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New Care Management Service Codes

Explore CMS’ final rule on policy changes for Medicare payments under the PFS, including new codes.
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On November 2, 2023, CMS issued a final rule announcing finalized policy changes for Medicare payments under the physician fee schedule (PFS) effective January 1, 2024. These changes include a handful of new codes intended to help patients better navigate their care and purposely identify and value the additional time and resources needed to support CMS’ pillars for equity, inclusion, and access to care to help improve patient outcomes. 

These new codes align with new services that include principal illness navigation (PIN) services, community health integration (CHI) services, and administration of a standardized, evidence-based social determinants of health (SDOH) risk assessment. These new codes are added to an already long list of existing care management service codes. As the ever-evolving list of codes continues to grow, organizations are left pondering several questions. Which care management service(s) will provide the highest quality of care to my patients while improving resources and revenue? Are there missed billing opportunities that exist today under the current operating model? How can I best leverage existing staff and resources to meet these new service requirements? 

These codes will require strong care coordination among the provider team and alignment with an organization’s value-based care and population health strategies. Our population healthcare management assessment can consider an organization’s population health strategies, capabilities, and overall readiness for billing these new codes and existing care management service codes. In addition, our experienced professionals at FORVIS can offer strategies for implementing a seamless process to help operationalize these services without duplicating existing care management services. We can assist your organization to achieve better interoperability across the care team and divisions, determine the correct staffing skill set and mix to help increase profitability when billing for care management services, and identify key performance measures that can help demonstrate productivity and return on investment. 

If your organization needs assistance navigating care management services or assessing new population health strategies in value-based care to help drive your business forward, please contact the Healthcare Strategy and Healthcare Finance teams at FORVIS.

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