Understanding the New CMS Reimbursement Codes: A Guide for Oncologists

The recent introduction of new reimbursement codes from the Centers for Medicare and Medicaid Services (CMS) marks a significant step towards recognizing the holistic needs of patients with cancer.

In order to provide practical insights on how oncologists can effectively implement them in their practice, let’s explore the new CMS reimbursement codes for Social Determinants of Health (SDOH) risk assessment, Community Health Integration (CHI), and Principal Illness Navigation (PIN).

Understanding the New CMS Reimbursement Codes

1. SDOH Risk Assessment Codes

• These codes allow oncologists to conduct comprehensive assessments of social determinants impacting patient health and well-being.

• By identifying factors such as housing instability, food insecurity, transportation barriers, and social isolation, oncologists can tailor care plans to address these underlying challenges.

2. Community Health Integration Codes

• Community Health Integration codes facilitate collaboration between oncologists and community-based organizations to address social determinants and improve patient outcomes.

• These codes support activities such as care coordination, referral to community resources, patient education, and follow-up to ensure continuity of care.

3. Principal Illness Navigation Codes

• Principal Illness Navigation codes provide reimbursement for services aimed at guiding patients through the complexities of their cancer diagnosis and treatment journey.

• Oncologists can use these codes to offer personalized navigation services, facilitate access to supportive care resources, and address barriers to care.

Implementing New CMS Reimbursement Codes in Oncology Practice

1. Establish SDOH Screening Protocols

   • Develop standardized protocols for conducting SDOH risk assessments during patient encounters, using validated screening tools such as the Patient Discovery platform.

   • Train oncology practice staff on how to address social determinants sensitively and effectively with patients and incorporate assessment findings into care plans.

2. Forge Community Partnerships

   • Collaborate with local community-based organizations, social service agencies, and other healthcare providers to expand access to resources and support services for patients with cancer.

   • Establish formal referral networks and communication channels to facilitate seamless care coordination and follow-up.

3. Integrate Navigation Services

   • Implement Principal Illness Navigation services within the oncology practice to provide personalized support and guidance to patients throughout their cancer journey.

   • Designate trained navigators or care coordinators to assist patients with scheduling appointments, accessing financial assistance programs, and navigating complex healthcare systems.

4. Leverage Technology and Data Analytics

   • Utilize digital tools such as the Patient Discovery platform, to streamline documentation, billing, and communication processes.

   • Leverage data analytics to track patient outcomes, identify trends, and measure the impact of SDOH interventions on cancer care delivery and patient well-being.

Conclusion

The new CMS reimbursement codes for SDOH risk assessment, Community Health Integration, and Principal Illness Navigation offer oncologists a valuable opportunity to address the holistic needs of patients with cancer and improve care coordination efforts. By understanding the functionalities of these codes and implementing strategic approaches to leverage them effectively, oncologists can optimize reimbursement opportunities, enhance patient outcomes, and advance health equity in oncology care.

As you begin to navigate the implementation of these codes, Patient Discovery can help. Click here to learn more and request a demo for your practice.