We want to offer an intensive outpatient program (IOP) that provides group psychotherapy to patients who require a higher intensity of treatment than our outpatient setting provides. We need a thorough understanding of the billing process for the state of Indiana and the Centers for Medicare & Medicaid Services (CMS), as well as the requirement for social workers. Can licensed social workers perform this therapy or must a licensed clinical social worker do it?
We also have a licensed mental health counselor who would perform these services. We planned to list the attending physician on the bill. Because therapy and charge entry are performed and documented by staff performing the services, not physicians listed on claims, what else should we understand about this type of billing?
Answer: My understanding is that for Part B professional billing, CMS only pays for a clinical social worker, not a regular social worker. We don’t bill a hospital charge in these circumstances, only professional, so I’m not sure what the hospital requirements would be. We are not located in Indiana, so I am not familiar with any specific state requirements for your facility.
This question was answered by: Ruth Landé, senior vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, and a member of HFMA’s Metropolitan New York Chapter.
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