Clinician Handbook

Welcome aboard! We’re thrilled to have you as part of the Call to Mind team.

Call to Mind was founded with a vision to better utilise modern technology to address the barriers to accessing mental health services in rural and remote communities.

Our clinicians started seeing patients for appointments via our secure telehealth platform in June 2018, and since then, we have grown into a diverse group of psychiatrists ranging in background and specialty, all working to provide better mental health services to people all over Australia.

In addition to providing excellent care to people in areas where access to mental health services is limited, we also aim to provide a flexible and supportive way for psychiatrists to work.

Dr Dave Carmody – Director
dave@calltomind.com.au
0408 446 997

Erin Cody – Practice Manager
erin@calltomind.com.au
0431 015 573

Onboarding / Careers 
careers@calltomind.com.au

The following outlines our processes prior to and after an appointment:
– Referral received from GP, Call to Mind admin enters patient details in Halaxy and uploads the referral letter
– Referral screened by Call to Mind intake team and/or Director to try and identify patients not suitable for telehealth appointments and to appropriately allocate referral.
– Referrals are screened based on suitability for telehealth and ability to wait until appointment can occur. Referrals may be rejected based on concerns about acuity of presentation/possible need for inpatient admission or assertive outreach, symptoms that may interfere with ability to engage in appointment (i.e. psychotic symptoms, cognitive impairments) or when there are significant barriers to facilitating the call (i.e. no internet and unable to attend GP). Referrals are not triaged based on acuity, though we sometimes consider requests for shorter wait times.
– Both 291 assessments and ongoing appointments will be allocated to psychiatrists.
– Once screened, Call to Mind admin then contacts the patient to arrange an appointment with a suitable clinician, based on the clinician’s specialty and availability.
– The patient receives an email with details of their appointment time, billing arrangements, instructions on how to access the waiting room and a “How To” video for attending the appointment.
– The patient also receives a link to the Patient Agreement / Terms and Conditions. They must also agree to the T&Cs through Coviu prior to entering the waiting room. While there is no record kept of this, they cannot enter the room without agreeing, so any patient who is in the waiting room is taken to have consented.
– Prior to the appointment, the patient receives a confirmation SMS and email 5 days prior to the appointment and then again on the day of the appointment. If the patient contacts the practice to cancel the appointment, we will remove it from the calendar and alert the GP. NB we will not let each clinician know if an appointment is cancelled unless if it is within 24 hours of the appointment time, clinicians are responsible for monitoring their own schedule to stay informed.
Billing:
– Patients are sent an invoice at the time of booking to pay prior to the appointment taking place.

Once the appointment has taken place, please: 
1) Mark the appointment as “Arrived” in the appointment entry in Halaxy calendar (click the pencil to edit the appointment) 
2) Add comments about whether the code needs to be altered (eg. 291 > 296) and what follow up is required, eg. “Rebook for 30 min review in 2-4 weeks” 
3) If the patient did not attend, add a note saying “DNA” 

Call to Mind uses a program called Coviu as our secure telehealth platform.
Call to Mind now uses a practice management software called Halaxy. You will receive an invite to set up a password and customise your account. We recommend using 2-factor identification.

Scheduling by Call to Mind admin staff is done in the Halaxy calendar. Please provide us with details of your schedule and availability with at least 4 weeks’ notice, so we can set this up and book appointments in a timely fashion.

1. Ensure you are properly set-up for telehealth prior to your appointment:
– Test that your camera and speakers are functioning
– Make sure your background/wall is not distracting
– Ensure your environment is well-lit for the call: this either means overhead lights are turned on, or plenty of light facing you, whether from a window or another light source. Avoid bright/direct sunlight on yourself or on your screen.
– Check that audio cannot be heard by others outside of your room, especially if contractors/staff are working from home
2. Login to Halaxy and go to Scheduler -> Calendar to see that day’s appointments.
– Click on the day to select and see appointments in more detail
– Click the appointment once to see “Appointment Information”, with details of the location (this will be Online Consultation), reminders and an option to call the patient from within the program.
– Click on the patient name to go to their clinical file
– The referral is entered either as a clinical note in their file, or alternatively go to the “Funding” tab and select the referral from “Claims & Referrals”.
3. Notes:
– Referral information will be accessible as an entry in their clinical file
– A patient’s file can be accessed from the calendar or by searching the patient name under Patients
– To enter a letter to the GP, select the “Referral” tab and under “Reports & Notes”, select Add a new note. This will ensure the letter is populated with the referrer details correctly.
– You can type and save free text or select the “Consult letter” template to use the partially pre-filled letter template
– To continue work later you can save the letter or click the blue drop down (next to save) to select “Publish” which finalises the note and populates any dynamic terms like patient name and date.
– Important: From the same dropdown, select “Fax” and send to the GP listed (it should pre-populate with fax number). If there are no referral, make a note to Admin (See 4. Admin instructions) letting us know and we will update and send the letter.
4. Admin instructions:
– Once the appointment has taken place, return to the Calendar and select the appointment. From the drop down, select “Arrived” if the patient turned up (add note saying “DNA” if non-attendance). Then enter any notes to admin eg. “Bill private 92437, rebook for 4-6 weeks for 30 min review”
5. Accessing video call (Coviu):
– Coviu is integrated with Halaxy so you do not need to login separately.
– In the Appointment Information panel, the Location is a link that says “Online Consultation”. Click the hyperlink to enter the Coviu appointment session at the time of the appointment (clicking the hyperlink before the time of the appointment takes you to a screen that shows the appointment has not yet begun). Click the Back button on your browser to return to your Halaxy calendar after the end of your Coviu appointment session.
– Each Coviu appointment session has a unique link which protects security and patient confidentiality. The patient will receive this unique link in their booking / reminder messages.

