COVID-19 Lockdown – “Telepsychology Consulting Fees”

Dear EPASSA members

As most of you know, the HPCSA recently published guidelines for psychologists to conduct online or telephonic  “Telepsychology” in the COVID-19 circumstances. We are aware that many of our members have in fact been conducting both telephonic and on-line consultations for a while, but that most of us have shifted almost exclusively to this platform during the time of lockdown.

Whilst many practitioners have been continuing with billing as usual, there has been much anxiety, confusion and concern as to how medical aids will reimburse their members for these consultations. Some medical aids have published their approach to telemedicine, but we are not  sure as to all of the details and it seems to vary extensively between medical schemes.

Some of our executive committee who are on the Discovery Psychology Advisory Panel approached Discovery directly to query how they would reimburse remote consultations during this time.  In the interim Discovery published a new scale of rates for “Telehealth” (applicable to all medical disciplines) on their website, which represented a 35% reduction in 2020 rates, along with a “Telehealth Verification Note”, which required, amongst other details, the completion of the SOAP questionnaire. This resulted in an outcry from the psychology community regarding the reduction of rates as well as the need to divulge confidential patient information.

The Psychology Advisory Panel met with Discovery on Wednesday and presented the grievances felt by psychologists regarding Discovery’s unilateral decision to reimburse on-line or telephonic consultations at a lower rate, and the requirements that a form and SOAP questionnaire be completed for each consultation. We also challenged Discovery  for not communicating these changes directly to their members or practitioners.

The meeting was a difficult one and we did not reach consensus on all issues. The positive outcome is that the required documentation for telephonic/online consultations was conceded. The SOAP questionnaire will be dropped and all that Discovery will require is a brief verification note giving ICD-10 code, treatment code (eg. 86205) and whether it was a telephonic or online session.

Discovery has applied for a coding modifier which in future will identify “tele consultations”. However, as the matter stands currently, there is no “telemedicine” code modifier. In the interim, this brief “verification note”  is the only thing that will differentiate the type of consultation. After some discussion, it is our opinion that until Discovery communicate directly with practitioners requesting this information, or it is made a matter of law (with a modifier code), psychologists  should in fact proceed with business as usual and bill our clients in the same manner with the same fees and codes as we did prior to the COVID-19 lockdown.

The second positive outcome is that PMB’s will continue to be reimbursed at the full rate, whether online or face-to-face.

The rate itself is being defended by Discovery as a “telehealth” rate that applies to all medical practitioners, based on apparent global research regarding the cost effectiveness of telemedicine. We argued our position and questioned the timing of their announcement – which they conceded. We also implored them to delay their approach to “telemedicine” until it has been carefully researched and discussed with relevant parties. The matter has not been concluded and we will be meeting again. For now, however, the current rate of reimbursement to their members for “tele consultations” remains at 65%. Discovery has stated that we as practitioners can decide on the actual rate that we charge and they will then reimburse their members according to their tariffs. We did not reach consensus on all issues, but there is still a degree of consultation taking place. We hope that they will reconsider their timing and their “telemedicine” rates for psychology after having heard our arguments and we will keep our membership informed of further developments. Since the meeting on Wednesday Discovery have continued to engage with panel members individually. They have said that they are taking our concerns seriously and have requested a follow-up meeting next Tuesday.

Finally, Discovery gave an assurance that announcements will be made soon about how they will assist practitioners who are struggling in their practices, but were not able to give details until the launch of this proposed assistance to medical practitioners. This is a time for ALL psychologists, regardless of paradigm or “scope” to pull together and present a unified front to the world.

As outlined in our previous communication, EPASSA will be holding a group ZOOM meeting for all of our members. We hope to hold this meeting on Wednesday 8 April at 7.30 pm and will forward the ZOOM link in the next few days.

Wishing you and your families health and peace in these difficult times

The EPASSA Executive Committee