Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
I have received a deluge of emails from you about the use of POS “10” for Medicare and other insurers. This guidance that Medicare has provided about this policy is complicated.
The current guidance from CMS is that:
Be sure to check with EACH private insurer for a patient to find out what combination of POS and Modifier are being requested so that claims will not be denied.
I hope this resolves the confusion about POS codes. Let me know if there are any other questions.
POS Codes as of 4/1/22 – Medicare
There has been some confusion about what Point of Service (POS) Codes should be used for Medicare and other insurers as of April 1, 2022.
As you know, there were changes to POS codes that were announced as of January 1, 2022 to be “available” for Medicare as of April 1, 2022. POS “10”, a new POS code for telemental health services that are provided when the patient is in their home, and the LCSW is in their office or elsewhere. Other POS Codes are “2” which is used when a patient is not in their own home and receiving telemental health services from an LCSW or “11” which is used when seeing a patient in the LCSW’s office.
The Medicare modifier is 95 for any of the above codes.
It appears that the POS 10 is now being used instead of POS 2 for Medicare for reimbursement. All other insurers, public and private, should be contacted about the POS codes that are required for reimbursement of claims. The same goes for which modifier is being used – check with the individual insurer.
For more information, go to https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set If you have other question, contact me at firstname.lastname@example.org.
Transgender children have been in the crosshairs of conservative groups in the legislature and elsewhere for the past decade. Amongst legislative attempts to discriminate against them, there have been attempts to ban them from gender-specific bathrooms or from participating in sports consistent with their gender identity. Support for transphobic attitudes and actions has grown. Now there is an attempt in Texas to lay blame on parents who affirm their child’s gender identity. This bill is one of the most harmful to trans children, but is the tip of the iceberg; there have been over 235 state-based bills that limit the rights of trans children in 2022 (https://www.msn.com/en-us/news/us/nearly-240-anti-lgbtq-bills-filed-in-2022-so-far-with-most-targeting-trans-people/ar-AAVhMSa) . The current law that has passed in Texas, abhorrently describes parental support of trans children as child abuse; though, for now, it has been placed on hold by a Texas appeals court.
CSWA believes that gender identity is an integral aspect of our intersectional identities and that children’s rights to express their identities, and to participate in everyday activities of childhood, regardless of this expression, should be protected. LCSWs work with trans-children and adults who have been harmed because their trans identities. To our affiliated colleagues in the Texas Society for Clinical Social Work, we send our support and encouragement to stand strong. No law can persuade us to ignore our ethical stance on respecting the identity of any individual child, and for parents that support and affirm their children. Also notable, the Texas law does nothing to prevent the violence directed toward trans BIPOC youth for being themselves. This violence has increased at alarming rates in the last few years.
As reported by Forbes, 30 trans youth were killed in 2020, including 23 that were BIPOC youth. (Forbes, “Transgender America: 30 Killed And Fatally Shot Already In 2020”, 10/2/20, https://www.forbes.com/sites/jamiewareham/2020/10/02/30-trans-woman-have-now-been-violently-murdered-in-america-in-2020/?sh=296cb38564a4). The work of groups like GLAAD (glaad.org), the Trans Youth Equality Foundation (http://www.transyouthequality.org/), and the Transgender Law Center (https://transgenderlawcenter.org/) are crucial to educating the public and advocating across multiple domains to prevent transphobic violence and discrimination against trans youth and their parents. CSWA supports the work of these groups in preventing harm and protecting trans children.
President Biden’s State of the Union address tonight will have a major focus on the need for more mental health funding and services. A few of the areas he will discuss are:
To see a complete summary of what the President will discuss regarding mental health go to: https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/
CSWA will provide a message to send to Congress, who will have to approve the funding and policy measures regarding mental health, on the issues that most affect clinical social workers following the State of the Union speech.
Laura Groshong, LICSW, Director, Policy and Practice
Clinical Social Work Association
In the rush to figure out the Good Faith Estimate, another important issue has been on the back burner.
As you know, the No Surprises Act also had a provision that we see every patient at least once every 12 months. This was extended from the previous rule which required this provision every 6 months.