To register for e-prescribing you will need to:
– Find your HPI-I by going to AHPRA and logging in, it will appear under ‘My Details’
– In Halaxy, go to Personal>Profile and click on ‘Healthcare Identifiers’ and add your HPI-I. (If you can’t see this option, let us know and we will contact Halaxy to have this enabled.)
Steps:
– Within Clinical note for a patient, select “Add orders”. Note: if you cannot see “Add orders” please email community@halaxy.com with a request to add this feature for your account.
– Select prescription and Create
– Add a drug and complete any required authorities
– Go to the dropdown next to Edit and select “Publish”. A window popup appears asking for your prescription type. Select Electronic. Before publishing to MediSecure, you can then review all the prescription details in the pop-up, including prescriber details and patient details.
– Fill in the token receipt details, which specifies who is receiving the electronic prescription and how they are receiving it. You can set the recipient to the patient or to a nominated guardian or caregiver. Select whether the recipient is receiving the prescription via SMS or email.
–Review the prescription items.
– To finalise, confirm your password, then click Publish. (This button will only be enabled when token receipt details are filled, and password is confirmed.)
– The prescription has now been published to MediSecure and sent to the patient.

– See here for the Halaxy help article which has further info. 

We advise keeping up to date with the Medicare Benefits Schedule and the criteria for the codes you use and familiarising yourself with the conditions mentioned in the appendix documents for each code.

We also suggest you are familiar with RANZCP recommendations, particularly re: use of the 291 code, found on the RANZCP website.

Call to Mind processes billing each weekday. The pay cycle reflects the billings received during the previous two weeks. If billings are not received by the second Friday (due to not receiving billing instructions or Medicare delays), they will be paid during the next pay cycle. Payments to clinicians are processed every second Wednesday. Please note that most third party payers have a 30 day turn-around.

Call to Mind collects all patient fees for your consultations from various providers, and at the end of each billing cycle, issues an invoice on your behalf for the agreed service fee. Call to Mind then pays you the remaining balance via direct deposit to your bank account. Clinicians will also receive a document detailing their corresponding patient billings for that period.

Private billing patients are billed during the week prior to their appointment and any Medicare rebates are processed after the appointment has taken place. If there is a change to the billing (eg. from a 306 to a 304), the patient will be refunded the difference. If the patient does not attend, the DNA fee is deducted, and they are refunded the difference. Call to Mind pre-bill your patients based on the length of the appointment booked. If a patient is booked for a 30 minute consult, we have quoted and charged for this. If you require an additional fee if the appointment runs overtime, please ensure this is discussed with the patient in the consultation to ensure we have obtained informed financial consent.

Any suggestions about codes we offer are just that; it is the clinician’s responsibility to ensure they are compliant with the MBS requirements. With that in mind, here are some common queries about aspects of MBS billing:
– Private billing is suggested for all patients. As a practice we do not set fees; we have a suggested upper limit to fees that is set below AMA rates. As part of the financial consent process with patients, we provide them with details of these maximum fees. Each individual clinician is welcome to set their own fees, simply advise our admin staff of this. See the separate maximum private rates document for reference.
– Follow up appointments are available using the 293 code. This appointment requires a re-referral from the GP, asking for a review of the 291 appointment. Please include this in your 291 report as a suggestion or instruct the patient to discuss this with their GP. We will not automatically book the patient in if not re-referred or chase a re-referral.
– Make sure the notes and letters reflect the criteria for the 291 code, found on the MBS Online website.
– NOTE: MBS specifies 291 reports should be completed and returned within a maximum of 2 weeks; we recommend a maximum of 7 days.

The Call to Mind DNA (Did Not Attend) policy is as follows:
– If a patient does not attend their appointment, please follow the steps in section 6.
– Our default position is to issue a non-attendance invoice, with an amount of $150 for psychiatry appointments. The patient will not be able to reschedule if they have not paid this in full.
– In certain circumstances, we will seek advice from the clinician about whether to issue a DNA invoice; waiving of non-attendance fees is at the discretion of the clinician.

