Skilled Medical Social Services • The patient/client has an underlying social or emotional problem impeding the patient’s/client’s treatment and recovery. • The patient/client is having difficulty coping with illness/disability, e.g., loss of independence, confinement, reliance on others. • The patient/client lacks an adequate support system, e.g., receives little or no support from family/friends. • The patient/client is experiencing financial problems, e.g., difficulty paying utility bills, medical bills, rent, inadequate food supply, etc. • The family is unable to cope with illness, e.g., indecision about responsibilities, unrealistic expectations. • The patient/client and/or family needs information on placement, e.g., skilled care, personal care, etc. • The patient/client has a diagnosis that will qualify for services through specific disease related agencies, e.g., American Cancer Society, American Diabetes Society, Multiple Sclerosis Foundation, Arthritis Foundation, Alzheimer’s Association, etc. Medicare does not cover medical social services if: • Services of a medical social worker to complete or assist in the completion of an application for Medicaid. Federal regulations require the state to provide assistance in completing the application to anyone who choose to apply for Medicaid. • Continued social services for more than two to three visits to assist in the removal of family members or caregivers who obstruct, contravene, prevent, or interfere with the patient’s/client’s medical treatment or recovery of the patient/client. CMS examples from Publication 100-02, Section 50.3 Medical Social Service. Example 1: The physician has ordered a medical social worker assessment of a diabetic patient/client who has recently become insulin dependent and is not yet stabilized. The nurse, who is providing skilled observation and evaluation to try to restabilize the patient/client notices during her visits that the supplies left in the home for the patient’s/client’s use appear to be frequently missing, and the patient/client is not compliant with the regimen although she refuses to discuss the matter. The assessment by a medical social worker would be reasonable and necessary to determine if there are underlying social or emotional problems impeding the patient’s/client’s treatment. Example 2: A physician ordered an assessment by a medical social worker for a multiple sclerosis patient/client who was unable to move anything but her head and who had an indwelling catheter. The patient/client had experienced recurring urinary tract infections and multiple infected ulcers. The physician ordered
