Becker's Clinical Quality & Infection Control

17 PATIENT & CAREGIVER EXPERIENCE Do private insurers and Medicaid cover navigation the same as Medicare? Coverage outside of traditional Medicare is inconsistent. • Commercial insurers vary widely in whether they cover navigation services comparable to Medicare's PIN and CHI codes. • e American Medical Association has issued coding guidance pointing practices toward Principal Care Management codes — CPT 99424-99427 — as one option for billing navigation-type services to private payers. • Medicaid has no federal navigation benefit equivalent to Medicare's. Coverage instead comes through individual state plan amendments, waivers or managed care contracts and varies by state. ese services are typically framed as community health worker services rather than navigation specifically. n Code Description Place of service Total rendering providers Total beneficiaries Total services 0023 General PIN, first 60 minutes/month Facility 14 124 130 G0023 General PIN, first 60 minutes/month Office 402 2,002 4,173 G0024 General PIN, each additional 30 minutes/month Office 223 812 2,311 G0140 PIN-PS, first 60 minutes/month Facility 2 42 45 G0140 PIN-PS, first 60 minutes/month Office 13 82 344 G0019 CHI, initial visit/first 60 minutes/month Facility 4 42 56 G0019 CHI, initial visit/first 60 minutes/month Office 179 2,517 5,365 G0022 CHI, each additional 30 minutes/month Office 100 1,667 24,232.50 What makes patients choose 1 hospital over another? By Kristin Kuchno M ost patients decide on a hospital before settling on a physician — or land on both in the same step — when they first encounter a new health concern, according to survey results U.S. News & World Report published July 20. U.S. News worked with PureSpectrum to poll 500 Americans nationwide who had personally arranged care for themselves or a family member within the past two years. Here are six things to know from the survey: 1. Fifty-three percent of respondents said the hospital came first in their decision, or that hospital and physician were chosen together. The other 47% picked their physician before the hospital entered the picture. 2. When a preferred physician cannot practice at a patient's hospital of choice, 80% follow that physician to a different facility rather than give up the relationship. Only 20% take the opposite route, opting for a different physician to stay at the hospital they want. 3. Patients trust referrals from physicians the most when it comes to sources of information about hospitals, averaging at 4.0 on a five-point scale of trustworthiness. Next was data directories, such as online directories or hospital websites, at 3.5 to 3.7, followed by AI chatbots, social media and podcasts, at 2.7 to 2.8. 4. Patients still trust their own physicians' referrals above any other source of hospital information. Methodology- backed rankings, along with hospital and insurer directories, land just behind that. Podcasts, AI tools and social platforms rank lowest of all the options. 5. Age shifts that picture: patients between 26 and 40 place nearly as much trust in podcasts, AI chatbots and social platforms as they do in referrals or hospital websites — a gap that is far wider among older patients. That same younger group also leans on consumer reviews: 81% said sites like Google and Yelp shape what they decide. 6. Once inside a hospital, respondents pointed to cleanliness as the top safety cue (51%), ahead of visible technology and equipment (36%), staff presentation (35%), visible security (26%), how crowded the space feels (20%), noise levels (17%) and wayfinding signage (15%). 7. Proximity matters most for routine care — 62% called a hospital's location "very important" to that decision — but patients loosen that standard for serious conditions: 36% said they would go beyond three hours for specialized treatment. n

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