Brent Fryling, MD
Lahey Primary Care, Danvers
5 Federal Street
Danvers, MA 01923
978-777-6544 (F): 978-774-2091
Andre Markarian, MD
Northeast Emergency Associates
85 Herrick Street
Beverly, MA 01915
978-922-3000 (F): 978- 921-7011
Meghan Weir, MD
Garden City Pediatric Associates
83 Herrick Street – Suite 1003
Beverly, MA 01915
978-927-4980 (F): 978-922-9115
NEWS FROM NEPHO
JULY 2020 EDITION
IN THIS ISSUE:
PRACTICE CHANGES AND UPDATES
- Jagruti Patel, MD of Premier Plastic Surgery has closed her practice effective 7/17/2020
- Gary Mendese, MD is leaving DermPhysicians of New England to open a private practice, Dermatology and Skin Health, 23 Centennial Drive, Peabody, MA 01960 effective 9/29/2020
- Sandra Wozniak, MD of Northeast Emergency Associates has terminated her affiliation effective 3/24/2020
- Munrih Yeshwant, MD of Northeast Emergency Associates has terminated his affiliation effective 10/15/2019
- Blackburn Primary Care has transitioned to athenaClinicals effective 7/14/2020
SAVE THE DATE
NEW PHYSICIAN ORIENTATION
Date: Wednesday, August 19, 2020 @5:30 p.m.
Location: GoogleMeet Conference Call
RSVP: firstname.lastname@example.org or 978-236-1784
CODING AND BILLING WEBINARS
Have Practice Prepared for 2021 E/M Updates
Date: Wednesday, August 19, 2020 @ 10:00 a.m.
Location: GoogleMeet Conference Call
RSVP: judith.o’email@example.com or 978-236-1739
Please check the meeting calendar on our website to get the latest meeting status, notification of the Coding and Billing webinars, Specialty Specific meetings, and POD/IPA meetings. Due to the COVID-19 directive from Governor Charlie Baker, regarding social distancing for meetings we will be providing conference call information and links for upcoming virtual meetings.
AllWays Health Partners
COVID-19 Commercial FAQ: Questions from Providers about Coronavirus (COVID-19)
The Questions from Providers about Coronavirus (COVID-19) has been revised, effective 7/15/2020. Revised question: What are your prior authorization requirements during the COVID-19 state of emergency (Updated 7/15/2020)? For details about authorization and referral requirements, refer to the COVID-19 state of emergency PA grid. For the period March 23 through September 30, 2020, AllWays Health Partners is removing prior authorization requirements for post-acute care including: home health care, skilled nursing facility, in-patient acute rehabilitation at an acute rehab, long term acute care (LTAC), and chronic disease hospitals. For additional information and to view the notification, click here.
Coming soon: New tools to simplify the prior authorization process
During this unprecedented time, we understand that it’s more important than ever for providers to spend less time on administrative work and more time on what matters most – your patients. To support this, AllWays Health Partners is launching several enhancements to our digital prior authorization tools and removing prior authorization requirements for certain services.
We’ve created a webpage to highlight all the enhancements. The latest updates and resources will be added as they become available.
Here’s a sneak peek at what’s coming.
Search authorization requirements by code
Later this summer, we’re launching a tool so you can search by code to see authorization requirements instantly. By having easy access to the latest requirements, this will reduce the number of unnecessary requests and save you time.
Immediate approval for medically necessary outpatient services
In September, we are enhancing the prior authorization functionality in our provider portal:
- For outpatient services that meet criteria, you will receive approvals in seconds
- Seamless process: request authorization and enter medical necessity information in one screen
- Get approvals 24-hours a day, 7 days a week
These enhancements are designed to speed up the authorization process so you can discuss next steps with your patients before they even leave your office.
Removing prior authorization requirements
As part of the efforts to improve the provider experience, there will be several changes to the authorization requirements for services managed by eviCore effective July 1, 2020.
