I would really like to connect with others about this because I have been working on this issue for over a year.
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
Hi everyone! My name is Aimee Dundas, in Litchfield Park Arizona. I’m excited to introduce myself and become part of this community of patient advocates and navigators.
I have more than 15 years of experience in oncology and hematology, with a background as a Medical Assistant, Oncology Patient Navigator and Principal Illness Navigator. Throughout my career, I’ve worked directly with patients and families as well as behind the scenes with providers, insurance companies, treatment teams and community organizations.
Today, my work has expanded beyond oncology to include patients facing chronic and serious illnesses. I especially enjoy taking complicated situations, figuring out where the barriers are, and helping patients and families find a path forward.
I currently serve as Director of PINs with Cancer Care Concierge™ and Chronic Care Concierge™, where I also mentor navigators and continue working directly with patients. I am also the creator of the CCC™ Patient Navigation System™, which grew out of years of seeing how difficult it can be for patients and caregivers to keep track of everything involved in their care.
One of the things I value most about navigation is that none of us knows everything. We each bring different experiences, resources and areas of expertise to the table, and we become better advocates when we learn from and support one another.
I’m looking forward to getting to know all of you, learning about your areas of expertise, sharing resources and experiences, and hopefully collaborating along the way!
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
I have more than 15 years of experience in oncology and hematology, with a background as a Medical Assistant, Oncology Patient Navigator and Principal Illness Navigator. Throughout my career, I’ve worked directly with patients and families as well as behind the scenes with providers, insurance companies, treatment teams and community organizations.
Today, my work has expanded beyond oncology to include patients facing chronic and serious illnesses. I especially enjoy taking complicated situations, figuring out where the barriers are, and helping patients and families find a path forward.
I currently serve as Director of PINs with Cancer Care Concierge™ and Chronic Care Concierge™, where I also mentor navigators and continue working directly with patients. I am also the creator of the CCC™ Patient Navigation System™, which grew out of years of seeing how difficult it can be for patients and caregivers to keep track of everything involved in their care.
One of the things I value most about navigation is that none of us knows everything. We each bring different experiences, resources and areas of expertise to the table, and we become better advocates when we learn from and support one another.
I’m looking forward to getting to know all of you, learning about your areas of expertise, sharing resources and experiences, and hopefully collaborating along the way!