Social Determinants of Health: New SDoH Coding and Reporting Guidelines to Insurance Payers

Course Description:

Social determinants of health are the conditions in which people are born, grow, live, work, and age that affect their health and well-being. Addressing social determinants of health in a medical office setting can help improve the quality of care and outcomes for patients, especially those who face health disparities or social barriers.

Health equity is the principle that everyone should have a fair opportunity to attain their full health potential. No one should be disadvantaged from achieving this potential because of their social position or other socially determined circumstances. Health equity is a matter of justice and a strategic priority for improving population health and well-being. Addressing health equity means tackling the root causes of health disparities, such as poverty, discrimination, lack of access to quality health care, education, and environmental factors. By promoting health equity, we can reduce the disease burden, improve quality of life, and enhance social cohesion and economic development.

The Centers for Medicare & Medicaid Services (CMS) continues their commitment to advancing healthcare equity through various initiatives, policies, and programs to reduce disparities in healthcare access and clinical outcomes. To improve value-based initiatives and to support the agency’s continued commitment to health equity, CMS finalized its 2024 Medicare Physician Fee Schedule (MPFS) to include policies that expand access to care and advance healthcare equity. CMS finalized coding and payment for Social Determinants of Health Assessments, Caregiver Training, Community Health Integration, and Principal Illness Navigation services.

Caregiver training is an essential component of quality care for older adults and people with disabilities. The Centers for Medicare & Medicaid Services (CMS) provides guidance and resources for caregiver training programs. These programs aim to improve the skills and competencies of caregivers and reduce caregiver stress and burnout. Caregiver training can also benefit the care recipients, by improving their health outcomes, safety, and quality of life.

Community health integration (CHI) is a new model of healthcare delivery that aims to improve access and quality of care for Medicare and Medicaid beneficiaries in rural areas. CHI services are performed by certified or trained auxiliary personnel, such as community health workers, under the general supervision of a billing practitioner.

Principal illness navigation aims to improve the quality of life and well-being of patients and their caregivers, as well as to reduce the burden on the healthcare system.

Join us for an informative webinar where we will explore how to address Social Determinants of Health (SDoH) and promote health equity in your practice. You will learn how to use the new services that were introduced in 2024 to improve the health outcomes of your patients. We will also provide you with coding and documentation guidelines for the new services, and answer any questions you may have.

Learning Objectives:

Gain an understanding of what health equity is and why it must be addressed
Discuss Social Determinants of Health
Learn how to utilize ICD-10 codes to report Social Determinants of Health (SDoH) to insurance payers
Learn what caregiver training is and how to document the service appropriately
Understand when to report the Social Determinants of Health (SDoH) assessment HCPCS code
Gain an understanding of new Community Health Integration (CHI) and Principal Illness Navigation (PIN) services and how to utilize them
Learn how to report new services with proper coding for accurate reimbursement
Recognize and foster a culture of equity

Areas Covered in the Session:

Health Equity
Factors contribute to health inequities
Why Does Heath Equity Need to be Addressed?
Health Equity vs. Health Equality
CMS Initiatives
- Comprehensive Framework
- Close the gaps in health care access, quality, and outcomes for underserved populations
Challenges
Social Determinants of Health
Utilize Z Codes
Social Determinants of Health Deal with ICD-10-CM Z Codes
Recent SDOH Code Categories and New Codes
- Z55 – Problems related to education and literacy
- Z56 – Problems related to employment and unemployed
- Z57 – Occupational exposure to risk factors
- Z58 – Problems related to physical environment
- Z59 – Problems related to housing and economic circumstances
- Z60 – Problems related social environment
- Z62 – problems related to upbringing
- Z63 – Other problems related to primary support group, including family circumstances
- Z64 – Problem related to certain psychosocial circumstances
- Z65 – Problems related to other psychosocial circumstances
CY 2024 CMS finalized changes to Social Determinants of Health (SDOH) Action Plan
- SDOH Risk Assessment
- Community Health Integration (CHI) services
- Principal Illness Navigation (PIN)
Caregiver Training
Community Health Integration (CHI)
- Integrates healthcare services with community-based resources
- CMS established separate coding and payment for CHI services
- Designed to specifically include care provided by community health workers
Principal Illness Navigation Services
- Services for Vulnerable Patients – PIN (2 New Codes)
- Patient eligibility requirements are similar to Principal Care Management (PCM) services
Coding
- Social Determinants of Health Assessment
  - HCPCS G0136
- Caregiver Training Services (CTS)
  - 96202
  - 96203
  - 97550
  - 97551
  - 97552
- Community Health Integration Services
  - HCPCS G0019
  - HCPCS G0022
- Principal Integration Navigation (PIN)
  - HCPCS G0023
  - HCPCS G0024
  - HCPCS G0140
  - HCPCS G0146

Suggested Attendees:

Healthcare Administrators
Physicians
Non-Physician Practitioners
Medical Office Managers
Billers and Coders
Medical Assistants
Nurses
Agency Owners
Clinical Supervisors
Directors of Nursing
Quality Improvement/ Quality Assurance Managers
Compliance Officers
Clinicians
Administrative Staff

About the Presenter:

Jan Hailey, MHL, CMC, CMCO, CMIS, CMOM, CMCA-E/M, has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has led comprehensive interdisciplinary teams working closely with providers, management, staff, communities, and payers to develop strategies for process improvement, quality gap closures, and patient experience. Jan has a Master of Health Leadership degree and five professional certifications in office management, coding, insurance processing, auditing, and compliance. She is a WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group member and has also been instrumental in developing Practice Management Institute’s Workforce Initiatives program.

Additional Information:

System Requirement:

Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

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