Three PYA leaders discuss social determinants of health (SDOH) in an article in a recent issue of the Report on Medicare Compliance. The national publication is produced by the Health Care Compliance Association (HCCA) to provide updates on compliance strategies specifically pertaining to Medicare.
The article, “For Payment, CMS Requires Physicians to Link SDOH to Treatment,” written by Nina Youngstrom, features Consulting Principal Martie Ross, Manager Miriam Murray, and Manager Katie Croswell, during the June 5 PYA webinar, “Getting Paid to Address Social Determinants of Health.”
SDOHs are environmental factors that impact one’s health, such as housing instability, food insecurity, education, or safety. “You may reduce the individual cost of care [through the value-based care model], but if you want to reduce this on a societal level, you have to address who can’t access health care because of inequities,” Ross says in the article.
She explains the Centers for Medicare & Medicaid Services (CMS) “struggled with using funds to screen and address the [SDOH],” so the agency “linked SDOH to medical necessity.” A challenge for physicians and non-physician practitioners is documenting the reasons they believe the SDOHs interfere with treatment or diagnosis.
Murray states Medicare’s foray into SDOH is new, but since it’s tied to Medicare reimbursement and performance, practitioners must be ready with policies and processes.
Medicare now reimburses for four SDOH-related services: the administration of a medically necessary SDOH risk assessment, Community Health Integration, Principal Illness Navigation (PIN), and PIN-Peer Support. PIN services can be provided by supervised auxiliary personnel but require an initiating visit with a physician, Croswell says.
Read the full article about social determinants of health that ran on June 17, 2024, on HCCA’s online platform, COSMOS, or access a PDF of the article.
Learn more!
Check out the PYA white paper, Providing and Billing Medicare for SDOH-Related Services, for in-depth information about social determinants of health.
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