Clinical Social Work: Reimbursement

At the beginning of each calendar year, Medicare establishes new payment rates for clinical social workers and other health care providers. For 2007 the Medicare payment rate for Medicare Part B providers is layered with several changes.

The Centers for Medicare and Medicaid Services (CMS) recently announced implementation plans for the revised CMS-1500 Form, formerly known as HCFA-1500.  The form is commonly used by clinical social workers and other providers who are excluded from the mandatory electronic claims submission requirements and submit paper claims to Medicare carriers. 

On behalf of 150,000 members of the National Association of Social Workers (NASW) and the 40,000 clinical social workers who are Medicare providers, I am submitting comments to you in response to the proposed notice, “Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule and Proposed Changes to the Practice Expense Methodology.”  This proposed notice appeared in the Federal Register dated June 29, 2006.

The Centers for Medicare and Medicaid Services (CMS) issued a proposed notice in the Federal Register, dated June 29, 2006, that addresses two components of the Medicare Physician Fee Schedule: the RVU (work) and the Practice Expense values. Clinical social workers’ reimbursement fees are based on this schedule. CMS is proposing that clinical social workers receive a 7 percent reduction in work values and a 2 percent reduction in Practice Expense values effective January 1, 2007.

For the first time since 1990, clinical social workers and other providers who seek reimbursement soon will be required to use a new version of the CMS-1500 Claim Form.   Formerly known as HCFA-1500, the CMS-1500 is commonly used to submit claims for reimbursement of health and mental health services.  Revisions are being made by the National Uniform Claim Committee (NUCC) to accommodate the new National Provider Identifier (NPI) and were announced in the Federal Register on February 24, 2006 with a 30-day comment period.

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.