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January 22, 2014

To the San Antonio Study Group,

Please consider joining or renewing your membership with Texas Society for Clinical Social Work for 2014.  This is an exciting and challenging time for clinical social work, and we need your membership to continue providing educational, legal, and professional opportunities for Clinical Social Workers in Texas.  In addition to Membership for those holding the LCSW, we have Associate Memberships for those holding the LMSW, as well as a category for students and retirees.  Please feel free to share the membership form and benefits of membership handout with colleagues.

Thank you for your interest and participation in the Texas Society for Clinical Social Work.

Dates to remember:  February 14, 2014 is the monthly study group meeting, to be held at Ute’s house on Sabina Speilrein’s contributions to the field of psychoanalysis through her life and work.  March 8 is the Spring Conference on the DSM-5 to be held at LCRA in Austin.  Further information on both these dates will follow.

Find out more about membership.


Jennifer Hill, LCSW
President, TSCSW


October 15, 2013

Dear CSWA Affiliated Society Members,

Today is the day that all LCSWs that are Medicare providers who want to have CMS figure out their PQRS claims must be signed up with IACS and PV-PQRS (see previous posts on CSWA website under Legislative Alerts). This should be a small percentage of LCSWs.

The majority of LCSWs are choosing to submit the Quality Data Codes (QDCs) for PQRS Measures on the CMS-1500 claim forms. The primary change is to add the QDC(s) in Section 24D under the CPT code and add $.00 or $.01 in Section 24F on the same line. For a sample CMS-1500 with PQRS data go to . This is for surgeons, so ignore the diagnoses, but most of the other information is the same (except for Section 24J for group billing which does not apply to LCSWs in private practice which should be left blank).

Many LCSWs have been stymied by the fact that there is so little correlation between the PQRS measures and our diagnostic codes (DSM/ICD). The only measures that mention a diagnostic code are #106 and #107 for major depression. However, ALL diagnostic codes we use can be linked with whether people smoke, drink, use substances and several other behaviors that CMS is tracking. Use the QDCs that apply to them if you are sending in information for other diagnoses, which you can find on the CSWA website at under “Clinical Practice” and then “PQRS Options”. Scroll down to find the PQRS Measures and QDCs for those Measures.

There is NO deadline today for LCSWs who send in their QDCs on the CMS-1500. You can wait until February 28, 2014 to do so, though getting it out of the way sooner is a good idea. You should continue to send QDCs for Medicare patients on every claim.

Remember, for 2013, you only need send in one QDC for one patient to be in compliance and avoid a reimbursement penalty in 2015. It is unlikely that you will qualify for the bonus in 2015 unless you have been sending in QDCs all year OR you have very few Medicare patients.

I know what a difficult task this has been and hope that this information is useful in navigating these rough waters.

Laura Groshong, LICSW, Director, Government Relations
Clinical Social Work Association


October 4, 2013

Dear CSWA Members,

Here’s a correction and more information on how to submit PQRS Quality Data Codes (QDCs).


Instead of adding QDCs under the word Modifier, add the QDCs to Section 24-D under the CPT code as a procedure. Your CPT code, e..g, 90791, 90834, 90837, have a charge in 24-F for the procedure; the QDCs have no charge ($0) in 24-F. As stated in the “PQRS Options” article, there can be several QDCs with no charge for a single claim.

More Information:

If you want to receive the bonus for 2015 of 1.5% added to reimbursement, you need to have submitted three QDCs for at least 50% of your Medicare patients. However, if you submit one QDC for one patient in 2013, you will avoid the penalty of 1.5%. Unless you have been submitting QDCs all year, it is unlikely that you will be able to meet the 50% standard. You CANNOT resubmit claims to add QDCs.

QDCs refer to all Medicare claims whether the beneficiary is enrolled for disability or age.

PQRS reporting requirement apply to all Medicare plans, including Medicare Advantage.

Screening tools for Preventive Care for Clinical Depression (#134) besides the ones listed may be used but check on the SAMHSA website to see if any others are approved before using them.

