Note from CSWA - Medicare Changes
Act By Date: Immediate

Medicare has had some changes in provider enrollment and reimbursement for LCSWs since January 1 which CWSA would like to bring to your attention.
1.    Medicare LCSW Providers - In spite of the fact that LCSWs are ‘automatically’ Medicare providers, we must complete a Medicare provider application to be reimbursable.  This application has now changed and must be COMPLETED and RESUBMITTED by any LCSW who wants to continue being a Medicare provider.   The new system is called PECOS for Medicare “Provider Enrollment, Chain and Ownership System.”  Anyone who has not renewed their registration with CMS as a provider since 2003 must send in a new complete PECOS application by December 31, 2010.  Applications can be accessed at http://www.cms.hhs.gov/MedicareProviderSupEnroll/02_EnrollmentApplicatio...
2.    Co-Pay Changes – The Medicare Improvements for Patients and Providers Act of 2008 included a phased-in equalization of mental health co-pays and medical co-pays, which began on January 1, 2010.  LCSW clients now have to pay a 45% co-pay, which will become a 40% co-pay in 2011, and so on, until 2014 when the co-pay will be the same 20% as medical services.  CMS will now pay 55% of the reimbursable LCSW claims, which will gradually increase to 80% by 2014.   
3.    “Telehealth” Services - Medicare providers may be reimbursed for LCSW telephone services only if they occur 1) in a rural health professional shortage area or in a county outside of a Metropolitan Statistical Area; and 2) are offered from a rural health or mental health clinic, a hospital, the LCSW’s office, or a skilled nursing facility.  For more information, seehttp://www.cms.hhs.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf
4.    Reimbursement Reduction – There will be reductions in reimbursement for “practice expenses” for all Medicare providers totaling as much as 7% by 2013. Practice expenses include direct expenses such as clinical labor, supplies, and equipment.  The 2010 decrease for LCSWs is 1%.  In some regions, Medicare administrators have cut LCSW reimbursement rates by as much as $5 due to this across-the-board reduction.
5.    Hold on Medicare Claims – Because the 21% cut to Medicare providers due to the Sustainable Growth Rate (SGR) formula could not be removed by March 1, a hold was placed on all Medicare claims for the first two weeks of March.  Congress is working on getting the cut rescinded by March 14 and pay claims submitted in the first two weeks of March without the 21% cut, retroactively.
Please let me know if you have any questions on the Medicare changes.
http://www.clinicalsocialworkassociation.org/alerts/medicare-changes