The Benefit- Reduce Provider and Staff Load by Adding a CHW

CMS has introduced new billing policies aimed at bolstering primary care and advancing health equity by incorporating the utilization of auxiliary personnel such as care navigators or peer support specialists. These policies include provisions for payment for Principal Illness Navigation (PIN) services, which aid beneficiaries and their families in navigating treatment for serious illnesses such as cancer, COPD, CHF, Dementia, HIV/AIDS, substance use disorder (SUD), and mental illness. PIN services are extended to patients with high-risk conditions, putting them at significant risk for various adverse outcomes such as hospitalization, nursing home placement, exacerbation or decompensation of their condition, functional decline, or death.

At Prime Clinical Associates, we employ certified Community Health Workers (CHWs) to assist patients in navigating their course of care, addressing any unmet social needs that may significantly impede the practitioner's ability to diagnose or treat the condition. While Chronic Care Management (CCM) and PIN services may seem similar, CCM primarily emphasizes the clinical aspects of care, whereas PIN services encompass a broader focus on both clinical and social aspects.

All PIN services are provided under the general supervision of the billing practitioner, meaning that the provider does not necessarily have to be physically present at the same facility where the services are rendered.