Having a list of patient medication (#9) does not imply prescribing authority. It means that you have a list of the medications the patient is taking in the record.

Feel free to continue to send me questions on this complex system.

Laura Groshong, LICSW, Director, Government Relations
Clinical Social Work Association


September 30, 2013

Dear CSWA Affiliated Society Members,

There have been several questions about accessing the HIPAA Templates and PQRS Options at the CSWA website.  Here are some answers to those questions:

HIPAA Templates:
You MUST be a member of CSWA to access the templates which are found in the Members Only section of the website under “Templates”.   You will only see the Members Only tab (top, far right) if your membership is current and you are logged in.  The most common reason for not getting this section is not being a CSWA member.  Once you start/renew your membership, you will see the templates.  You must click on the links to the Notice of Privacy Practices and Business Associate Agreement to get the templates to come up.

PQRS Options:
To access the PQRS Options, Measures, and Quality Data Codes, go to the CSWA website and click on the tab Clinical Practice.  Then click on “PQRS Options.”  First you will see the summary of the three ways to submit the QDCs (claims, claims administration and registry) followed by the 12 measures and the QDCs that go with each measure.  You send those codes according to the submission choice that you make.

There have been some questions about PQRS and secondary/gap Medicare policies.  We are still investigating whether codes need to be sent for these policies but advise use of the codes for any Medicare-related plan at this time.  QDCs will be ignored if they are not needed.

More information will be available shortly.

Laura Groshong, LICSW, Director, Government Relations
Clinical Social Work Association


September 24, 2013
PQRS Options for LCSWs
Laura Groshong, LICSW, CSWA Director, Government Relations

The Physician Quality Reporting System (PQRS), a program managed by the Centers for Medicare and Medicaid Services, has been in effect since 2007.  The goal of PQRS is to improve the quality of care provided to Medicare beneficiaries. The requirement that LCSWs report certain information to CMS on Medicare Patients with conditions covered by PQRS began this year, 2013, in terms of receiving penalties and incentives.

PQRS applies ONLY to LCSWs who are Medicare providers.  Keep in mind that while LCSWs do not have to submit PQRS information, or “quality measures”, there will be a penalty of 1.5% imposed in 2015 (2013 data) if the LCSW does not submit quality data in 2013. LCSWs who do not submit quality data in 2014 will see a 2% reduction in their Medicare payments in 2016. YOU MUST SIGN UP FOR PQRS BY OCTOBER 15 TO AVOID PENALTIES!

Successful participation in PQRS in 2013 will earn you a 0.5% bonus payment on your Medicare claim in 2013.  In order to earn that bonus you must report three PQRS codes on at least 50% of all your Medicare claims.

There is a simple way to avoid the 2015 penalty: you need only submit one Medicare claim with one PQRS quality measure.  You will not receive a bonus in 2013, but you will not receive a penalty in 2015 either.

If you have not enrolled with Medicare, you must do so. This is a Federal requirement for all LCSWs, whether we see Medicare patients or not. Some LCSWs enroll, then file an opt out letter with their Medicare Administrative Contractor. For more information on opting out, go to the CSWA website (Clinical Practice). If you have opted-out, you need read no further.  PQRS applies only to LCSWs who participate in Medicare.

There are a number of Quality Reporting Measures also known as QDCs, or Quality Data Codes, but only 12 apply to mental health.

This post will summarize the following information about PQRS requirements for LCSWs: 1) Applying to the PQRS System; 2) CMS-1500 Claims Reporting; 3) Administrative Claims; and 4) Registries.  This information has been taken from CMS at the following link: and a webinar offered by CMS e-health at

Many thanks to Bill Rogers, Medical Director of CMS, Lauren Fuentes and Ashley Spence of CMS, and Martha Gautier, Ketchum Vice-President and CMS Coordinator for their help in gathering this information.
This is complicated so be sure to follow all the steps listed below carefully.

