Clinical Social Work: Reimbursement

Clinical social workers who are Medicare providers frequently encounter claim denials due to unreported changes in their solo or group practice. Clinical social workers are responsible for reporting changes to their Medicare Administrative Contractor (MAC) as soon as possible or within 30 days of the change. Reporting changes immediately ensures timely and proper processing of claims and prevents rejections.

Beginning July 1, 2008, clinical social workers who are Medicare providers received an increase in reimbursement. This increase is the result of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008 (also known as HR 6331, public law number 110­-275).

The National Association of Social Workers and more than 70 other health care professional organizations are conducting a comprehensive multi-specialty survey of clinical social workers and other health care professionals.  The survey is collecting up-to-date characteristics of practices from a variety of health care disciplines, and will be used to positively influence national decision makers.

Medicare establishes new reimbursement rates for clinical social workers and other health care providers at the beginning of each calendar year. For 2008, there are several layers of changes in the Medicare Part B reimbursement for clinical social workers.

The Centers for Medicare and Medicaid Services (CMS) has announced July 2, 2007 as the deadline for the implementation of the revised CMS-1500 Form, version (08-05) for paper claims submission.  Claims received on or after July 2, 2007 using the CMS-1500 Form, version (12-90) will be rejected.  CMS had previously targeted June l, 2007 as the delayed implementation date for the revised CMS-1500 Form due to revised forms that had been incorrectly printed to specifications and distributed.  The problem has been remedied and the correct form is available.

The Centers for Medicare and Medicaid Services (CMS) recently extended the implementation date for the revised CMS-1500 Form from April 1, 2007 to the targeted date of June 1, 2007. The CMS-1500 Form is the most frequently used reimbursement form by clinical social workers and other providers who perform health and mental health services in outpatient settings. The extension in implementation is due to the distribution of incorrectly formatted versions of the revised CMS-1500 Form sold by the Government Printing Office.