Judy Ratliff and Wayne Martin, Co-Chairs, VA Legislation and Advocacy Committee

Looking for a Lobbyist

As you may know, GWSCSW and VSCSW share a lobbyist.  Sue Rowland has been our lobbyist over the past several years and she is leaving to go into semi-retirement.  She was very helpful in arranging zoom meetings between members of our committee and Senators George Barker and Janet Howell of Fairfax.  Dan Campbell joined us in meeting with Senator Howell, who was very appreciative of his input with VOICES in trying to obtain full funding for Crisis Receiving Centers and the STPE VA System.  We will sorely miss Sue's lobbying efforts on our behalf and that of our clients.

Responding to Our Members' Insurance Concerns

Last fall, our members voiced numerous concerns about pressures from insurance companies, including justifying certain payment codes and withholding or delaying payments.  We heard you.  Our lobbyist contacted the Virginia Bureau of Insurance (BOI) and the VSCSW took the lead in setting up a conference with a BOI representative in October, 2021.  Many concerns were voiced during that conference.  One of the most serious concerns is that the BOI, by law, can only accept complaints from our clients who are the insurance recipients and cannot accept complaints from therapists.  Sue Rowland took this concern to Senator Barker, who agreed to submit legislation to change the existing law to allow treatment providers to contact BOI directly.  Unfortunately, we were unable to get it on the legislative docket for this year.  We understand that there will be strenuous pushback from the insurance companies.  We also understand that the psychiatrists have expressed the same concerns and it may be possible to "join forces" with them during the rest of this year, to push for this much needed change in the law during the 2023 Legislative Session.

The Joys of Sharing

I stated above that the GWSCSW and the VSCSW share the cost of a lobbyist who will represent our interests, and those of our clients, in the Virginia Legislature.  However, we share even more.  We jointly sponsor meetings and allow full members of each society to attend each others' workshops for free or at member rates.  This allows members of both societies to benefit from a greater range of low-cost CE programs.  Additionally, Wayne Martin and I regularly attend quarterly VSCSW zoom board meetings, which the lobbyist also attends.  This facilitates smoother coordination of efforts toward the same goals.

Telehealth

There will be telehealth legislation proposed this year.  We will keep you posted.

Contributions from Our Members

Below, please see an article by Roger Rothstein, who documents the power of our members working together to deal with a request from Medicare for case documentation to justify the use of procedure code 90837.

In January 2021, I received a letter from Novitas Solutions, the Medicare administrator for the DC Metro Area, which is summarized below:

The Centers for Medicare and Medicaid Services continually strive to reduce the improper payment of Medicare claims .  As a Medicare Contractor, Novitas is tasked with preventing inappropriate Medicare payments.  One of the ways this is conducted is through medical review of claims.  Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded and medically reasonable and necessary. Services you billed to Medicare were chosen for a post-payment service specific review for procedure code 90837 (psychotherapy 60 minutes) because data analysis has identified these services are frequently not billed and coded correctly per the Medicare guidelines.

As a result of this data, we have selected a post-payment sample of 20 claims reporting code 90837 from 2019 .  You are responsible for providing documentation for the services identified by March 8, 2021 (6 weeks).

Translation to the above:  Here are 20 claims for services rendered in 2019.  You need to document your justification for these services provided with procedure code 90837 by sharing your records of each of these 20 encounters.  After the review,  we are authorized to require you to reimburse us for monies paid to you for those services if we deem them not justified as needing 60 minutes of clinical time.

After reading this several times and noting my anxiety level elevating by the second, I started to call a few colleagues about this.  One person said she had received the same letter, but others did not.  I am sure my news elevated their anxiety as well.  I decided to put this out to the GWSCSW listserve soon after I received the letter.  By a few days later, it became clear that these letters had arrived at many offices:  specifically they seemed to have targeted Northern Virginia clinicians in social work and psychology.

What to do? Having a live meeting in January 2021, didn’t seem like a wise idea so a zoom meeting was offered to anyone interested in discussing this situation and planning a response. Within a week or so, we had identified a Saturday morning to meet and about 18 people were on the call.  This group came together in ways to strategize and support each other.  Various record-keeping templates were exchanged electronically;  members were tasked to contact the Clinical Social Work Association and consult with an attorney; research for documentation on rationales for using various ICD codes were shared; “talking points” on what Medicare was looking for in patient records was discussed; how and whether to inform clients of this review was discussed (two of the client’s whose cases they wanted me to document had died since 2019). At the end of this first meeting, we had developed a strategy to work together with the goal of helping each person prepare to provide the information requested.

Over the next couple of weeks, much information was gathered and we again met as a group .  The reduction in anxiety was evident as members of the group talked about how they had begun to approach this task.  There was much appreciation expressed to everyone who had contributed their time, thoughts and clinical knowledge. What a great example of how in this digital age, people can exchange ideas and research both in text and online chat to help manage challenging tasks! The Clinical Society’s listserve networking technology and being able to tap into it’s vast informed membership were invaluable to our meeting this challenge.

I was able to submit my documentation late in February and was notified shortly afterward that I “passed” and therefore would not need to reimburse Uncle Sam for my efforts.

We welcome input from members.  If any of you are out there advocating for clients or legislation, please let us know and submit an article for us to include here in the GWSCSW quarterly newsletter.

Judy Ratliff, Co-Chair, jratliff.lcsw@gmail.com  | Wayne Martin, Co-Chair, wamnoles@aol.com