There are three ways for LCSWs to become report PQRS data in 2013: 1) to submit measures on CMS-1500 claims; 2) to register for administrative claims on PV-PQRS; or 3) join a registry which will process PQRS data for you.  Here are the steps required.
For all options:

You must first have an NPI and become a Medicare provider through PECOS at (  This is a complex process.  Be prepared to spend 2-4 hours completing the application.  If you decide to opt out of being a Medicare provider, send a letter to CMS informing them of your choice (see template at CMS website.)

If you decide if you want to submit your PQRS information through your CMS-1500 claims (CSWA recommended) submit PQRS QDC Measures on your claim forms.  To find PQRS QDC measures,  go to, the PQRS Specifications Manual, and look up the measures for mental health diagnoses.

A list of QDC measures for mental health can be found below.  You need to submit the following information as the patient “denominator”, i.e., the basic information about the patient, including patient group; patient diagnosis; and patient CPT code, which we already submit for reimbursement, all of which we already submit on Medicare claims.

Then go to Measures Codes for the patient “numerator”.  That is where you will find the measures and codes that you need to use for Quality Data Codes (see summary below).  The quality data codes (QDC) that you will be using will start with the letter “G” or end in the letter “F”.
To send in PQRS information for Medicare patients that you are billing for currently, use the G or F QDC codes, in addition to the ICD-9 diagnostic codes that you are already using.

You may not submit QDC Codes for Medicare claims that have already been processed.

To gain a PQRS payment bonus from Medicare in 2013, you must send in three numerator measures for 50% of Medicare patients on your CMS-1500. To simply avoid a PQRS payment adjustment in 2015, you can send in one measure for one Medicare patient in 2013.

You must have all 2013 PQRS data submitted by February 28, 2014.

N.B.: There is a new version of the CMS-1500 (2/12) which you must start using on April 1, 2014.  The old CMS-1500 (08/05) can be used until that date.

For additional information, review the CMS fact sheet at

If you decide to let CMS calculate administrative claims through PV-PQRS,go to Individuals Authorized Access to the CMS Computer Services (IACS) and sign up as a business partner (  It takes 24 hours for your IACS account to be in effect so make sure you sign up well before the October 15 deadline.  Then go to and click on “Login to CMS Secure Portal” on the right side of the page.  Then use your IACS ID and password to sign in if you want to register for the administrative claims option.   Click on PV-PQRS in the tabs across the top of the next page which is part of the CMS Enterprise Portal and be able to register for PQRS.  If you have any problems with PQRS registration, call 866-288-8912, x3. You will receive an email confirmation that you have been included in the PV-PQRS data base.  You do not need to take any further action in 2013 to avoid the 2015 PQRS payment adjustment.

For complete information, review the following resources:

To submit measures through a registry, go to and sign up with a registry to calculate your QDC measures.

To gain a PQRS payment bonus from Medicare in 2013, you must send in three numerator measures for 80% of Medicare patients through a registry.  To simply avoid a PQRS payment adjustment in 2015, you can send in one measure for one Medicare patient in 2013.

Review the CMS fact sheet at

The specific information on PQRS measures is not supported on this server; for specific information about each measure go to the CSWA website under “Clinical Practice”.  We hope this is helpful to CSWA members.

Laura Groshong, LICSW, Director, Government Relations
Clinical Social Work Association

Contact contact Kathy Rider at


Legislative Alert from CSWA: Update on Medicare Cuts,
December 23, 2011
Congress has delayed the pending Medicare reimbursement rates cuts, for two months until February 29th, 2012. This is the 12th time that Congress has postponed a cut to Medicare reimbursement rates since 1997. The amount of the proposed cuts were 27.4-32.4% for LCSWs.

This included Sustainable Growth Rate (SGR) broad universal cut (27.4%) and the psychotherapy “extender” cut (5%). These numbers are slightly revised from the ones that I had yesterday. While we would have preferred to see a longer delay or, ideally, a change in the SGR formula, this is certainly better than the cuts that were being proposed.

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Jennifer Hill, LCSW, TSCSW President