News from NEPHO – AUGUST 2021 Edition

PRACTICE CHANGES / UPDATES

• Nicholas Avgerinos, MD of Family Medicine Associates, 195 School Street Manchester, MA 01944 has resigned effective 8/15/2021. Dr. Avgerinos will be opening and transitioning patients to his private practice, Essex County Primary Care, 42 Asbury Street, South Hamilton, MA 01982 Phone: 978-233-8210 Fax: 978-233-8310
• Galina Feldman, DO of Lahey Health Primary Care, Danvers has resigned effective 11/19/2021.
• Spencer Amesbury, MD of Mindful Medicine will be closing his private practice effective 9/1/2021. Dr. Amesbury will be joining Lahey Health Primary Care Beverly, 30 Tozer Road Beverly, MA 01915 Phone: 978-927-7727 Fax: 978-927-4598
• Yuliya Mandel, MD of Lahey Health Primary Care Gloucester, 298 Washington Street 4^th Floor, Gloucester, MA 01930 has resigned effective 10/1/2021. As of 10/4/2021, Dr. Mandel will be joining Cape Ann Medical Center, 1 Blackburn Drive, Gloucester, MA 01930 Phone: 978-281-1500 Fax: 978-282-3699
• Edward Martinez, MD of Lahey Institute of Urology, Beverly has resigned effective 9/15/2021
• REMINDER: Kevin Ollington, MD of North Shore GI has resigned effective 9/25/2021
• Sports Medicine North has transitioned their EHR from GE to Athena as of 11/2020

SAVE THE DATE

OPEN MEETING II – SCHEDULE BELOW – We are offering 3 meeting dates/times for your convenience. The same presentation will be conducted at all sessions. Please note: attending more than one session will not earn additional meeting credit.

NEW ANTICOAGULATION NOTES AND LETTERS IN CHART REVIEW

Beginning in August, the anticoagulation clinics will begin using a new system, Dawn AC, to support the tracking and dosing of patients on anticoagulation therapies. Some information from Dawn will interface with Epic. Providers will see two new note types in Chart Review. The two new note types are DAWN AC Anticoag note Warfarin and DAWN AC note DOAC. As in the past, you will continue to find your patient’s dosing schedule in the note tab under chart review. Additionally anticoag clinicians will use DAWN AC to generate letters to patients and providers. These letters will appear on the letters tab in chart review. 

REFERRAL MANAGEMENT

Surprise Billing Changes Effective January 1, 2022 – Massachusetts Commercial products, Tufts Health Direct

Effective January 1, 2022, and per the Consolidated Appropriations Act: No Surprises Act and Massachusetts Chapter 260 of the Acts of 2020, Tufts Health Plan will implement the following regulatory requirements:

• Providers must disclose their participation in a member’s health plan upon scheduling a service, as well as provide information about the member’s anticipated costs, if requested.
• If a member has a scheduled service with a provider that is out-of-network, the provider must notify the member in writing within two days or less before the service is provided. Note: Failure to provide proper notification restricts the provider from billing the member except for applicable copayments, coinsurance or deductibles.
• Providers are prohibited from balance billing members for out-of-network emergency care or care with an in-network provider at an out-of-network facility without documented consent. Members can only be billed for the in-network cost share in this scenario.
• Providers are required to verify their contact information every 90 days. Failure to update or attest to current information will result in the removal of a provider from the provider directory. For more information on the provider directory, refer to Reminder: Review and Update Tufts Health Plan Provider Directory Information.
• Providers will be required to submit a notification to trigger an Advanced Explanation of Benefits (AEOB) for scheduled services.

Note: Providers are reminded to periodically refer back to the News section of the public Provider website to check for updates on these requirements.

For questions, call Commercial Provider Services at 888-884-2404 or Tufts Health Public Plans Provider Services at 888-257-1985.

Boston Children’s Hospital Dermatology Program – Temporarily not Accepting New Patients

Boston Children’s Hospital sent a memo to referring providers announcing that due to high demand and limited physician availability, the Boston Children’s Dermatology Program is temporarily not accepting new patients unless the patient’s condition is deemed to be medically urgent. This temporary interruption in new patient appointments will allow them to provide better service to their current patients and give time to hire more physicians.

