Principal Illness Navigation
The 2024 CMS Physician Fee Schedule includes a major win for Medicare patients dealing with a serious medical diagnosis. Patient navigation can now be reimbursed through Principal Illness Navigation (PIN) codes.
Studies in cancer patients have shown that navigation helps people successfully cope with both practical matters and emotional changes that come with a diagnosis. Navigation programs have shown to decrease patient emergency room visits and hospitalizations, which can interrupt treatment and increase out of pocket costs. Patients themselves characterize navigation as ‘very important’ to their journey.
Key PIN Guidelines:
For those with a serious high-risk medical condition expected to last at least 3 months.
Patient must have an initiating visit with a practitioner who determines need for navigation service and obtains verbal consent from the patient.
PIN services are provided by auxiliary personnel and under the general supervision of the billing physician (‘incident to’)
PIN services may be performed by non-clinical staff who are certified or trained as navigators.
PIN can begin during initial work-up for a suspected diagnosis
No time limit on the duration of services.
Medical record documentation is required to insure clinical integration
How we help
Live Oak Navigation meets certification and training requirements of CMS. We are credentialed by the American Cancer Society’s Leadership in Oncology Navigation (ACS LION) program. We bring many years of experience assisting cancer patients and their families to as they navigate their changing needs. We are available to assist patients with other serious conditions as well.
We can bring value to your patients by helping coordinate care in the following ways:
Provide encouragement and support to patients and families.
Assess barriers to care
Assist patients in engagement and communication with the health care team.
Assist patients in effectively navigating the health care system to ensure that appointments, testing and consults are completed in a timely manner.
Help patients apply for transportation and other services needed to meet needs.
Help patients prepare for and attend appointments.
Work with clinical staff to reinforce education regarding diagnosis, testing, treatment, managing side effects and clinical trials.
Communicate patient needs and how those are being addressed to the care team.
Private Pay Navigation
We also welcome your referrals of patients who could benefit from working with an independent navigator, and for whom private pay is an option. Please feel free to refer patients to our website or share our contact information with them.
Questions?
Please call or message us to discuss how we can assist you and your patients with navigation services.