With recent guidance from CMS, it is now clear that this requirement will go into effect after the end of the Public Health Emergency (PHE). That is not likely to be before the end of 2022 at the earliest.
CSWA is hoping to work with many other mental health groups to eliminate this rule. We will keep you posted.
Laura Groshong, LICSW
Clinical Social Work Association
Director, Policy and Practice
The Aware Advocate: Focus on 2022 Medicare Changes
December, 2021 Laura Groshong, LICSW, CSWA Director, Policy and Practice
There are a number of issues that are affecting LCSW practices in the waning days of 2021, particularly in the area of Medicare (which we know affects commercial insurance heavily). These issues are: 1) giving patients a “Good Faith Estimate” of what the treatment we provide will cost; 2) elimination of 2022 cuts to Medicare reimbursement; 3) telemental health coverage; and 4) DCEs. Discussion of each of these follows.
Good Faith Estimates
This rule requires us to give a “good faith estimate” (GFE) to a patient of what our services will cost and how long they may last. While this policy is part of most of our informed consent forms, signed by the patient already, it is prudent to review what the GFE is more formally requesting we include in our information to the patient. The main difference about past practices and the GFE is that it applies to private pay patients as well as insured patients and uninsured patients.
For more information and a template of what belongs in a GFE, go to the CSWA website under “Templates” in the Members Only section.
Medicare Cuts Stopped
LCSWs can take a deep breath as Congress has acted to prevent the trio of Medicare payment cuts that were set to take effect at the beginning of 2022—a 3.75% cut due to scheduled changes in the Medicare Physician Fee Schedule (“PFS”), a 2% cut for Medicare sequestration, and a 4% Statutory Pay-As-You-Go Act (“PAYGO”). These Act cuts would have slashed Medicare payments by nearly 10% during a tumultuous time for healthcare. Instead, tThe Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) was approved by the U.S. House of Representatives on December 7 and passed the U.S. Senate on December 9, 2021. The bill has been sent to President Biden’s desk for his signature.
The Protecting Medicare and American Farmers from Sequester Cuts Act includes:
This is the second year that a last-minute change stopped a substantial reimbursement cut for LCSWs. CSWA will be encouraging CMS and Congress to stop these attempts to balance the Medicare budget on the backs of clinicians moving forward.
Telemental Health Coverage
As you know, CMS issued a new rule last month to expand telemental health and audio only psychotherapy through 2023. You also know we are still unable to practice across state lines unless we are licensed in the state where the patient resides and/or there is still increased reciprocity in the state where the patient resides. CSWA is still working with Department of Defense and the Council of State Governments to create a “Compact” that will make it much easier to work across state lines; it should be ready to begin implementing in early 2023.
The requirement that LCSWs see patients in person every 6 months has been extended to every 12 months. This is a still a hardship for some patients and LCSWs who have given up a physical office. CSWA will be working to eliminate this requirement.
For more information go to the CSWA website under “Legislative Alerts”.
Medicare Direct Contracting Entity
Over the past decade, over 50 models of delivering health care through Medicare have been explored, with the goals of lowering costs for dual-eligibles; eliminating access to care, based on economic disparities; and, moving away from a fee for service (FFS) payment model. The last goal has an impact on LCSWs in private practice who have used the FFS model for some time.
A new model has been emerging called the Medicare Direct Contracting Entity (MDCE). It is similar to the Accountable Care Organizations that have been in use for the past five years, but is run by commercial for-profit agencies. CMS has started to ‘assign’ beneficiaries who are in traditional Medicare to MDCE plans without consent. There is concern that this could lead to the privatizing of Medicare which would have the same difficulties that commercial insurance for-profit plans have, i.e., the focus on profit leads to diminished health care services.
Surgeon General Report on Youth Mental Health
U.S. Surgeon General Vivek Murthy, MD, released an advisory statement on December 7 to highlight the urgent need to address the nation’s youth mental health crisis. “Protecting Youth Mental Health” (PDF, 1.01MB) . This excellent document outlines the COVID-19 pandemic’s harm to the mental health of America’s youth and families, as well as the mental health challenges that had accumulated before the pandemic began. CSWA is delighted to see the Surgeon General paying attention to this increasingly difficult situation.
