The Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2024 Medicare Physician Fee Schedule (CMS–1784–P).
The 2024 Physician Fee Schedule details services to address health equity and health-related social needs available to Medicare beneficiaries.
According to an NASW post written by NASW Senior Practice Associates Carrie Dorn and Chris Herman, the Social Determinants of Health (SDOH) Assessment is a comprehensive social history, using a standardized evidence-based tool, for patients who may have unmet social needs that affect the diagnosis and treatment of a condition. They note that:
Community Health Integration (CHI) Services address unmet social needs/social determinants of health that present barriers to the diagnosis and treatment of a patient’s identified medical issue.
Principal Illness Navigation (PIN) Services help individuals who are diagnosed with a high-risk condition that is expected to last for at least three months and presents a significant risk for hospitalization, functional decline, or death (such as cancer, chronic kidney disease, HIV/AIDS, severe mental illness, and substance use disorder). Patients may or may not have identified social needs and would benefit from supportive services and resources.
Dorn and Herman said SDOH Risk Assessment, CHI services, and PIN services may be delivered by social workers under the general supervisionof physicians or other qualifying billing practitioners such as nurse practitioners, clinical nurse specialists, certified nurse-midwives, physician assistants, and clinical psychologists.
As auxiliary personnel, social workers may perform these services“incident to” a physician or billing provider. Incident to services are explained in the NASW resource Incident to Billing for Clinical Social Workers. Health care and community-based organizations may engage social workers at different levels to perform these services when meeting incident to requirements and conditions of payment outlined by Medicare.
Social workers cannot be reimbursed independently for these services, however. NASW has advocated, without success, for social workers to be able to seek independent Medicare reimbursement for the provision of SDOH Risk Assessment, CHI services, and PIN services rather than billing incident to a qualified practitioner. NASW is continuing its advocacy in this area.
Read more on the NASW Tips and Tools for Social Workers page.