Adding a Social Worker

Sdinola

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We would like to add a social worker to our staff-how can we code for her services? Do insurance companies reimburse? Thank you for any help you can give me.
 

Pam Brooks

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Social work services in the office setting can be reimbursed under a patient's mental health coverage. You would need to check with your payers in regards to credentialling guidelines, and whether or not they need any kind of billing supervision. Also, a lot of the time, the mental health coverage is carved out of the major medical policy and administered by a third party, which means you might have to deal with somewhere different than your medical claims. Counseling services are billed from the medicine codes 908xx, so you would want to review those codes. Most mental health services require pre-certification and ongoing treatment planning for continued services, meaning your social worker is on the phone with the insurance company asking for more visits for the patient. If this isn't done, you don't get paid. Any social worker who has been in private practice should know the drill. There are often visit or dollar amount limitations that are significantly less than the average major medical coverage. (for example 20 visits a year or 3,000.00 per year). Also, the patient would have to have a specific mental health diagnosis from that section of ICD-9. Insurances typically don't cover for things like social support services, and they're even pretty fussy about the mental health diags....they're more likely to cover major depession than they are dysthymia...but of course your documentation has to support the more serious diagnosis. Check the fee schedules....last time I looked, social workers weren't able to be reimbursed much more than 55.00 per hour, but it may have gone up since then.

It's interesting work, though, and one of the criteria for Medical Home.
 

kevbshields

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Specifically, be sure to find out what services this social worker will be offering to patients. Although mental health is a piece of their scope (assuming LCSW), most times I find that practices and hospitals want social workers for more nebulous services.

There may be HCPCS codes which capture more of the coordination of care and case management parts of social work, but reimbursement is unlikely.

As a starting point, ask for that list of services SW will supply and map them to the proper codes (908XX is not always correct, nor the most appropriate). Once that is accomplished, reaching out to payers is a tad bit easier. You at least have more than assumption and guess work to go on.

Best of luck to you.
 

Pam Brooks

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Good point, Kevin. SW services in the facility are not separately reimbursable and has been on the OIG list for a while now. It wasn't long ago that I had to bring this to the revenue director's attention, as she wanted to start billing for those services separately! Yikes!
 
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