CSWA wishes you a happy and healthy holiday season!
Laura Groshong, LICSW, Director, Policy and Practice Clinical Social Work Association
I want to call your attention to a new rule from CMS that will go into effect on January 1, 2022. This rule requires us to give a “good faith estimate” (GFE) to a patient of what our services will cost and how long they may last. While this policy is part of most of our informed consent forms, signed by the patient already, it is prudent to review what the GFE is more formally requesting we include in our information to the patient about the course of their treatment. The main difference about past practices and the GFE is that it applies to private pay patients as well as uninsured patients.
There is a CMS template for providing this information which can be found at good faith estimate (PDF, 130KB) . However, this 8-page document is more applicable to hospital stays and procedures. It may be more helpful for LCSWs to make sure they have the following information in their informed consent or verbally transmitted and documented.
Here is a list of what belongs in the GFE (which can also be part of an informed consent or disclosure statement) for private practitioners:
This information can be transmitted orally but should be given to the patient as soon as possible. For ongoing patients, there should be a new informed consent or GTE statement provided with the information above. CSWA will provide a template for this shortly.
Laura Groshong, LICSW, Director, Policy and Practice Clinical Social Work Association email@example.com
Next Tuesday the Senate Finance Committee will have a hearing on funding for mental health and substance use programs. While this does not affect Medicare reimbursement or private insurance rates directly, increased funding will be helpful in those areas.
Please read the attached statement which CSWA developed with other mental health groups. We will keep you posted on the outcome of the hearing.
Laura W. Groshong, LICSW, Director, Policy and Practice
Report on Social Work Compact Meetings – October 4-5, 2021 Laura Groshong, LICSW, Director, Policy and Practice
The first in-person meeting of the Social Work Compact Technical Assistance Group (TAG) took place in the Hall of States in Washington, DC. Kendra Roberson, PhD, LCSW, CSWA President, and I were the representatives from CSWA. The development of a social work interstate Compact is sponsored by the Department of Defense and the Council of State Governments, a non-partisan agency which has many projects that work to facilitate interstate cooperation. What began as a way for military spouses to take a social work license to another state when a spouse was redeployed will become inclusive of all licensed clinical social workers. For more information on CSG go to https://Compacts.csg.org/Compacts/
Compacts require that the home state for an LCSW be the state of residence, not the state of practice. Currently, if an LCSW wants to have licensure in a state separate from their state of residence, they must become licensed in that state. Under the Compact, if a clinical social worker is licensed in a home state that is a member of the Compact, the LCSW will be eligible to apply to practice in other states that also are in the Compact.
Work of the TAG
The TAG will now meet every three weeks to:
TAG will develop the following:
All the above should be ready for the Document Drafting Team by February, 2022. TAG will meet every three weeks until Compact language is completed. I will continue to send updates on the progress of the Compact.
The Council of State Governments (CSG) is partnering with the Department of Defense (DoD) and a coalition of organizations, including the Clinical Social Work Association (CSWA), to develop new interstate compacts for the social work profession. These compacts will create agreements among participant states to reduce the barriers to license portability and employment. Participants will learn about the aspirations for the project; the function of interstate compacts and the development process; and the need for license portability in the social work profession.
Dan Logsdon: Dan is the Director of the CSG National Center for Interstate Compacts where he provides technical support and consulting regarding the development and enactment of interstate compacts. In recent years Dan has worked with a number of professional associations to develop new interstate compacts for occupational licensing portability including the American Occupational Therapy Association, American Counseling Association, and American Speech-Language-Hearing Association.
Matt Shafer: Matt is a program manager in the CSG Center of Innovation where he manages a portfolio of grant funded projects including the cooperative agreement with the Department of Defense to create new interstate compacts for occupational licensing portability. Matt also managed two Department of Labor grants focused on state occupational licensing policy and has extensive experience developing and building consensus on policy options for state leaders.
Keith Buckhout: Keith is a research associate in the CSG Center of Innovation and is primarily responsible for supporting the DoD Interstate Compacts project. Keith came to CSG after several years of working with licensure issues in state government in Kentucky.
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