2008 Medicare Bonus Incentive Program for Clinical Social Workers

Jul 2, 2008

Clinical Social Work Practice Update

A quality reporting system for Medicare providers was established by the Tax Relief and Health Care Act of 2006 (TRHCA). The program is known as the Physician Quality Reporting Initiative (PQRI) and was first implemented during the period of July 1, 2007 through December 31, 2007.

The final rule of the 2008 Medicare Physician Fee Schedule continues the PQRI for 2008 and includes a 1.5 per cent bonus incentive payment of total allowed charges for Medicare covered services. To receive the bonus payment, providers must report quality measures on claims and correctly file these claims for reimbursement. Participation in the PQRI is optional at this time for clinical social workers and other Medicare providers. Since Medicare is moving towards a pay-for-performance system, all Medicare providers may eventually be expected to report quality measures to receive payment.

For 2008, there are a total of 119 measures available for use by Medicare providers. Six of these quality measures are for use by clinical social workers. Three of the six new measures were developed by Quality Insights (QI) of Pennsylvania, a Medicare contractor, in consultation with NASW and the American Psychological Association. NASW members participated in alpha and beta testing to validate the appropriateness of the measures in social work practice. The three measures are:

  • screening of depression
  • screening of cognitive impairment
  • co-development of treatment plan.

An additional three measures were developed through the American Medical Association Physician Consortium for Performance Improvement (PCPI) and the American Psychiatric Association. They are:

  • patients who have major depression disorder who meet the DSM-IV criteria
  • patients with major depression disorder who are assessed by suicide risks
  • antidepressant medication during acute phase for patients with new episode of major depression.

Reporting for the 2008 Medicare bonus incentive program has been simplified through the development of reporting tools which have been designed by the AMA and several other groups including the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). There are three reporting tools for each of the six quality measures to assist clinical social workers in successfully reporting the measures for reimbursement.

The documents are:

  • Measure Description – This informational sheet describes the measure, what information to report, and how frequently to report it. It helps clinical social workers to determine whether they would like to use the measure.
  • Data Collection Sheet – This data sheet is a tool for clinical and billing use. It helps clinical social workers record the required clinical information and select the appropriate measurement code.
  • Coding specifications – This coding specification sheet includes a list of ICD-9-CM and CPT codes to identify eligible patients for the measure. This tool is used with the data collection sheet to help determine the reimbursement codes to report.

The tools for each of the six codes are at www.cms.hhs.gov/pqri. It is not too late for clinical social workers to begin reporting measures for 2008. The deadline for filing claims to receive the 2008 bonus incentive payment is February 28, 2009.

NASW is advocating for additional measures for clinical social workers in order that they may have a variety of measures to choose from when participating in the bonus incentive program. An expert work group of clinical social workers is working with QI and CMS to develop additional measures for use in 2009 by clinical social workers.

Additional information on the PQRI is available online at www.cms.hhs.gov/pqri

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