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The ´óÏótv program was developed with specific training for CMS-required competencies announced as part of the 2024 Physician Fee Schedule and alignment to the PONT standards. It was uniquely designed to support successful billing for non-clinical navigation services under CMS Principal Illness Navigation (PIN). We also sought to provide greater role clarity and defined scope for non-clinical patient navigators and to expand the navigation workforce by offering a credentialing program without an in-person requirement.

The program meets the Centers for Medicare & Medicaid Services (CMS) training requirements for Principal Illness Navigation (PIN) reimbursement and is aligned with Oncology Navigation Standards of Professional Practice for navigation activities. This program is open to anyone seeking training in patient navigation. While the curriculum focuses on cancer as the primary disease site, many of the navigation skills and activities taught are?broadly applicable?to other serious illnesses.

This?program is offered at no cost, reflecting our commitment to removing financial barriers and the generous support of philanthropic funders to increase access to high-quality training for cancer care professionals and navigators.?

These new CMS billing codes are for patients with traditional, fee-for-service Medicare. It is common for Medicare Advantage plans and private insurers to also pay for codes which are first adopted in fee-for-service Medicare, but uptake timing is variable. PIN can be provided as part of the treatment plan for cancer and other serious, high-risk diseases.

PIN can be provided by certified or trained personnel under the direction of a billing practitioner. Training must include the competencies of patient and family communication, interpersonal and relationship building, patient and family capacity building, service coordination and systems navigation, patient advocacy, facilitation, individual and community assessment, professionalism and ethical conduct, and the development of an appropriate knowledge base, including specific certification or training on the serious, high-risk condition/illness/disease addressed in the initiating visit. The ´óÏótv training and credentialing program was developed to meet these competencies and be in alignment with the .

Since Medicare does not allow navigators to bill directly for their services, navigators must provide navigation services under the direction of a billing provider (in most cases, a physician, advanced practice provider, or psychologist) working in the outpatient setting.

´óÏótv is also providing learning opportunities in 2024 to help organizations understand the Medicare Physician Fee Schedule billing and documentation requirements, and to provide operational support in providing or expanding professional navigation. To learn more, please email ?´óÏótvLION@cancer.org .