(November/December 1998)
Medicare is a Federal health insurance program established by Title XVIII of the Social Security Act of 1965 for Americans age 65 or older, and for certain disabled Americans under 65.
The Medicare program has two parts, Part A and Part B. Part A is in-patient or hospital insurance which covers part of the costs of in-patient hospital care, limited care in skilled-nursing facilities, home health care and hospice care. Medicare beneficiaries pay no premium for Part A coverage, but are responsible for paying part of the costs - a deductible and co-payments.
Medicare Part B is out-patient health insurance, covering physician and specialized non-physician services, outpatient hospital care and lab services. "Licensed Clinical Social Workers" (currently, CSWs in New York State), categorized as "Specialized Non-Physician Practitioners" are qualified to provide mental health services.
To qualify as a Medicare provider, you must: 1) be currently certified as a Social Worker in New York State- where your services are performed; 2) possess a Master's or Doctorate degree in social work; 3) possess 2 years of full time supervised clinical experience, post graduate.
The CSW who qualifies as a Medicare provider agrees to accept assignment, that is, the approved amount specified by Medicare based on the specific service provided and the location of the service. [For example, a CSW Medicare provider whose service is a 45-50 minute psychotherapy session in Manhattan, agrees to accept the assigned fee of $71.42 - 50% paid by the Medicare patient.
To enroll as a CSW mental health services provider to Medicare Part B beneficiaries, call 914-248-2990 and ask for the Medicare Health Care Provider Enrollment Application, form HCFA 855. Once you have enrolled and been accepted as a Medicare provider, you are required to submit claims for the provision of services to at least one patient over a three-year period. If you have not submitted any claims over three years, Medicare automatically relegates you to the "inactivated provider" list. If you want to re-establish yourself as an "active provider," you must complete and resubmit the Medicare Health Care Provider Enrollment Application.
Do you need help filling out the provider enrollment application? If the answer is "yes," Empire Medicare Services welcomes you to a help session. In New York City, sessions are held the last Friday of every month, from 10 am to 1 pm, at 622 Third Avenue, 1st Floor, New York City 10017. For reservations, call 212-476-7932, 7934, or 7951.