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An Overview of 2015 Medicare Updates for Clinical Social Workers

Friday, January 23, 2015  
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NASW Clinical Alert Winter 2015

An Overview of 2015 Medicare Updates for Clinical Social Workers

Mirean Coleman, LICSW, CT – NASW Senior Practice Associate

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. An overview of changes impacting clinical social workers includes the following:

  • Sustainable Growth Rate (SGR): The SGR is an annual growth rate that controls growth in Medicare expenditures for provider services. The Patient Access to Medicare Act (PAMA) of 2014 provides a zero percent increase in Medicare reimbursement in 2015 from January 1 to March 31, 2015. Under the SGR beginning April 1, 2015 through December 31, 2015, Medicare reimbursement is scheduled to decrease by a minus 21.2 percent unless averted by Congress. NASW is advocating for a remedy to the SGR to prevent further reimbursement reductions.

  • Physician Quality Reporting System (PQRS): PQRS identifies individual measures that may be used by clinical social workers to improve the quality of care provided to Medicare beneficiaries. Clinical social workers are encouraged to report PQRS measures to avoid a penalty resulting in less reimbursement fees. In 2015, clinical social workers who did not successfully report PQRS in 2013, will receive a 1.5 percent Medicare penalty. The 2015 PQRS program year data will determine the payment adjustment for 2017. In 2015, PQRS will not offer a bonus incentive payment for reporting measures. Clinical social workers who satisfactorily report PQRS will be listed on the 2016 Physician Compare Website at https://data.medicare.gov/data/physician-compare. In 2015, NASW has scheduled several trainings to help its members report PQRS to avoid future penalties.

    Clinical social workers are encouraged to report PQRS measures
    to avoid a penalty resulting in less reimbursement fees.

    • Upcoming FREE call-in informational sessions on PQRS:

      • March 18, 2015 “Getting Started with Medicare PQRS in 2015” Noon to 1 pm EST

      • April 15, 2015 “Getting Started with Medicare PQRS in 2015” Noon to 1 pm EST

        • An Hour with Private Practice Q&A is held every third Wednesday of the month from noon until 1:00 pm EST. TELECONFERENCE LINE: Toll Free: 866.575.6535; Participant Passcode: 611223

        • See below for a full list of 2015 FREE call-in private practice informational sessions**

  • Telehealth Services: Medicare currently reimburses clinical social workers for telehealth services using the individual psychotherapy Current Procedural Terminology (CPT)* codes. In 2015, Medicare will also reimburse clinical social workers when using telehealth services for the following CPT codes:

    • 90845 – Psychoanalysis

    • 90846 – Family Psychotherapy (without the patient present)

    • 90847 – Family Psychotherapy (conjoint psychotherapy) (with the patient present)

    • NASW will publish a practice perspectives in early 2015 describing Medicare’s telehealth services and how to use it for reimbursement.

  • Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC): The Centers for Medicare and Medicaid Services removed regulations requiring clinical social workers who furnish services in a RHC and FQHC to be employees of the RHC and FQHC. This removal allows RHCs and FQHCs with flexibility to address their staffing needs without adversely impacting the quality of services or continuity of care of Medicare beneficiaries. In 2015, clinical social workers may contract for services in RHCs and FQHCs. In the future, guidelines on how to become providers in RHCs and FQHCS will be released and NASW will make them available to its members.

  • Health and Behavior Assessment and Intervention Codes: CMS continues to restrict payment to clinical social workers when services are performed using the Health and Behavior Assessment and Intervention CPT codes. NASW continues its advocacy efforts with CMS to change this.

  • ICD-10-CM: The International Classification of Diseases, Tenth Edition, Clinical Modification Codes will be implemented on October 1, 2015. Clinical social workers will not be able to use the ICD-9-CM Codes after September 30, 2015 and will suffer claim denials if they do. NASW has scheduled several trainings on the ICD-10-CM to help members transition to the new codes.

  • Electronic Health Record: Clinical social workers who are Medicare providers may continue to use paper documentation as long as they are in solo practice or in a group practice with 10 or less practitioners. At this time, clinical social workers and other non-physician practitioners continue to be ineligible for electronic health record incentives. NASW is advocating for members to receive financial assistance when converting to an electronic health record.

  • Skilled Nursing Facilities (SNF): Clinical social workers in independent practice continue to be reimbursed for mental health services only under Medicare Part B. For 2015, CMS continues to enforce its policy for the collection of overpayment for mental health services provided in a SNF by clinical social workers. NASW continues its advocacy efforts with CMS to change this. Additional information about 2015 Medicare updates is available online in the Federal Register of November 13, 2014 at:

*CPT copyright 2014. American Medical Association. All Rights Reserved.

**More Information on “An Hour With Private Practice: Questions and Answers”

  • A FREE question and answer session for NASW members which is held every third Wednesday of the month from January through November. The monthly call-in sessions focus on a specific private practice subject. There is no registration and members can join in the discussion, ask questions, and make comments. These sessions provide members with important clinical social work updates impacting the delivery of mental health services. Sessions are limited to the first 100 callers on the day of the event.

  • An Hour with Private Practice Q&A is held every third Wednesday of the month from noon until 1:00 pm EST. TELECONFERENCE LINE: Toll Free: 866.575.6535; Participant Passcode: 611223

  • 2015 Schedule:

    • January 21, 2015 Using Psychotherapy and Place of Service Codes Effectively in 2015

    • February 18, 2015 Transitioning to the ICD-10-CM Codes on October 1, 2015

    • March 18, 2015 Getting Started With Medicare PQRS in 2015

    • April 15, 2015 Getting Started With Medicare PQRS in 2015

    • May 20, 2015 Becoming a Provider for Insurance Companies

    • June 17, 2015 Guidelines for Using Technology in Private Practice

    • July 15, 2015 Highlights of Good Documentation

    • August 19, 2015 Transitioning to the ICD-10-CM on October 1, 2015

    • September 16, 2015 Transitioning to the ICD-10-CM on October 1, 2015

    • October 21, 2015 Social Media: Do’s and Don’t in Private Practice

    • November 18, 2015 Starting a Private Practice and Incorporating Safety Standards

For more information contact Mirean Coleman at mcoleman@naswdc.org or Jonas Goldenberg at goldenberg@naswma.org.


National Association of Social Workers - Massachusetts Chapter
14 Beacon Street, Suite 409, Boston MA 02108
tel: (617)227-9635 fax: (617)227-9877 email: chapter@naswma.org
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