Independent Advocates that bill Medicare for advocacy services
Hello fellow advocates! I’m seeking independent advocates that currently bill Medicare and private insurance for your advocacy services. I am seeking information about the process and charges. I just want to converse about how complex (or not) it is as my business is solely self pay. I don’t know if opening up to Medicare clients is worth it (time and reimbursement). So would love to discuss. Thanks in advance!
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The only Independent Advocate that I know that is billing Medicare is Terry McLellan — Sunnavhca. She is located in TX. I'm sure she will be happy to have a conversation with you. Here's her email: terry@sunnavhca.com
Let her know I referred you.
Tammy
When Medicare began covering Principal Illness Navigation (PIN) services in 2024, I was very hopeful that this would finally give more patients access to professional navigation services. Unfortunately, as an independent navigator, I have found actually getting these services reimbursed to be extremely difficult.
In the process I have been working through, the treating practitioner who establishes the care plan—such as the oncologist or radiation oncologist—must be involved, and the navigator's services are connected to that practitioner's billing. I have also encountered requirements involving reassignment of benefits and documentation identifying the PIN services/navigation being provided. In my situation, we have been working with the G0023/G0024 PIN service codes.
This is where I keep hitting a wall.
Many physicians and practices understandably do not want to enter into a reassignment/billing arrangement with an independent navigator because of the administrative responsibility, compliance concerns and potential risk to their practice.
I have had several conversations and meetings regarding Medicare enrollment and billing trying to determine whether there is a compliant way for an independent PIN to provide these services without creating such a burden for the treating physician. So far, I have not found a workable solution.
What frustrates me most is the impact on patients. I see people who genuinely need navigation services but cannot afford private-pay advocacy. Medicare created PIN services specifically to address many of these needs, yet accessing the benefit through an independent navigator seems incredibly difficult.
Has anyone here successfully created a model where an independent navigator provides PIN services that are billed to Medicare?
I would especially love to hear:
• How are you structured with the physician/practice?
• Who bills Medicare?
• Did you need a reassignment of benefits?
• How did you handle the initiating visit and care plan requirements?
• How are you compensated by the billing practice?
• Have you found a compliant model that doesn't place an unreasonable administrative burden on the physician?
If anyone has successfully navigated this, I would really appreciate connecting and comparing notes. After more than a year of working on it, I would love to find a practical solution—especially because there are so many patients who need these services and simply cannot afford to pay for them out of pocket. Feel free to contact me via email at Aimee@CCC.Care or leave me a message here. Thanks