Third Party Payers

In February 2024, NASW members informed the association of mass overpayment requests from Optum United Behavioral Health. Optum Recovery Service reported that they paid clinical social work providers 100 percent of the psychologist rate when they should have been paid only 75 percent of the psychologist rate. As a result, Optum requested overpayment of 25 percent from clinical social work providers who received reimbursement for services provided to beneficiaries of Medicare Advantage Plans.

Re: CMS–1751-P Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post-Payment Medical Review Requirements

On January 18, 2021, Optum Pay, a platform of UnitedHealthcare, launched an upgraded version of its payment management system, Optum Pay premium.

Beginning January 1, 2020, clinical social workers who are in independent practice and provide psychotherapy services to Medicare beneficiaries, must submite Medicare claims using the new MBIs to avoid claim rejections.

The current policy is the Paul Wellston and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA was enhanced by the Affordable Care Act (ACA) in 2010. Current expectations and how they impact clinical social workers and patients are outlined in this practice perspective.

The National Association of Social Workers (NASW) is committed to advocacy that preserves equal access to health care for all Americans.