Clinical Social Work Practice Tools: Third Party Payers

The current policy is the Paul Wellston and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA was enhanced by the Affordable Care Act (ACA) in 2010. Current expectations and how they impact clinical social workers and patients are outlined in this practice perspective.

The National Association of Social Workers (NASW) is committed to advocacy that preserves equal access to health care for all Americans.

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.

The 2015 Final Physician Fee Schedule was released in the Federal Register on November 13, 2014 and provides regulations for clinical social workers who provide psychotherapy services. Clinical social workers should note these changes to keep their Medicare practice running smoothly and effectively.

The Centers for Medicare and Medicaid Services (CMS) announced the final rule for the 2014 Medicare Physician Fee Schedule on November 27, 2013. Implementation of the final rule is January 1, 2014.

The Centers for Medicare and Medicaid Services (CMS) announced the final rule for the 2013 Medicare Physician Fee Schedule on November 1, 2012.