Billing Medicare for Social Care
Use Medicare G-codes to bill for CHI, PIN, and PIN-PS services delivered by CHWs, care navigators, and peer support specialists. Unlock sustainable revenue for your social care programs.
Who is this course for?
This course is designed for leaders, managers, and implementers who want to understand how to activate and operationalize Medicare billing opportunities related to social care. It is especially relevant for organizations building readiness across clinical and community teams. This includes:
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Directors and senior managers who work in health systems that have employed or contracted with CHWs, Care Navigators, and/or certified Peer Support Specialists to deliver CHI, PIN, and/or PIN-PS services to patient populations
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Directors and program managers who work in CBOs (including AAAs) that have existing contracts with health systems to provide CHI, PIN, and/or PIN-PS services
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Directors and managers who work in Hubs or CHW associations and are responsible for setting up closed-loop referral and case management systems to capture documentation and codes correctly
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State health department leaders who want to understand Medicare CHW systems
Learning Objectives
By the end of this course, you will be able to:
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Define Community Health Integration, Principal Illness Navigation Services, and Peer Support services
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Understand the specific G-codes associated with each service, as well as the delivery, documentation, and billing requirements for reimbursement.
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Optimize these services by identifying patient caseloads and utilization targets
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Use financial modeling and strategic messaging to strengthen the business case for these services
Course curriculum
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Course Introduction
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Course Objectives
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Who Is This Course For?
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Who Are We?
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Course Faculty - Tim McNeill
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Course Faculty - Sherri Ohly
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Course Overview
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Case Study Presentation
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Navigating Thinkific
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Resources: Reference Guide
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Module 1: Opportunity & The Services
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The Health System Background – Part 1
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The Health System Background – Part 2
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CHI services - Definitions & Eligible Patients
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PIN and PIN-PS services - Definitions & Eligible Patients
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Knowledge Check - The Services
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CHI/PIN/PIN-PS Authorized Service Providers
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Module 1 Complete
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Module 2: The G-Codes
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G-codes Definitions
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CHI G-codes
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PIN G-codes
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PIN-PS G-codes
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Knowledge Check - G-Codes
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Module 2 - Complete
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Module 3: The Business Case
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Decoding the G-codes Revenue
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How Do G-Codes Support Service Sustainability? Part 1
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How Do G-Codes Support Service Sustainability? Part 2
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Knowledge Check - The Business Model
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Explore how the financials work out for the clinic and CBO in a contracted model with 1 CHW. More explanation to come in Module 9
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Implementation Plan Roadmap - Phase 1
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Module 3 - Complete
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Module 4: Key Roles for Your Team
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Key Roles: Administrators
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Key Roles: QHPs
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Key Roles: Auxiliary Personnel
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Key Roles - Auxiliary Personnel: CHWs
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Key Roles - Auxiliary Personnel: Care Navigators
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Key Roles - Auxiliary Personnel: PS Specialists
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Key Roles: Operations Staff
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Knowledge Check - Key Roles
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Module 4 - Complete
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Module 5: The Workflows: Delivery, Documentation & Billing
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CHI Documentation, Delivery, and Billing Workflow
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Knowledge Check - CHI Workflow at Nexus
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PIN Documentation, Delivery, and Billing Workflow
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Knowledge Check - PIN Workflow at Nexus
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PIN PS Documentation, Delivery, and Billing Workflow
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Knowledge Check - PIN-PS Workflow at Nexus
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Implementation Plan Roadmap - Phase 2
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Module 5 - Complete
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About this course
- 102 lessons
- 1 hour of video content
- Reference Guide & Implementation Plan
Beyond the Course
In partnership with Freedmen's Consulting, we’re developing an associated implementation program for organizations, coalitions, and funders that want to go beyond the course and receive hands-on technical assistnace. If you’d like to learn more, reach out at [email protected].