Pathology requests can be made from the clinical file, similar to generating a script. Select the Add Orders button and choose Pathology.

Email:
– Go to the client file and click the Letter icon in the top right-hand corner. Emails will be sent from the info account address for any replies.
SMS:
– In the client file, as above.
Phone:
– You can either call directly from your phone (we would suggest using Private ID or dialing #31# prior to the number to hide your number) or you can call from the appointment entry by clicking on the phone icon (this will come up as a Call to Mind number) or by clicking on the phone icon in the client file in the top right-hand corner.

Depending on the level of acuity, options include:
– Contacting emergency services (000) and giving the address where the consult is taking place so police can do a welfare check or similar
– Contacting the Emergency contact, found in the demographics section of the patient file
– Contact the referrer (see referral in file) to alert them about the situation
– Contacting local area mental health triage or the local emergency department
Please also let the admin staff and Erin know if the above occurs and we will help in whatever way we can (eg. urgently preparing notes, contacting GP) during business hours.
In this scenario, we also suggest seeking advice from your own medical indemnity provider.
If patients contact admin and there are any concerns about their safety, our staff are instructed to provide them with crisis contact details (000, local mental health triage, or other support lines). If patients contact via email, they receive an automatic response with crisis contact information. If we receive correspondence from patients, we will endeavour to alert the clinician as soon as possible within business hours, either by email or phone.

Please ensure that you practice according to RANZCP and AHPRA professional standards. The HealthBright group has adapted accepted professional competencies for use as part of our quality assurance and any performance reviews, please find this here.

Call to Mind has a zero-tolerance policy to abusive behaviour from staff or patients.
If you feel uncomfortable due to abusive behaviour from a patient, we would support terminating the video call and letting our team know so we can support you in managing the situation.
Likewise, if you have any concerns about your interactions with Call to Mind staff, please contact Erin or Dave.
If patients are abusive towards Call to Mind staff members, we will let the clinician know and issue a warning to the patient. If this occurs again, we reserve the right to ban the patient from our practice. If this is necessary, we will let the patient, clinician and referrer know.

If Call to Mind receives a complaint or feedback from a patient or referrer regarding their interaction with the clinician, the clinician will be immediately informed.
Call to Mind will address any issues relating to our roles and responsibilities if they feature in the complaint.
We recommend that the clinician involves their own indemnity provider and then liaises directly with the patient to resolve the issue.

Please ensure you adhere to the RANZCP guidelines regarding the use of social media.

Please make sure you have your own treating GP and other supports. Please ensure you do not treat yourself or self-prescribe or treat staff members or family.
If you require any support or assistance, please contact the Call to Mind Director, Dr Dave Carmody, or Practice Manager, Erin Cody, to discuss this.

Process:
– Referals received from GP and this must be on new ADHD referral template. This includes an acknowledgement by the GP that they will take over prescribing once stabilised.

– Screened by MH Nurse and triaged as appropriate for ADHD Pathway (note we typically reject >75% of referrals due to being unsuitable for telehealth/pathway)
– Patient sent questionnaires including: ASRS2, DIVA (patient and family member), patient consent form, basic info questionnaire

– We request any school reports or collateral

– Once this has been received we then book,
1) the initial appointment with the psychiatrist (296),
2) appointment with psychiatrist for feedback and treatment planning (306).

– If the patient is diagnosed with ADHD and requires ongoing management, i.e. medication initiation, please let the admin staff know. We will then provide the psychoeducaton materials to the patient (ADHD Patient Resources Dropbox) and book follow ups after 2, 6, 12, 18 and 26 weeks (treatment session taken as week 0). Please also alert staff if requiring psychology sessions through Someone.health (recommended).

– If the patient is not diagnosed with ADHD OR if they require a different schedule of appointments, please let admin know.

Prescribing:
– please use Halaxy e-scripts for all prescribing
– please ensure you are aware of any state-based regulations (see AADPA website for a useful summary)

– as most of these referrals will be from NSW, we would highly recommend registering for a general authority to prescribe stimulants in NSW (this takes 1-2 weeks to approve) . See NSW Health “Application for General Authority to Prescribe Dexamfetamine, Lisdexamfetamine or Methylphenidate for the Treatment of Attention Deficit Hyperactivity Disorder (ADHD)”

We are partnered with the telehealth psychology group, Someone.health. They offer bulk billed psychology to people from anywhere in Australia and have >150 clinicians offering a range of different therapy types. Wait times are usually less than a week.

If you would like to refer you can either:
– tell the patient to see their GP or a Someone.health GP to arrange a MHCP
– provide a psychiatrist referral (allows up to 6 sessions before needing renewal). There is a template in the clinical notes for this, it can be completed and sent to the patient by email.

If you have particular questions about this or need some assistance arranging psychology follow up, let the admin team know who can liaise with Someone.health.

Thank you!

If you have any questions, comments or concerns about the above,

please contact Dave at dave@calltomind.com.au or on 0408 446 997­­­.