Consider A Business Case for Patient Navigator Program
Question: I would like to implement a patient navigation program, but leadership is worried about cost and efficacy. What can I do to build a business case for this work? New York Subscriber Answer: Keisha Wilson, CPC, CPCO, CPB, CPMA, CRC, addressed this in her AAPC HEALTHCON 2026 presentation “From Barriers to Breakthroughs: Building Effective Patient Care Navigation Programs.” You can make the case for patient navigation by tying it directly to the operational and financial problems leadership already wants solved. For example, if you’re dealing with no-shows, last-minute cancellations, or incomplete referrals, your patients may be facing barriers to getting the care they need. Having a dedicated patient navigator can help address such gaps in accessibility by helping patients with language services, transportation, insurance confusion, or financial hardship. Even though this sounds like a patient service, a thoughtfully written business case can help you frame patient navigation as a workflow and performance strategy. Some services, like G0023 (Principal illness navigation services, 60 minutes per calendar month), G0024 (Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to G0023)), G0140 (Principal illness navigation-peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month), and G0146 (Principal illness navigation-peer support, additional 30 minutes per calendar month (list separately in addition to G0140)), may be reimbursable from Medicare when requirements such as consent, barrier identification, a navigation plan, and time tracking are met. Mentioning the codes can help ground the service in a more familiar, business-based context. If costs seem intimidating, consider proposing a small pilot program, perhaps focused on a limited high-risk population. Track key metrics like appointment attendance, referral completion, denials, and billing revenue, and then see how dedicated patient navigation shows return on investment. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
