Third Party Payers

In February 2024, NASW members informed the association of mass overpayment requests from Optum United Behavioral Health. Optum Recovery Service reported that they paid clinical social work providers 100 percent of the psychologist rate when they should have been paid only 75 percent of the psychologist rate. As a result, Optum requested overpayment of 25 percent from clinical social work providers who received reimbursement for services provided to beneficiaries of Medicare Advantage Plans.

NASW members are seeking reimbursement clarifications when performing psychotherapy services to Medicare Part B beneficiaries who do not wish to use their Medicare benefits. In such situations, a clinical social worker may opt-out of Medicare. This means that the clinical social worker cannot bill Medicare for any services they perform. Instead, reimbursement is received from the Medicare beneficiary under the terms of a private contract.

NASW members are seeking reimbursement clarifications when performing psychotherapy services to Medicare Part B beneficiaries who do not wish to use their Medicare benefits. In such situations, a clinical social worker may opt-out of Medicare. Opting out means that the clinical social worker cannot bill Medicare for any services they provide for a two year period. Instead, reimbursement is received from the Medicare beneficiary under the terms of a private contract.

Under The Omnibus Budget Reconciliation Act of 1989, clinical social workers became eligible as Medicare providers to seek reimbursement under Medicare Part B for the diagnosis and treatment of mental illnesses performed in an outpatient setting.

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).