Instructors
Meet the course faculty
Rishi Manchanda, MD, MPH
CEO, HealthBegins
Dr. Rishi Manchanda is CEO at HealthBegins. He has advanced bold strategies to help health care move upstream and advance health equity for historically marginalized patients and communities throughout his career as physician, executive, and public health champion. Dr. Manchanda served as the founding director of social medicine for a network of community health centers in South-Central Los Angeles, as the first lead primary care physician for homeless veterans at the Greater Los Angeles VA, and as the inaugural chief medical officer for a self-insured employer with a large rural agricultural workforce. In his book—The Upstream Doctors—and TED Talk, he introduced “Upstreamists,” a new model of healthcare professionals who improve outcomes by addressing the social and structural drivers of health equity—patients’ social needs, community-level social determinants of health, and structural determinants of health equity including structural racism.
Tim McNeill
Founder and CEO, Freedmen's Health Consulting
Tim McNeill is a healthcare leader and course faculty member who brings extensive experience from the United States Navy and hospital and healthcare center operations. As founder and CEO of Freedmen's Health Consulting (FHC), he leads the firm's work specializing in the implementation of innovative models of care, serving clients including the U.S. Department of Health and Human Services (HHS), U.S. Administration on Aging (AoA)/Administration for Community Living (ACL), and various foundations and national non-profit organizations. Under HHS/ACL contract, Tim serves as the lead technical assistance provider tasked with establishing and supporting integrated networks to deliver new models of care that address medical risks and social determinants of health while supporting value-based contracting across twenty-six states.
Sherri Ohly
Director, Envision
Sherri Ohly is a public health leader and course faculty member with extensive experience supporting Community Health Worker workforce development, training, and systems change. Her work focuses on designing and implementing CHW-centered learning and technical assistance initiatives in partnership with CHWs, community-based organizations, public health, and healthcare systems at both state and national levels. Currently, she serves as Director of Operations and Development for Envision and supports CHW-centered programs at the University of Wisconsin, Madison, School of Medicine and Public Health's Population Health Institute. Sherri brings a practical, collaborative approach to learning that emphasizes real-world application, systems awareness, and workforce strengthening.
Testimonials
“As an academic partner who has assisted many organizations in exploring opportunities for billing Medicare for CHW services, I am grateful to have this excellent training to direct people to. The course provides great real-world scenarios and expertise, and many useful resources. ”
Louisa O'Meara, MPH Research Scientist, Center for Community Health and Engaged Research at Northern Arizona University
FAQ
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What's in this course and what's coming next?
This course is designed for leaders, managers, and implementers who want to understand how to activate and operationalize Medicare billing opportunities related to social care. It is especially relevant for organizations building readiness across clinical and community teams. We are planning additional frontline workforce training modules later this year, informed by partner feedback and early implementation experience. We are also launching an associated program for organizations that want deeper support applying this work in practice. It's designed for managers in clinical and community settings and frontline workers participating in implementation.
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What is the course format?
This self-paced and asynchronous online course includes ten modules with Masterclass-style video lessons, interactive knowledge checks. It also includes an implementation plan template and a reference guide.
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How long is the course?
90 minutes.
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What are my payment options?
At checkout, you can pay via credit card, bank transfer, and several other options. If you need an invoice, please email [email protected] with: name, email, organization name, organization address, number of learners, and preferred payment method. Our platform collects a sales tax at checkout for our digital course, in compliance with tax law. If your organization is tax exempt, we will be able to process a tax refund.
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I'm purchasing for my team. How do my team members get access?
If you purchase more than one seat, you’ll automatically receive seat manager access and can invite your team members with a custom invitation link.
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I am encountering technical difficulties. What can I do?
For minor technical difficulties with the learning platform, we recommend refreshing the page and proceeding. For deeper inquiries, please reach out to the HealthBegins team via the form linked at the bottom of the Course Reference Guide.
Turn your social care work from invisible to billable
Activate Medicare billing for social care across clinical and community teams. For facilitated programs and hands-on technical assistance, please reach out to [email protected].