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News & Press: Clinical Alerts

CPT Code & Reimbursement Crisis: What NASW is Doing For You

Friday, February 1, 2013  
Posted by: Kellie Veiga
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NASW-MA is well aware that our members in private practice are facing a significant crisis, including both financial disruption and emotional distress, caused by the actions of certain insurance companies who were not reimbursing them, in a timely way, for psychotherapy services provided during January, 2013. We share your outrage and are taking steps to directly express it, as well as making specific recommendations, to the Chief Executive Officers of these insurance companies.

Letters have been sent to these CEOs, and meetings have been requested with these companies, to address CPT code and reimbursement issues. We have urged them to:
  • Send a letter of apology, via hard-copy and email, to their behavioral health providers and post it on their website’s provider homepage;
  • Invite feedback from providers through a special hotline and/or survey;
  • Hold focus groups with social workers and other behavioral health providers to hear their concerns, frustrations, and suggestions for improved care for their members;
  • Rescind recent reimbursement rate reductions for any psychotherapy codes;
  • Pay behavioral health providers interest on the reimbursements withheld due to their internal problems;
In addition national NASW is responding to what has become a national crisis for social workers in private practice.

The following was sent to the NASW Chapters from Mirean Coleman, LICSW, Senior Practice Associate at NASW National:

"A large volume of clinical social workers have contacted the national office regarding claim denials. Denials for the month of January 2013 appear to have been precipitated by computer system problems created by the lack of notice from CMS to begin using the new psychotherapy codes on January 1, 2013. Many insurance companies have requested their mental health providers to refrain from billing until their computer systems have been updated. For clinical social workers who have received denials, insurance companies are requesting them to resubmit their claims.

Another concern expressed by members is the disparities in payment for the new codes. Per the Final Rule of the 2013 Physician Fee Schedule, CMS announced they were establishing interim work and practice expense values for the new psychotherapy codes until the entire family of psychiatric codes is surveyed. Having no permanent values for the codes has created additional chaos for the insurance community because they have no framework to determine proper reimbursement for the codes. NASW is working with the Centers for Medicare and Medicaid Services, American Medical Association, and other organizations to complete the survey process this year so that permanent values for the codes can be established in 2014. The national survey will take place in March 2013 and NASW will participate and survey its members.

The national office is also advocating for clinical social workers with the Centers for Medicare Services, American Medical Association, and the CPT Editorial Panel to enhance the implementation phase of the new codes and make changes to improve the interpretation and use of them. We have received constructive comments from many members and plan to use them to develop and revise psychotherapy codes.”

Both NASW National and NASW-MA Chapter will continue to support and advocate for you. What you think, say and do matters to us. Contact Jonas Goldenberg with your questions and concerns.


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