NASW has produced a revised and expanded reference booklet specifically designed for clinical social workers who deal with third-party reimbursement issues.

Mirean Coleman, NASW senior policy associate, said the booklet, Third-Party Reimbursement for Clinical Social Work Services, is the most comprehensive NASW guide yet on the subject. Available through NASW Press, the booklet covers areas involving clinical social work and third-party reimbursement.

“We’ve addressed the important questions that people most commonly have about reimbursement,” Coleman said. “Among the topics, it discusses types of third-party payers and provides an overview of federal insurance programs.”

The booklet is an important aide to clinical social workers who provide most of the mental health services in the U.S, Coleman pointed out. There are more than 167,000 licensed clinical social workers in the country, she said.

The guide is a useful tool for the novice clinical social worker as well as the veteran private practitioner seeking information about various reimbursement issues, Coleman explained.

Topics include:

• Requirements for social workers seeking reimbursement;
• The principal, third-party payers;
• How reimbursement rates are developed;
• How to become a provider;
• The Health Insurance Portability and Accountability Act (HIPAA);
• How to file paper or electronic claims; and more.

“We also cover emerging issues that may affect clinical social workers and third-party reimbursement,” Coleman said. “It’s an important aide in seeking reimbursement.”

The booklet also highlights NASW reimbursement resources, including practice updates, Medicare and Medicaid managed care contacts and legal notes.

There is a glossary of common reimbursement terms as well as a list that spells out common reimbursement acronyms. The booklet has licensing contact information for clinical licensing per state as well as a list of state insurance commissions who regulate insurance companies.

Most clinical social workers working in solo or group practices bill health plans independently for their services. Others may use the services of a billing company. In either case, clinical social workers are responsible for the services rendered for payment on the claim reimbursement form, Coleman explained. Therefore, it is important for them to understand the nature of third-party payers and the reimbursement process, she said. This includes how to properly code insurance claims. Familiarity with the process should help to reduce the possibility of delayed and/or denied claims or overpayment requests, Coleman added.

The booklet points out that clinical social workers who provide most of the mental health services in the nation file health claims through Medicare, managed care companies and other insurance carriers. In 2005 alone, more than 4.1 million claims were filed by clinical social workers through Medicare.

“Clinical social workers in solo or group practice may submit their own claims for reimbursement, which requires them to keep abreast of the changes in claims processing requirements,” Coleman said.

“NASW seeks to present and represent the position of the social work profession to legislators and regulators so that clinical social workers receive professional recognition and are appropriately compensated for their skills and expertise,” the booklet states in its introduction.