Overview

Effective January 1, 2024, CMS established a standalone code, G0136, for the administration of SDoH assessments. Beginning February 1, 2024, ThoroughCare supports this code and created an additional workflow to aid customers in the generation of G0136 claims so that practices are able to accurately bill for this service whenever applicable. Per CMS guidelines, a G0136 claim can be submitted on behalf of patients once every 6 months.

How to Assess Social Determinants of Health in ThoroughCare

ThoroughCare offers users two opportunities to assess and document health-related social needs of patients. The first is through the standalone HRSN assessment. The HRSN assessment includes questions addressing the five core domains (Living Situation, Food, Transportation, Utilities, and Safety) and additional questions from eight supplemental domains (Financial Strain, Employment, Family and Community Support, Education, Physical Activity, Substance Use, Mental Health, and Disabilities). The second is through the newly updated AWV Patient Questionnaire Health Risk Assessment. The HRA associated with an AWV now includes a HRSN section with the five core domain questions to help address unmet health-related social needs to support referrals to community services during an AWV. Both of these assessments are utilizing the Accountable Health Communities Health-Related Social Needs Screening Tool provided by CMS.

ThoroughCare will generate a maximum of one G0136 claim every 6 months. The methods mentioned above being used for that claim generation are interchangeable.

Generating G0136 through the HRSN Assessment

The first option to document SDoH-related information that will result in G0136 claim generation is through the Health-Related Social Needs screening tool. This tool is available for all patients through their Assessments/Screenings tab.

The claim will generate once the assessment is finalized.

Generating G0136 through an AWV Assessment

The second option to document SDoH-related information is through the newly updated HRA available during a patient's Annual Wellness Exam. During the AWV process, a patient, or a ThoroughCare user on their behalf, will have the opportunity to complete the Patient Questionnaire that contains our Health Risk Assessment.

The HRA includes an HRSN section that the patient may agree or decline to complete. If the patient elects to participate in this portion of the assessment, a G0136 claim will be generated once the questionnaire is finalized.

Please note the following additional details:

Per CMS guidelines, practices may only bill for G0136 during a patient's Initial and Subsequent AWVs. It will not be available through a patient's Welcome to Medicare (IPPE) exam.
The new Health Risk Assessment HRSN section is only available through a patient's Wellness tab. G0136 cannot be billed through a standalone HRA.

Viewing G0136 Claims in the Billing & Claims Worklist

G0136 claims will be listed under the 'All' Product filter in the Billing & Claims Worklist, alongside all other practice claims. To view a list of only G0136 claims, a user can go to the worklist's 'Filter' button, set the 'Product' dropdown to 'All', and search and select for the G0136 option under the new 'CPT Code' dropdown.

Note: If your practice has an EHR or requires ICD10 codes for billing G0136 codes will be under the status "Missing Info".

Best Practices for Submitting a G0136 Claim

While ThoroughCare adheres to regulatory guidelines, CMS does provide additional recommendations when submitting G0136 claims, listed below:

Submit in conjunction with an E/M visit, a behavioral health visit, a discharge visit, or an annual wellness visit.
- ThoroughCare currently only offers an automatic billing opportunity through the annual wellness visit.
Determine appropriate SDoH conditions and include applicable Z-codes with G0136 claims.
- ThoroughCare will automatically add a maximum of four Z-codes to a patient's G0136 claim based on the responses provided in their completed HRSN.
  - If the patient did not have any responses that resulted in a Z-code, ThoroughCare will automatically add one of the patient's ICD-10 codes to the claim instead.
  - To learn more about Z-code reporting, please see our article on Adding Social Determinants of Health (SDOH) Conditions and ICD-10-CM Z Codes
All HRSN assessment responses are viewable under the patient's Assessments/Screenings tab.

Additionally, G0136 claim submission is controlled by a practice setting. If a practice would like to enable or disable this billing functionality, they will need to contact ThoroughCare for assistance.

For further assistance, click the ‘i’ icon in the top right corner of your ThoroughCare screen to access additional articles and training videos, submit ideas, or contact ThoroughCare Support.