. You may use Doxy.me or Vsee if you need to set something up quickly and with ease for little to no cost. You also need to prepare your clients and yourself for how it is different. They will need to find a quiet place that is private so that they can share freely, as best to their ability. You will need to treat the session just as if you were in your office.
Again in times of emergency we do the best we can. We understand the telehealth sessions are not something you may be used to. Standards of care vary from state to state. However, it’s a great resource to have and can be a great way to support our communities through this.
Are there are any resources about how to support our client’s anxiety during this time?
Click here for more information on this.
Insurance and Finances:
I heard there is a bill waiting to approve all healthcare professionals to be able to do telehealth in every field during outbreak of Covid19.
There is a bill that was passed and things are changing day by day. Here is the most up to date inforamtion. Mental health care sessions in a patient’s home are now covered! Click here to learn of updates as of March 17th, 2020. Here is a detailed Q & A about what is and is not covered.
I was told by another therapist it is a MediCare bill but that other insurances will have to follow/comply. Have you heard anything about that?
While other insurance companies could choose to changed their contracts or requirements, there is no law to my knowledge that would make insurance companies do anything. They may CHOOSE to follow or comply, but you will need to call to confirm. They would choose to follow because it helped limit their costs, not because of the medicare bill. In other words, there is no blanket law that will apply to all of these different insurance companies. You, or your biller will need to contact each company directly to clarify what their COVID-19 response is. Do note the date, time, who you spoke with, and get whatever information in writing if at all possible.
My group practice is Medicaid based. I have signed up to contract for telehealth but was told each person’s insurance must still be individually checked and approved, even on the same panel.
Unfortunately, I’d assume this is true until you had documentation otherwise. It is frustrating, but it is the way that things work. Some clinicians are deciding to take the risk and offer sessions via telehealth and then check on the approval as the mass amount of clients and logistics is too much to verify before the sessions.
Are there any programs to support small businesses like mine that are impacted?
Yes. The Small Business Administration (SBA) is offering guidance, as well as low interest loans for small businesses. to get through this time. You can learn more about their recommendations and programs you may qualify for here.
What about support on the state level?
Best Accounting Software has produced a guide to the small business support that is available during the COVID-19 crisis. Whereas the IRS and SBA guides focus on federal support, this digs into what’s available at a state level as well.
What if I don’t want to go into debt because of this virus?
Sometimes there are no easy and perfect answers. Some therapists have enough resources or reserves that they are using the reduced caseload or time off to work on developing the foundation of their business so they can hit the ground running after the crisis is resolved. We have over 15 hours of training on all things private practice that you can access here. It isn’t a perfect solution, but nothing is at the moment. You also invited to the Masterclass for Therapists.
Will it impact the economy and private practices (ones that don’t take insurance)?
Yes. there are will be impacts to all businesses right now. While private practices that take insurances will have to do a LOT of researching and working with insurance companies to attempt to be reimbursed for telehealth sessions, cash-pay practices can simply provide the best services possible. At the same time, your clients may have changes in their economic situation and may need alternatives to private pay. Like all economies, it will ebb and flow. Having a solid business plan can help you mitigate any recession.
What do we need to ask insurance companies when we verify benefits for telehealth? Do we need any additional consent forms or anything like that? How do I find out if insurance will reimburse? Is there a hub for information somewhere or so I have to call each insurance company separately?
We’ve listed a sample consent above. When you contact insurance companies ask if telehealth sessions are covered, or if accommodations can be made for coverage due to the current situation. Ask them what location code they prefer on their billing. See below regarding how to bill for telehealth sessions. Ask them if they have any requirements about the location of the therapist or the client while they are providing teletherapy. Consider looking over the laws in your state here in case you need to advocate with the insurance company. There is no main hub, beyond the link listed above, and that only lets you know laws it does not give you the specifics of how each private insurer is handing this area by area.
Do you cover teletherapy in general?
How do you define telehealth (do they cover video, phone, or text based therapy?)
In the case of the CDC guidelines of social distancing, are you covering telehealth for the time being?
Do you have any requirements about the location of the client or the clinician during telehealth?
What are the details about how you prefer telehealth to be billed? Do you use the modifier 95 or GT?
Does the reimbursement rate change for telehealth?
What if the insurance company won’t reimburse for telehealth, and I can’t see clients in person?
You will need to talk with your clients about options. Those options include:
Private pay (if they have an FSA or HSA this is an eligible service
Taking a break from therapy if the client is stable enough to do so
Referring the client out to someone who can see the client in person for a short period of time, or on an ongoing basis.
