Introduction

The understanding of how significantly health outcomes are influenced by factors beyond medical treatments alone has become increasingly evident. Social Determinants of Health (SDoH) encompass a spectrum of non-clinical factors, including socioeconomic status, education, employment, and access to resources. Recognizing the profound impact of these determinants, payers are now beginning to reimburse providers for screening for them. EngageQUALITY seeks to support your efforts to provide the best possible care for your patients, while maximizing your success and the sustainability of your practice. With that in mind, this article explores the importance of screening and billing for SDoH as well as the implications of screening on fostering comprehensive and equitable care for your patients.

Understanding SDoH

SDoH represent the environmental and social conditions in which people are born, live, and work. These factors play a pivotal role in shaping patients’ opportunities for health and well-being. For example, patients from marginalized communities often experience barriers such as limited access to healthcare, nutritious food, safe housing, and educational opportunities, contributing to health disparities and poorer outcomes.

The Role of Screening

Screening for SDoH involves the assessment of patients’ social and economic circumstances in the course of your care for them. This process enables healthcare providers to identify underlying issues that may influence patients’ health outcomes and make meaningful adjustments to the care provided.

Enhancing Patient Care

In an advanced model of care that is patient-centered and comprehensive, integrating screening and billing for SDoH is crucial to understanding and addressing patients’ unique needs and circumstances. Screening for SDoH creates opportunities for providers to more meaningfully engage with patients, fostering trust and collaboration.

Improving Population Health

Screening and billing for SDoH has the potential to drive improvements in population health by addressing upstream contributors to disease and promoting health equity. Ultimately, this can prevent illness, reduce healthcare costs, and improve the overall well-being of communities.

Billing for SDoH

To support your success in billing for SDoH screening, here are some tips:

• G0136 is a new code for 2024, used for a risk assessment which takes 5 to 15 minutes.

• Screening tool must be one that is tested and validated through research. (EngageQUALITY is currently working with CHI St. Vincent Medical Group EMR teams to build out the Protocol for Responding to and Assessing Patient’s Assets, Risks, and Experiences (PRAPARE) tool for provider use.).

• The screening should not be performed more often than every 6 months.

• G0136 cannot be billed with the Welcome to Medicare Visit (G0402).

• It CAN be billed with the Annual Wellness Visit (AWV) G0438/G0439 and will be paid at 100% of the allowance, with no beneficiary cost sharing. If performed outside the AWV, it is subject to cost-sharing (copay and deductible).

• CMS expects that, at a minimum, a provider who performs the risk assessment would refer the patient to relevant resources and use the results of the assessment in their medical decision-making or diagnosis and treatment plan for the patients.

• EngageQUALITY will be providing educational sessions on this topic in the near future.

Conclusion

Screening and billing for social determinants of health supports the improvement of health outcomes and health equity. Practices can pave the way for a care system that meaningfully and more comprehensively meets the needs of the patients for whom we care, while also maximizing every opportunity for improved practice financial performance.

If you have specific questions about screening for SDoH, email quality@engagemed.com.