Social workers adjust to new claims and reimbursement processes

Mar 5, 2014

By Rena Malai, News staff

Licensed Clinical Social Worker Camielle Call knows how daunting it can be to keep up with the changes in claim procedures that are taking place this year for those in her profession.

But she and other clinical social workers said thoroughly educating oneself on the revisions will make adapting to them much easier.

The claims and reimbursement processes that are changing include a revised CMS-1500 form; the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM); the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5); and requirements to file quality measures from the Physician Quality Reporting System (PQRS).

Adjusting to what may seem onerous can be simplified by studying the changes, researching expectations from all avenues — including insurance companies — and revisiting obligations that social workers have to themselves and their clients, said Call, who has a private practice in Sitka, Alaska.

“We are the ones who are held accountable for the ethical and successful management of our practices,” she said. “We need not fear these changes; instead we can embrace them and utilize them to better benefit ourselves, our practices and our clients.”

NASW Senior Practice Associate Mirean Coleman said the DSM-5 and the ICD-10 are harmonized, and mental health providers now have one classification system for diagnosing mental illness.

The CMS-1500 form has been updated to accommodate the implementation of the ICD-10 codes. Clinical social workers are required to use PQRS measures in 2014 when filing claims for Medicare patients, she said, or they will be subject to a 2 percent penalty in 2016 for not using measures in 2014.

“It’s important for clinical social workers to remain on top of these changes and become familiar with deadlines so they can avoid reimbursement denials,” Coleman said.

NASW has created Practice Perspectives detailing the updates (see accompanying sidebar), and many NASW chapters have workshops and seminars planned to help clinical social workers familiarize themselves with the changes.

NASW member Doris Tomer, a clinical social worker in New York, said these modifications definitely impact whether claims are paid, what reimbursement will be and how long clinical social workers may have to wait to be paid for services rendered. By not staying informed, she said, “claims could be denied, and there may be some penalties.”

“It takes time (to adjust), which is in short supply when you are balancing many other professional and personal things,” Tomer said, adding that it is unusual to have so many changes happening at the same time.

Tomer said adapting to the PQRS requirements could prove to be the most challenging because clinical social workers are not used to performing quality measures.

The 2014 PQRS has 358 quality initiative measures, Coleman said,  and each measure is assigned a measure number and title such as #248 (measure number) “Substance Use Disorders: Screening for Depression Among Patients with Substance Abuse or Dependence” (measure title).

From the March 2014 NASW News. NASW members can read the full story after logging in.

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