Offer a virtual support group for clients at a lower price point to bridge the gap.
The client contacting their insurance company to self-advocate and them offering a single-case agreement so that the client can get telehealth services.
Do insurance companies require new contract or addendum to do telehealth? Do clinicians have to be credentialed in telehealth?
Every contract and state are different. You will need to contact each of your insurance plans and carve outs individually to determine their particular guidelines. Do NOT rely on Facebook groups as people may be referring to regulations specific to their state, or their carve out.
Here is a link that shows the state laws and reimbursement policies by state for telehealth. I am not aware whether they have everything completely up to date with the changes in the last week.
I have worries about paying clinicians who are hourly if people stopped coming. From the president’s press conference earlier this week it sounded like small businesses would only get relief in the form of small business loans, and I don’t want to go into debt because of Covid19. The other option is laying people off if there aren’t enough hours to work because of employment laws in CA. I’m doing my best to prepare by signing up for the telehealth contracts. Anything other suggestions to prepare and keep clinicians employed?
Great question! It is a responsibility to employ people and in times like this it can feel quite heavy. If you must lay off people, you must, and there are resources for them in the form of unemployment. It isn’t perfect, but it is there.
However, a good marketing plan and client engagement plan can be integral to keeping your business stable no matter what the dynamic is. In some cases of weather disasters, we don’t even have the option of telehealth. I’d recommend the following:
Have clinicians reach out for a brief phone check-in with clients to see if they have concerns and develop a plan for the next 8 weeks- whether it is in-person or telehealth depending on the needs of your community. During times of stress like this, maintaining support is more important, not less.
Ask your clinicians to focus on creating a clear schedule of weekly appointments at the same day and time whenever possible so you have clarity of exactly how many openings they have in their schedule.
Ask them to cluster appointments on fewer days whenever possible so there aren’t large gaps during the days they are in the office. Ask them to check in on past clients that have a history of anxiety, trauma, or others they believe would benefit to see if they are in need of telehealth services. They should NOT be trolling for clients. But, it is kind to reach out and let them know that you are offering telehealth sessions.
Let your community know the steps you are taking to offer telehealth services as appropriate and what your illness and cleaning process is. Create a marketing plan for the ideal clients for the clinicians that do have openings.
Group Practice Steps:
Put procedures and policies in place with your staff for hand washing and cleanliness.
Provide telehealth options for your clinicians
Check in with your clinicians about their stress level, needs, and preferences
Train your clinicians to do telehealth sessions as well
Health and Exposure:
What if I am, or some of my staff are, in the vulnerable population?
It is ok to switch to Telehealth sessions right now, to protect. yourself, your family members, or your employees. If you are an employee, it can be difficult to ask for what you need or share a private medical status. Employers, take note that your employees may be vulnerable and unwilling to share that data with you and thus please make a decision considering this.
What if you test positive for MERS, SARS, COVID 19 or some other spreadable disease that the CDC covers? As a therapist, do you have to release information to the CDC about whom you’ve seen in practice that could’ve been exposed?
In short, if you test positive and the CDC asks you for names of people who you’ve been in contact with in order to stop the spread of the virus, yes, you need to provide that information. “the Privacy Rule expressly permits disclosures without individual authorization to public health authorities authorized by law to collect or receive the information for the purpose of preventing or controlling disease, injury, or disability, including but not limited to public health surveillance, investigation, and intervention.” Here is in depth information on HIPAA and privacy as it pertains to the CDC and stopping the spread of disease: https://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm Here is an overview in more detail about HIPAA, the CDC and when and what to release in light of Covid-19.
My community is recommending social distancing, but my employer still has me in client’s homes.
No matter what your setting or employment status right now, you need to have access to the illness policy, and all of your clients should have gotten a copy of it with the current issues. You need information and resources about how to stay safe and that could include your employer providing you with wipes, hand sanitizer and other strategies to reduce the spread as you are moving from home to home. If your employer has not provided this information yet, respectfully ask them for this information. Your safety matters. Yes, nurses and doctors are still going to work, but they are also taking the precautions and taking everyone’s temperature.
What if a client comes in sick?
“A client came in for her scheduled session today, in full flu-mode! She adamantly tried to tell me that while she hadn't been evaluated by a medical professional, she was "sure" she didn't have COVID19. WHAT??? Fever, cough, difficulty breathing, headache, extreme fatigue.. ugh. Could be Influenza as well, but my point is, this is not ok. I sanitized everything, canceled the remainder of my clients for the day, and would like to understand the next best course of action for not only myself, but all my clients. HELP!”
