CLINICAL  SOCIAL  WORK  PRACTICE  BULLETIN

2007 Medicare Payment for Clinical Social Workers

Mirean Coleman, MSW, LICSW, CT
Senior Policy Associate
January 2007

At the beginning of each calendar year, Medicare establishes new payment rates for clinical social workers and other health care providers. For 2007 the Medicare payment rate for Medicare Part B providers is layered with several changes.

The Tax Relief and Health Care Act of 2006 (H.R. 6111) reversed the Sustainable Growth Rate (SGR) for 2007 to the same payment level as 2006. Thus, there is no 5 percent statutory payment reduction for 2007. Despite this zero change, payment rates for 2007 are less than 2006. This is due to the following factors:

1. There is a 7 percent reduction in relative value units (work values) for clinical social workers.
2. An additional 2 percent cut is related to changes in the practice expense methodology.

As a result, clinical social workers can expect a 9 percent decrease in their Medicare reimbursement for 2007.  The Centers for Medicare and Medicaid Services (CMS) has instructed Medicare carriers to inform clinical social workers of these changes either by electronic or paper notices.

Per the Tax Relief and Health Care Act, another positive factor that may affect Medicare payments beginning July 1, 2007 is a bonus payment to Medicare providers of 1.5 percent of their total Medicare charges for reporting quality measures. The quality measures are part of the Physician Voluntary Reporting Program (PVRP).  A lump sum payment will be paid in early 2008 for quality measures that Medicare providers report  from July through December of 2007. Clinical social workers are eligible to receive this bonus. NASW is now seeking clarifications from CMS about how clinical social workers may take advantage of this bonus payment.  Once the plans are announced, NASW will inform its members of the steps to take to meet the requirements for the bonus.  

In the meantime, NASW continues to lobby Congress on behalf of its members for better reimbursement rates, and is participating in a national Multi-Specialty Health Care Professional Practice Survey to help determine practice expense data for clinical social workers. Based on the information acquired from the survey, CMS plans to adjust practice expense payment rates. NASW is encouraging clinical social workers in private practice to participate in this survey process to help obtain accurate practice expense data that will have an impact on reimbursement. Further information about this survey is available at http://www.socialworkers.org/practice/clinical/csw010207.asp    

Additional information about the Medicare cuts is available at the CMS Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5443.pdf