Play It Forward Therapy

Are you practicing telehealth legally?

Are You Practicing Telehealth Legally?

My question for you today is are you practicing tele-health legally?

You might be thinking, well, of course I am….Or at least I hope I am.

The truth is you don’t know what you don’t know!

How do you stay out of telehealth trouble?

In this episode, I’m going to share with you the five most important legal and ethical considerations to help you see out of tele-health trouble, telemedicine, teletherapy, telepractice or whatever your profession may call it.

[00:00:22] Tele-health has its own unique set of legal and ethical considerations that you, as a therapy provider are responsible for.  The five principles I’m going to share with you apply to all practice settings. Whether you work in pediatrics are with adults.

You’re in the right place if you want to play by the rules, protect your patient safety and confidentiality and you’ll want to make sure that you are upholding the requirements of your professional license.

My name is Jessica McMurdie from, and I’m on a mission to help you enjoy ever rewarding and profitable business so that you can continue to grow your practice while helping and healing others.

[00:00:59] Before we dive into the Five C’s of compliance, make sure to like, subscribe and hit the notification bell so you don’t miss out on any future videos of private practice.

The impact of COVID-19 on Telehealth

Let’s start with implementation of telehealth. So tele-health was accelerated with the rapid onset of COVID-19, which really made the field of telemedicine feel like the wild West when it came to knowing what all the rules were in your town.

[00:01:24] And now that the dust has settled, the rules and regulations are quite clear. And it’s your responsibility to ensure the health and safety of your clients and that you’re following best practices to keep your license. So as a therapist, your heart might be in the right place when it comes to helping others, but if you’re not mindful of the legal and the ethical ramifications of telehealth in your practice, you could find yourself in some serious tele-health trouble.

There are very specific requirements that you need to be aware of… and you don’t know what you don’t know.

I’m going to share with you what you need to protect your practice and your patients.

[00:02:01] And this isn’t necessarily a legal advice. Absolutely not, but it definitely is real life practical tips that I learned from my own research to make sure that I was in compliance when I started my tele-health practice. And I’d like to save you some time and some stress by sharing these with you right now.

Here are the 5 C’s to help you stay out of tele-health trouble.


[00:02:22] The first is consent. In other words, you need patient consent before you start any type of tele-health treatment. Now, typically this is a form that you would have your patients complete before you start the session. And this could be a form that you include as part of the intake paperwork or your front desk or admin team.

[00:02:43] Make sure this form is part of your patient records before you start the session, and it’s always good to double check. If you find that you don’t have that written signed patient consent, then you can send your patienet the form at the beginning of the session and make sure you take care of it.


[00:03:01] Then the second C is compliance. When it comes to state licensing requirements and federal regulations a really great, easy resource is to head over to your national association website and see what they have in terms of compliance at a national and state level.   Compliance also includes making sure that you are using the right billing codes for telehealth.

[00:03:22] There are specific modifiers for a lot of the payers and you need to use these modifiers to indicate that it was a tele-health session. There are other requirements when it comes to documentation, and there are certain things that you need to make sure you have documented in your treatment note to make sure that you’re compliant with the requirements for documentation and billing.

[00:03:42] Now, the tricky thing is, some of these requirements and all these billing codes, can really vary between state to state and also between payer to payer. So, it’s really important that before you start the session, you want to make sure that you will get reimbursed and compensated for your services by using the proper billing codes and accurate documentation.

[00:04:01] It’s always better to check beforehand to make sure that you have all your ducks in a row when it comes to knowing how to bill and knowing how to properly document to help any claims from coming back.  It’s also important to prevent any claims from coming back as denied.


[00:04:25] The third C is comfort. Now when I’m talking about comfort, I’m talking about the comfort level during the session. As the provider, it’s really up to you to set the tone. It’s also up to you to be able to take a look at your client or your patient’s environment and make sure that they’re comfortable and that they’re safe.  Now, oftentimes as therapists, we’re doing virtual home visits where we are going into the home, or maybe we are working on self-care routines or certain things that definitely would be considered more personal or related to personal hygiene.

[00:04:53] You’ll want to make sure that you are setting your client up for comfort when it comes to privacy. Another aspect of comfort is also when it comes to mental health and making sure that the your patients are comfortable sharing. Keep in mind that just because you are in a space that’s virtual, you still need ensure that you are doing everything to make sure the client feels comfortable by letting them know you’re in a private room, there aren’t other people present, and that this is a safe space where they can share anything that’s going on in a confidential, comfortable space.


