Clinical Social Work: Reimbursement

NASW receives questions from clinical social workers about how to terminate their contracts as insurance providers and move to a private pay fee-for-service practice. This practice perspective highlights several important steps to facilitate the transition.

Clinical social workers (CSWs) in private practice make decisions as they manage their practice about accepting insurance,cash payments, and contracting with alternative payers.

NASW encourages its members to provide their professional expertise during the  development of the International Classification of Diseases, Eleventh Edition, Clinical Modification (ICD-11-CM).  The World Health Organization’s Department of Mental Health and Substance Abuse has formed a global network of mental health professionals to develop the next version of the Classification of Mental and Behavioral Disorders of the ICD-11. 

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014.  There are several areas of this new law, two of which directly impact clinical social workers.

Beginning April 1, 2014, Clinical social workers and other health care providers are required to use the new CMS-1500 form when filing paper claims for psychotherapy services with third-party payers. The new form is identified as version 02/12.  Clinical social workers who do not use the new CMS-1500 Form beginning April 1 will receive claim rejections.