CLINICAL SOCIAL WORK PRACTICE UPDATE

2006 Revised Medicare Reimbursement For Clinical Social Workers

Mirean Coleman, MSW, LICSW, CT
Senior Policy Associate for Clinical Social Work

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.

Medicare claims-processing contractors are beginning to pay all 2006 claims at the higher rate. Clinical social workers who already have received payment for January claims will automatically receive reprocessed claims payments. Due to the volume of claims involved, contractors are not expected to complete reprocessing until July 1, 2006. Clinical social workers may receive several aggregate payments in the coming months.

The higher 2006 payment rate may affect a clinical social worker’s decision to participate as a Medicare provider. Therefore, the Centers for Medicare and Medicaid Services (CMS) has announced a second 45-day participation enrollment period to allow clinical social workers to change their participation decision.

NASW will keep its members abreast of any further changes. Clinical social workers can find additional information about the Deficit Reduction Act at www.cms.hhs.gov/apps/media/press/release.asp?Counter+1779