The following are some examples of medically urgent conditions:

• Changing mole/suspect melanoma
• Epidermolysis bullosa or other blistering disease (EB)
• Growing skin lump/suspect malignant tumor
• Infected or severe atopic dermatitis/eczema
• Ulcerating, large, or facial hemangioma
• Unusual birthmark
• Drug rash

This list highlights the most common medically urgent conditions referred to the Dermatology Program, but is not exhaustive.

If a patient/family calls the Department directly for a new patient appointment, they will direct them back to their Primary Care Physician for an initial evaluation.

As a reminder, the following Northeast PHO Pediatric Dermatologists have the specialized training and expertise to see your younger pediatric patients in a timely manner.

PAYOR UPDATES

PHARMACY

PROVIDER RELATIONS

Things are constantly changing within NEPHO practices – it truly is inevitable. As a reminder, please reach out to the Provider Relations Department periodically to request updates or assistance in creating provider lists. Examples of frequent outreach we receive include and are not limited to:

• Primary Care Providers with open panels for patients transitioning out of Pediatric care
• Primary Care Providers with open panels for Special Needs patients transitioning out of Pediatric care
• NEPHO PCP practice rosters used to update EMR mapping tied to billing/ referral network identification

Please do not hesitate to reach out to Alycia.Messelaar@lahey.org for such requests. We are here to help bring ease to both the practices and the patients you serve.

Message from North Shore G.I.

A Message from Susan Henry
Practice Administrator, North Shore G.I.

Dear colleagues,

As you know, North Shore GI – NMP has been working to reduce our screening colonoscopy backlog exacerbated by the COVID19 pandemic and the departure of several local Gastroenterologists over the past year or two. In collaboration with NEPHO, we are providing a monthly update via the PHO Newsletter to apprise our PCP colleagues and team members of our progress.

NSGI Practice Update:

• Maria “Mary” Lonshteyn, MD – Northshore GI START DATE: 8/2/2021
• Rosa Bui, MD – Northshore GI START DATE: 8/9/2021
• Kevin Ollington, MD – Northshore GI TERM DATE: 9/25/2021
• 2 administrative colleagues have been hired to help facilitate referrals etc.; interviews for an MA and receptionist are in progress

Other Updates:

• Diagnostic colonoscopy referrals are being reviewed and cases are opened within 24 – 48 hours (evidence of an open case will be noted in a progress note created by a NSGI colleague in Epic or a letter is FAXED to non-Epic providers)
• Screening colonoscopy referrals are being reviewed and cases are opened within 2 weeks or less. Please let patients know the current reasonable expectation for contact from NSGI is now 2 weeks; down from 4 – 8 week
• Colonoscopies are being booked into December of 2021 / January 2022
• Essex Surgical has agreed to support NSGI in scheduling colonoscopies for NEW patients. NSGI is facilitating this process to minimize the backlog
• NSGI will now update the Epic problem list when a “new diagnosis/problem” is identified from pathology results, at the same time results letters are generated.

Providers making referrals to NSGI are asked the following:

• be sure to use the correct diagnosis when making the referral
• please provide patients with “reasonable expectations” as to when they will be contacted by NSGI; now within 2 weeks
• use REF25 when making a referral in Epic or FAX to 978-232-0110

Additionally, please know that diagnostic colonoscopies are being scheduled in a timely manner. Should there be any concerns about the timeliness of diagnostic colonoscopies, please reach out to me or one of our Gastroenterologists by email or EPIC messaging. I am happy to personally have that particular referral reviewed right away, to ease the mind of the patient and to lessen the number of calls being made to the PCP offices. If a patient calls the office directly, we send an internal message to the new screening reviewer, who reviews and takes action the same day.

Sincerely,
Susan B. Henry
Practice Administrator
North Shore GI – NMP
100 Cummings Center, Suite 107C
Beverly, MA 01915

E-mail: susan.henry@lahey.org

Phone: 978-712-4402 Fax: 978-232-0110

QUALITY

As we enter the fall season and the final months to encourage patients to get care that is due this year, here are a few quality and patient experience notes to maximize your efforts.

