Everything a Psychiatry Practice Needs

Telepsychiatry follows the patient. The practice of medicine takes place in the state where the patient is located during the visit, and that state's laws apply, so a psychiatrist seeing patients in five states generally needs five licenses. For physicians who qualify, the Interstate Medical Licensure Compact (IMLC) is often the faster route: your state of principal license verifies your eligibility once, and each member state you choose issues its own full license.

Psychiatric mental health nurse practitioners hold two layers of licensure. The Nurse Licensure Compact covers the registered nurse license only; practicing as a nurse practitioner in another state still requires that state's APRN license or authorization, and state rules on practice authority and controlled substance prescribing differ widely. The current status of each compact is shown below.

We plan which states to license in first based on where your patients are, check IMLC eligibility before recommending it, and file traditional applications where a compact does not fit. A few boards, including the Iowa Board of Medicine and the Alabama and Mississippi Boards of Nursing, do not allow a third party to complete or submit the application; there, we prepare everything and you submit it.

Stimulants for ADHD, benzodiazepines and buprenorphine are all controlled substances, which puts DEA at the center of a psychiatry practice. DEA requires a separate registration in each state where you prescribe controlled substances, and each registration rests on your state license and, where the state requires one, a state controlled substance registration. Nurse practitioners register as mid-level practitioners and need state authority to prescribe first.

Prescribing controlled substances by telemedicine without an in-person visit is governed by DEA telemedicine rules that have been extended and revised several times. The current federal status is shown below. States add their own requirements on top, and those can be stricter than the federal rule.

Our telehealth platform runs video visits from a browser under your practice's name, with no app for patients to install, connected to your scheduling, chart and payments. Before you prescribe into a new state, we confirm the license, registrations and telemedicine prescribing rules that apply there.

The X-waiver is gone. The Consolidated Appropriations Act of 2023, signed December 29, 2022, eliminated the DATA-Waiver program. DEA has confirmed that a DATA-Waiver registration is no longer required to treat opioid use disorder with buprenorphine, that prescriptions need only a standard DEA registration number, and that there are no longer any limits on how many patients a prescriber may treat for opioid use disorder with buprenorphine.

Two things did not go away. State laws and regulations on buprenorphine and office-based opioid treatment still apply, and the same law added a one-time, eight-hour training requirement on treating opioid and other substance use disorders for every DEA-registered practitioner. It is affirmed on the DEA application the first time the form asks, whether an initial registration or a renewal, and is not repeated at later renewals. We confirm your state's rules and that the training affirmation is on file before you register.

For Medicare Advantage plans, CMS requires credentialing of every physician and every independently practicing professional, with recredentialing at least every three years that re-verifies your license, DEA or state controlled substance certificate, malpractice coverage and any board certification due for renewal. Medicare enrollment is its own process, revalidated every five years, and psychiatrists and psychiatric nurse practitioners are among the practitioners who may opt out of Medicare instead.

A psychiatric medication management visit that includes psychotherapy is billed as an E/M code plus a psychotherapy add-on code. The add-on is chosen by psychotherapy time alone: the time spent on the E/M service does not count toward it, psychotherapy under 16 minutes is not reported, and you report the code closest to the actual time. The documentation has to show that the E/M service and the psychotherapy are separately identifiable, so we look for psychotherapy time recorded on its own, not one block of time covering the whole visit.

Two more rules matter. Prolonged service codes cannot be reported when psychotherapy is billed with an E/M service. Interactive complexity, code 90785, is not billed when the patient cannot communicate by any means, and when it is billed with time-based codes, its time has to be documented. For an initial psychiatric diagnostic evaluation with medical services, Medicare allows either 90792 or an E/M code.

Every psychiatry practice that bills electronically needs a HIPAA program: a security risk analysis, a security official, written policies, training and business associate agreements. Practices that treat substance use disorders may also be covered by 42 CFR Part 2, the federal rule on the confidentiality of SUD patient records.

Part 2 applies to federally assisted programs. A program is a person or unit that holds itself out as providing, and provides, substance use disorder diagnosis, treatment or referral for treatment. Federal assistance includes participating in Medicare and holding a DEA registration to dispense a controlled substance used to treat substance use disorders. A psychiatry practice that advertises addiction treatment and prescribes buprenorphine should assume the question applies to it and get an answer alongside its attorney.

Where Part 2 applies, its current rule lets a patient give a single consent for all future uses and disclosures for treatment, payment and health care operations, after which records can be used as HIPAA permits until the patient revokes consent in writing. Violations are subject to the same civil and criminal penalties as HIPAA, and HIPAA's breach notification rules apply to breaches of Part 2 records. We build Part 2 consent forms, notices and record handling into your compliance program alongside HIPAA.

Psychiatry practices open in more models than most specialties: in-network, cash-pay, hybrid, telehealth-only across several states, or as part of a group with therapists. Each model changes the order of the work. A multi-state telehealth practice starts with licenses and DEA registrations; an in-network practice starts credentialing on day one; a cash-pay practice decides on Medicare opt-out early.

We build the timeline for your model, coordinate the entity with your attorney and accountant, and set up the EHR with e-prescribing, the telehealth platform, patient portal and payment processing so they are ready when you see your first patient. When you add therapists or nurse practitioners, we license and credential each one and link them to the group with every payer.