Attention Clinical Social Workers Who Are Optum Providers
Mirean Coleman, LICSW, CT, Director of Clinical Practice
August 2024
Optum Behavioral Health Care has informed NASW that a second wave of recovery overpayments will take place between August 2-8, 2024.The recovery may impact clinical social workers who are Optum Behavioral Health Care providers and provided services to Medicare Advantage Plan beneficiaries and were reimbursed incorrectly at 100 percent of the Centers for Medicare and Medicaid Physician Fee Schedule. The recovery seeks 25 percent of the 100 percent reimbursement. The Social Security Act, Section 1833 (a)(1)(F), confirms that clinical social workers are paid 75 percent of the physician fee schedule.
The first wave of recovery took place December 2023 through January 2024 for dates of service January 1, 2022, through April 30, 2023.The current wave is expected to cover dates of service from May 1, 2023, through February 28, 2024. NASW prepared the following resources for its members during the first wave of recovery and the information remains valid for the second wave of recovery.
Optum Resources
NASW members may also contact NASW at clinical.practice@socialworkers.org