[00:05:40] This leads us to the fourth C, which is confidentiality, the presence of extenders or otherwise known as family members or caregivers or any type of support people.

Confidentiality is really important when it comes to what happens on the other side of the screen. Make sure that your patient feels comfortable with whoever’s in the room, and if they don’t feel comfortable, what can be done about that to prevent any breaches in confidentiality?

When it comes to confidentiality on your side of the screen, you want to make sure that you are set up to protect your patient records.

[00:06:04] For example, you wouldn’t leave a chart open on your desk for an in-person visit or have an chart lying around the office, right? You definitely don’t want to leave windows open on your computer. You want to make sure that everything is encrypted and that your software is locked down to ensure confidentiality when it comes to ePHI (electronic protected health information) and HIPAA regulations.



[00:06:28] And final C is competence. This comes down to your level of competence as a provider, when it comes to being able to navigate the technical aspects of tele-health sessions by making sure that you’re competent and that you’ve practiced.  You should  really feel comfortable with knowing how to use the software when it comes to screen-sharing or annotating or any other of the technical features required to enhance your client’s online sessions or that you might need to use in order to make your session go smoothly.

Secondly, you also need to be competent in terms of helping your client problem solve any issues that they might be having on the other side of the screen.  Another area of competence comes to your profession’s scope of practice.

[00:07:15] Now, making sure that you’re competent as tele-health provider is super important because it really affects the quality and the level of care. It also dives into ethical reasons too.

Ask yourself, are you a competent provider when it comes to telehealth to be able to really provide the best services for that client?

[00:07:42] Competence can also refer to compliance in the sense that some States are requiring that all healthcare providers are competent with tele-health. And that they have mandated tele-health training.

In my home state of Washington, all healthcare providers with the exception of physicians are required to take state approved tele-health training in order to maintain their license. Now, you don’t necessarily have to take the state training if there is another program that fulfills those requirements.

[00:08:04] It’s really important that you look up your state’s licensing requirements and make sure that you have your level of competence checked off on your list and their list as well.

Because you’re here, we can assume that you are a conscientious, follow-the-rules type of therapist who wants to make sure you are in compliance and doing everything within best practice that’s within your power.

Don’t get caught by surprise

[00:08:27]  However, tele-health has caught many providers by surprise. Now that I’ve shared the five CS, your next step is to make sure that you can check them all off your list. So let’s do a quick recap.

Number one was consent. So making sure that you have patient consent before you start your tele-health session.

[00:08:45] Number two is compliance, making sure that you’re compliant with all the state and federal regulations, as well as being aware of what all of the billing and documentation requirements are for the payers, the state and the federal regulations.

Number three is comfort. So ensuring the comfort level of your patient during the tele-health session and making sure that they’re safe and that their privacy is protected.

[00:09:09] And that leads to number four, which is confidentiality. When it comes to electronic protected health information and HIPAA regulations.

And finally number five was competence and making sure that you have all the required training needed to make sure that you are competent and confident telehealth provider within your scope of practice.

If you found this video helpful, make sure to like and subscribe, and don’t forget to hit the notification bell to make sure you don’t miss out on any future episodes of private practice tips.

[00:09:39] If you need some extra support, I’ve also left you some additional resources in the below, so feel free to check those out now.

Wishing you all the best for starting your online telehealth practice!


Here’s what you’ll learn in The 3 Essentials For Telehealth Success:
You’ll walk away from this training with 3 specific steps to immediately feel more prepared and confident before your next telehealth session… pretty cool right?…so if you want a few secrets to feel more confident and competent when it comes to your online practice…

FREE Training | AOTA Approved! (1 CEU)

Here’s what other’s have to say about the training…

“Jessica made the introduction to telehealth less intimidating to me. I can now breathe and move forward.” ~ Stephanie OTR/L

“Jessica’s course made me feel more positive and comfortable about telehealth practice. It was practical and actionable; I can use Jessica’s suggestions right away.”  ~ Kelli OTR/L

“I just finished watching your course and loved every minute of it! The lessons are very informative and engaging.” ~ Sabrina COTA/L

“The telehealth resources were a hit, so I plan to keep on using them even though I’m back to working with kids in person.” ~ Suzanne OTR/L