SDOH are non-medical factors that influence health outcomes, including economic stability, education, social and community context, health care access, and the neighborhood and built environment. Addressing SDOH is critical for achieving health equity, improving patient care, and reducing healthcare costs.

CMS's new mandates reflect a growing recognition that healthcare extends beyond clinical interventions. By formally incorporating SDOH into patient assessments, CMS aims to:

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- Enhance the quality of patient care

-Identify and mitigate health disparities

- Inform policy and resource allocation

- Support holistic patient management

Z codes, part of the ICD-10-CM coding system, are used to describe circumstances and problems that affect a patient's health but are not classified as diseases or injuries. The new Z codes introduced by CMS specifically address various SDOH factors. Here are some key additions:

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Z55-Z65: These codes cover various social determinants such as education and literacy (Z55), employment and unemployment (Z56), occupational exposure to risk factors (Z57), housing and economic circumstances (Z59), lack of adequate food and safe drinking water (Z59.4), and social environment (Z60).

Using these Z codes enables healthcare providers to document SDOH systematically, facilitating better care coordination and resource allocation.

G codes are used for billing and identifying professional healthcare services. CMS's new G codes related to SDOH are designed to capture and reimburse for specific activities related to assessing and addressing SDOH. Some of the key new G codes include:

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- G9001: Coordinated care fee, initial rate

- G9002: Coordinated care fee, maintenance rate

- G9919: Documentation of social determinants of health using a standardized tool, positive finding for at least one domain

- G9920: Documentation of social determinants of health using a standardized tool, no positive findings

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These codes support providers in performing SDOH assessments and managing related care activities, ensuring that they are compensated for the time and resources dedicated to this important aspect of patient care.

For healthcare providers, integrating the new CMS mandates involves several steps:

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1. Training and Education: Ensure that all healthcare staff are familiar with the new Z and G codes and understand how to use them correctly.

2. Standardized Screening Tools: Implement standardized tools for assessing SDOH to ensure consistency and accuracy in capturing relevant data.

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3. Workflow Integration: Adjust workflows to incorporate SDOH assessments into routine patient evaluations without disrupting clinical efficiency.

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4. Data Utilization: Use the collected SDOH data to inform care plans, coordinate community resources, and address identified needs.

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5. Continuous Monitoring: Regularly review and analyze SDOH data to track trends, identify gaps, and measure the impact of interventions.

CMS's new mandates around SDOH assessments and the introduction of new Z and G codes mark a significant step towards holistic and equitable healthcare. By systematically addressing the social factors that influence physical health, healthcare providers can improve patient outcomes, reduce disparities, and enhance overall community health. As these mandates take effect, ongoing education, proper implementation, and continuous evaluation will be key to maximizing their impact.

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For healthcare providers looking to seamlessly integrate these new requirements, consider utilizing our 360° Value-Based Care Software for Complex Case Management. Our first-of-its-kind collaboration tools are designed to cover SDOH, behavioral, and physical health needs of high-risk patients, ensuring comprehensive care management and improved health outcomes. By leveraging our software, providers can efficiently document and address SDOH, streamline workflows, and ultimately deliver better, more coordinated care.

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