Whether she has Covid19 or not, that is not ok. It is important to take this as a learning opportunity to set better policies and boundaries in the future. Clean your office thoroughly and then decide if you’d prefer to move to telehealth or not. We can be exposed anywhere out in the world, so it is hard to know what our risk profiles actually are.
Can I get COVID-19 if I am young and healthy?
Unfortunately, while you are more likely to survive Covid-19 if you are young and healthy, you can still catch it, spread it, and yes, you can still die from this virus no matter your age or current health status.
Can a therapist, over their clients spread COVID-19 if they are not showing any symptoms?
Yes, studies are showing that you can.
Are therapists overreacting?
Here is an article about a therapist who went to a group therapy conference where everyone looked fine. She came home feeling like she had allergies, went about daily life including seeing 6 clients, and then fell ill and tested positive for Covid-19- along with MANY other attendees at the conference.
It is not overreacting to listen to the recommendations of the CDC and practice extreme social distancing. Choosing to follow those recommendations is not an overreaction.
You may have reasons why you continue to see clients in person. That is your decision that you made after research, thoughtfulness, and taking appropriate precautions. Every persons situation is different, so we practice kindness whether someone is seeing clients in person or virtually.
Scheduling and Lifestyle Changes:
Just learned today that my daughter’s school district will shut down for 2 weeks if there’s a confirmed case anywhere in the county. What are some ideas how to navigate this for clients and myself? Online sessions are an option but I imagine not all will agree/want that.
Part of your job as a therapist is to develop treatment plans for the needs of your clients. Yes, it may be less than ideal not to have all of the treatment options and modalities available during a crisis, but that is life. There are several questions within this question:
How can we support parents who may suddenly have to find childcare?
Childcare shares with friends or neighbors that your children have already had contact with can be explored. I think also working with our clients about how to manage anxiety and stress response in extraordinary situations.
What if I can’t see clients due to my kids being at home?
This is NOT the normal standard of care, but this is also not a normal situation for everyone. Document the options that you explored and WHY you decided to provide care in the way that you did. Simply referring clients out to a stranger to provide teletherapy may not be as beneficial as having a session where children can be heard laughing in the background. In other cases, it may be more beneficial to cancel the session completely.
You may need to be more mentally flexible about when and how you see your clients than you normally would be if you are able to, and want to continue seeing clients. That might mean your spouse or a friend watches your kids in the evening while you see clients, or seeing clients later in the evening or earlier in the morning than you normally would.
It also may mean if you are single or don’t have options for childcare or canceling appointments it’s time to start exploring if you might provide “good enough” services. That *could* look like for some clients your kids playing in another room and understanding that you may need to answer questions or attend to them during sessions. It could also mean shorter more frequent sessions. Honestly, with the way things change so rapidly from day to day with information, this might be what is needed for our clients.
You need to use sound clinical judgment and explore what makes sense in these unique situations. It also may mean having sessions while client’s children are around when you wouldn’t normally- and adjusting the way you are doing the work with them to fit with the current crisis. You *may* even consider a text based therapy during this time if that is best clinically. Document, document, document during these times what, why, and how you are working and the alternatives you explored. You will be back to business as usual soon. It will be ok.
Realize that for many of our clients and ourselves this taps into previous traumas AND previous resources and strengths.
For clients that have been through past hurricanes, tornadoes, flooding, etc. this may bring up old trauma. It may also help them tap into their internal sense of resilience. So, be sure to consider ways to use this experience clinically. Plus, we understand this impacts you. You have been through things and have past traumas as well AND have strengths and resources.
How do I manage the amount of cancellations coming up in my schedule?
A lot of therapists do not have businesses with reserves. When the crisis is over, it is important to develop a business plan that allows you to create reserves for you if you are sick, injured, or taking a vacation. For the moment, do your best to stay calm and offer alternative services. Realize that there are a LOT of people who are in need of your services- so you will be able to find additional clients. And remember, this is a SEASON. This will NOT last forever. You will recover, even if this gets scary and dicey. We’ve been through recessions, losses of jobs, and more. We can do this!
Should I travel?
The decision to travel is a personal one and should be decided upon based on risk factors and the ever changing recommendations regarding quarantines and travel recommendations. Based on the current climate, social distancing is recommending and moving to telehealth would be recommended regardless.
COVID-19 Information and Preparedness:
Are there any checklists or best practices for responding to a pandemic?
Click here for a Planning Checklist from PHE.gov.
Where are Covid19 cases currently?
I found this map to be helpful in getting a visual of what areas are impacted and which are not.
If you have further questions about COVID-19 and private practice or telehealth, please post them in the comments below.
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