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2008 Medicare Payment for Clinical Social Workers


Mirean Coleman, MSW, LICSW, CT,
Senior Policy Associate, National NASW

January 2008

Medicare establishes new reimbursement rates for clinical social workers and other health care providers at the beginning of each calendar year. For 2008, there are several layers of changes in the Medicare Part B reimbursement for clinical social workers.

In the Federal Register dated November 27, 2007, the Centers for Medicare and Medicaid Services ( CMS) announced a 10.1 percent decrease in the Medicare fee schedule for Medicare providers in 2008. Shortly afterwards, on December 19, 2007, the U.S. Congress passed the Medicare, Medicaid and SCHIP Extension Act of 2007. The Medicare, Medicaid and SCHIP Extension Act temporarily replaced the 10.1 percent decrease in 2008 with a 0.5 percent increase, effective January 1, 2008 through June 30, 2008. However, the Medicare fee schedule may decrease 10.1 percent on July 1, 2008, without further intervention from Congress.

Despite this 0.5 percent increase for the next six months, Medicare reimbursement rates for clinical social workers are being reduced an additional three percent, resulting from the impact of the new practice expense methodology implemented in 2007. The new practice expense methodology expands a seven percent decrease from 2007 to 2010.

There may be an additional five percent bonus incentive payment through June 30, 2008, for clinical social workers who provide services in designated physician shortage areas.

Clinical social workers have an option to increase their Medicare reimbursement by participating in the 2008 Physician Quality Reporting Initiative (PQRI). The Tax Relief and Health Care Act of 2006 (TRHCA) authorizes the PQRI for bonus payments to clinical social workers and other Medicare providers who satisfactorily submit data on the quality of covered professional services furnished to Medicare beneficiaries in 2008.

The PQRI bonus payment is 1.5 percent of a provider’s total allowed covered Medicare services rendered during 2008. Additional information on PQRI and on how to meet the 2008 requirements for the bonus will be provided in a future practice update, "2008 Physician Quality Reporting Initiative for Clinical Social Workers.”

To improve reimbursement rates for clinical social workers, NASW is participating in the national Multi-Specialty Health Care Professional Practice Survey to help determine practice expense data for clinical social workers. This survey is expected to be completed in late 2008. Based on the information acquired, CMS plans to adjust practice expense payment rates. NASW encourages clinical social workers in private practice to participate in this survey process to help provide accurate practice expense data that will have an impact on reimbursement.

In the meantime, NASW continues to lobby the U.S. Congress on behalf of its members for better reimbursement rates. During the second session of the 110th Congress, NASW plans to re-introduce a Medicare bill to recover the five percent Medicare reduction in relative value units (work values) that clinical social workers lost in 2007.

Additional information about Medicare cuts is available at the following Web sites:



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