NASW Meets with Optum about Second Wave of Overpayment Recovery
October 2024
On October 15, 2024, The National Association of Social Workers (NASW) met with Optum leadership to follow up on the second wave of overpayment recovery which occurred in August 2024 and to discuss issues impacting clinical social workers (CSWs) who seek reimbursement from Optum. The recovery impacted CSWs who provided services to Medicare Advantage Plan beneficiaries and were reimbursed incorrectly at 100 percent of the CMS Medicare and Medicaid Physician Fee Schedule. The recovery seeks 25 percent of the 100 percent reimbursement.During the meeting, NASW emphasized the importance of maintaining clear and consistent communication between Optum, NASW, and CSWs, particularly around issues like overpayments. Here are the key takeaways:
- Medicare Overpayment Recovery: Optum announced that the 25 percent recoupment of the 100 percent overpayment had ended with no plans to continue it. NASW raised concerns about current duplicate overpayment request letters and amounts due. Optum acknowledged this issue and plans to update their website and factsheet to provide clear guidance to CSWs. Regarding concerns about inaccuracies in overpayment amounts, the association is actively working to ensure these discrepancies are fully addressed. For further guidance, CSWs are encouraged to review Optum’s resources available on the Optum - ProviderExpress Home.
- Documentation Audits: Optum is currently conducting documentation audits, and while audits are focused on psychologists and psychiatrists NASW sought clarification regarding the inclusion of clinical social workers. Per NASW request, Optum agreed to provide documentation training to help clinical social workers pass a documentation audit prior to an audit taking place. To access relevant documentation resources, clinical social workersshould refer to the Medical Records Documentation Used for Reviews page.
- Measurement-Based Care: Optum expressed interest in encouraging the use of standardized assessment tools to measure patient progress. NASW encouraged incentives for using these tools without penalizing providers who opt not to use them. For information on clinical tools and quality initiatives, visit Optum’s Clinical Tools and Quality Initiatives page.
- Provider Data Validation: Optum discussed the challenges of keeping provider availability information up-to-date in their systems. NASW stressed the importance of reducing the administrative burden on CSWs when updating availability data. Simplifying this process will help ensure accurate provider directories while allowing social workers to focus on patient care.
- Quarterly Meeting:NASW and Optum agreed to meet quarterly to discuss clinical social work issues impacting clinical social workers who seek reimbursement from Optum.
NASW Resources on Optum Recovery
Additional Resources