Clinical Social Work: Reimbursement

On behalf of 150,000 members of the National Association of Social Workers (NASW) and the 40,000 clinical social workers who are Medicare providers, I am submitting comments to you in response to the proposed notice, “Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule and Proposed Changes to the Practice Expense Methodology.”  This proposed notice appeared in the Federal Register dated June 29, 2006.

The Centers for Medicare and Medicaid Services (CMS) issued a proposed notice in the Federal Register, dated June 29, 2006, that addresses two components of the Medicare Physician Fee Schedule: the RVU (work) and the Practice Expense values. Clinical social workers’ reimbursement fees are based on this schedule. CMS is proposing that clinical social workers receive a 7 percent reduction in work values and a 2 percent reduction in Practice Expense values effective January 1, 2007.

For the first time since 1990, clinical social workers and other providers who seek reimbursement soon will be required to use a new version of the CMS-1500 Claim Form.   Formerly known as HCFA-1500, the CMS-1500 is commonly used to submit claims for reimbursement of health and mental health services.  Revisions are being made by the National Uniform Claim Committee (NUCC) to accommodate the new National Provider Identifier (NPI) and were announced in the Federal Register on February 24, 2006 with a 30-day comment period.

President Bush signed the Deficit Reduction Act of 2005 (DRA) into law on February 8, 2006. One of the act’s provisions reverses a 4.4 percent reimbursement reduction for clinical social workers and other Medicare providers that took effect earlier this year. The DRA allows clinical social workers to be reimbursed retroactively for services rendered on or after January 1, 2006, at the 2005 rate. This means there is a zero percent increase for services provided in 2006.

 In the United States, 40,000 clinical social workers in solo or group practice are Medicare providers under Part B and receive reimbursement for mental health services provided in an outpatient setting.  A number of social work providers who have received overpayment notices from Medicare have contacted NASW with questions about the administrative process.  This practice update provides an overview of the Medicare overpayment process.

 

Effective October 1, 2005 , Medicare will not process electronic claims submitted for payment that are not HIPAA compliant. Electronic claims that do not meet the electronic format will be automatically rejected and returned to the clinical social worker. This does not pertain to paper files.