• The outcome measures (Blood pressure for DM and HTN patients <139/89, A1c<9) represent a significant part of the quality performance score. 
• Please continue to encourage patients to get their A1c completed if they have not already. 
• Telehealth offers an option to capture patient reported blood pressures for patients who are unable to come in for screening.  
  • The minimum documentation that must be included with the BP reading(s) is: date of reading(s), who took the reading(s), who the BP was communicated to (does not have to be a provider), how it was communicated, and that it was taken with the digital device. Only BPs taken with a digital device are acceptable. 
• Health plans require us to submit the last blood pressure of the year, regardless of whether the last BP is taken by the treating provider. We have found in some cases that the last BP of the year is taken during a specialist visit (not related to BP management).
  • If you are seeing a patient as a specialist and it is your process to record a blood pressure, please record 2 blood pressure readings if either the systolic or diastolic is high for the first reading (high, meaning systolic >139 and/or diastolic >89).   
  • Health plans allow us to submit a composite reading, e.g. best systolic/best diastolic from readings taken on the same day.
  • In the upcoming weeks, NEPHO Quality team will be reaching out to different specialties to answer questions and offer tools and training related to documenting BPs.
• Please continue to capture patient cell phone numbers in the correct field in the EMR as texting is being used for quality and patient experience surveying/outreach (avoid putting the cell phone number in the “home” number field). 
• Please continue to collect patient emails, as the patient experience data collection has expanded to include e-surveys.

CODING TIP OF THE MONTH

OPTUM Newsletter – August 2021 | Major Depressive Disorder

Highlights of 2022 ICD-10 Clinical Modification (CM) Updates:

ICD-10-CM seems to have returned to more normal volumes of new codes with 191 new codes, 159 are billable codes set to launch this October 1, 2021.

Marijuana use

With more and more states legalizing marijuana for medical and recreational use, it is no surprise to see almost 25% of this year’s code updates are in Chapter 19: Injury, poisoning, & certain other consequences of external causes (S00-T88).

Social Determinants of Health

Social Determinants of Health (SDOH) is a big area update in healthcare this upcoming year. The pandemic has highlighted the need to capture information that may not be purely medical in nature but certainly affect an individual or population health outcomes. This update contains 22 new codes in Chapter 21: Factors influencing health status and contact with health services (Z00-Z99). Thirteen of these codes are related to the very important areas of housing insecurity, food insecurity, and education level. They have been identified as priorities and submitted for approval.

Cell therapy and cough hierarchy

12 new codes were added for complications of immune effector cellular therapy, immune effector cell-associated neurotoxicity syndrome, and a personal history of cellular therapy. 

There are 6 new codes added to the R05: Cough hierarchy that better define those characteristics of a cough.

Impact of COVID-19

COVID-19 related codes continue to be added to the codes set, with two new U codes for Post-COVID condition and Post-COVID condition, unspecified. There is the new Z code Z71.85 Encounter for immunization safety counseling. This code will be seen a lot in the first few months of implementation of ICD-10 CM 2022.

Example of new ICD-10-CM codes for 2022:

R05.1 – Acute cough (R05 will have a subset of 6 codes)
T40.715 – Adverse effect of cannabis
T80.82xS – Complication of immune effector cellular therapy, sequela
U09 – Post COVID-19 condition
Z71.85 – Encounter for immunization safety counseling
Z92.85 – Personal history of cellular therapy

Telehealth

Telehealth coding will take center stage in some arenas with technology being key to managing patients. CPT-2022 Updates will be effective January 1, 2022 and NEPHO will be offering the most up-to-date information on these code updates. Please look for announcements coming soon. 

NEPHO will be providing Coding and Billing webinars focused on the ICD-10 CM 2022 updates. The webinars will focus on ICD-10 CM chapter highlights to help with practice specific focus. As always please reach out to Shawn Bromley at shawn.m.bromley@lahey.org or 978-236-1704 if you would like additional education on the new ICD-10 CM updates to better support your practice and providers. 

PATIENT EXPERIENCE COMMENTS

PRACTICE RECOGNITION

The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local and meet our quality targets.

This month’s winners are:

Cheryl Hathaway, Family Medicine Associates, Hamilton, was recognized for her efforts to keep specialty care in the Northeast PHO network.

Danielle Joly, Lahey Health Primary Care, Danvers, for her patient experience comment “Danielle is by far my favorite nurse, she made it a point to get to know me and find a way to connect with me to build trust and make me feel comfortable when I visit.”

Shown L-R – Brent Fryling, MD, Danielle Joly, RN, Lisa Jordan, PA

Dr. William Medwid and Cheryl Hathaway

Please let us know if you would like to nominate a team member in your practice or another practice for the recognition program. We will deliver gift cards to the winners each month, and they will be announced here and in our website “Hot Topics” section.

Please be sure to look for the new winners in next month’s issue!