AllWays Health Partners will be lifting the prior authorization requirement across all lines of business for several services that are currently managed by eviCore. This includes:
- Diagnostic heart catheterizations
- Nuclear medicine
- Radiation therapy
- Diagnostic ultrasound
- And more
Additionally, prior authorization will be managed by AllWays Health Partners for the following service. Please submit requests for this service through our secure provider portal:
- A9513 – Lutetium Lu 177, dotatate, therapeutic, 1 mCi
For full list of changes, click here.
There are no changes to all other services managed by eviCore. These services will continue to require prior authorization. The list of services that will continue to require prior authorization through eviCore is available on eviCore’s webpage.
Blue Cross Blue Shield of Massachusetts
A new way to submit and view authorization requests
Starting Monday, November 9, 2020, you’ll have a new way to submit and view the status of your authorization requests for our members. The new tool, called Authorization Manager, will allow you to submit authorizations for a greater range of services than you can submit today through Online Services.
To read your News Alert, log in to Provider Central and go to News.
We’ve also posted a message to your My Alerts inbox. Log in to read it.
COVID-19: Resuming Provider Audits and Claim Reviews
On April 8, 2020, BCBSMA notified providers that it is pausing the following activities for 60 days or until the end of the public health emergency, whichever came first. Effective immediately we will resume these activities: Retrospective provider audits for: Professional providers; Inpatient and outpatient facilities; Prepayment reviews for forensic claims; any other claim recovery activities. To view the complete notification, click here.
COVID-19- BCBSMA is Extending Prior Authorization Waiver
BCBSMA understands that this is a trying time for all medical care providers due to COVID-19. To better support providers, BCBSMA continues to waive referral and prior authorization requirements for all inpatient levels of care. This includes acute, long-term acute (LTAC), acute and subacute rehabilitation (rehab), and skilled nursing facility (SNF) admissions. Starting with dates of service on or after October 1, 2020, providers will need to submit authorizations. To view the complete notification, click here.
Increased Fees for COVID-19 Lab & Specimen Collection Codes
BCBSMA is increasing the reimbursement for COVID-19 lab and specimen collection codes, retroactive to their effective date, in response to the Massachusetts Division of Insurance (DOI) Bulletin 2020-16, issued May 18, 2020. BCBSMA will reprocess all claims for these testing codes back to the code effective date. BCBSMA will continue to monitor our reimbursement for these codes as new information becomes available. This change applies to all products except Medicare Advantage. To view the complete notification, click here.
Temporary Payment Policy Update: COVID-19
Addition of reimbursement information for C9803. To view the complete policy, click here.
Boston Medical Center Health Net Plan
Electronic Claims Clearinghouse Update
BMC HealthNet Plan (BMCHP) has partnered with TriZetto Provider Solutions (TPS) to manage its electronic data interchange (EDI) transactions exclusively. Effective September 2, 2020, all clearinghouse service organizations and billing agencies that submit EDI transactions must send through TPS. To view the complete notification, click here.
Timely Submission of Clinical Documentation
Effective 9/1/2020, BMC HealthNet Plan Inpatient Utilization Management department requires that clinical documentation be submitted to the Plan within 24 hours from the submission of the Notification of Admission. For additional information, click here.
MyHealthNet: User Roles
We wanted to spotlight the new User Roles feature. Office Managers/Administrators can now assign portal access based on a staff member’s job function. You may have already noticed that your provider portal homepage is different from that of someone else in your office. That’s because different User Roles have different homepage widgets depending on their access level.
- New User Roles define portal access based on job needs
- Access levels streamline the user experience by only showing the functionality a job requires
- Provider Office Staff roles include Office Manager/Administrator, Super User, Claims, Auths, Claims and Auths, and Eligibility Only
To learn more about the User Role assigned to your account please consult your Office Manager/Administrator. The Main Office Contact is considered the Office Manager/Administrator in MyHealthNet and they are tasked with validating and assigning User Roles. They will be able to ensure that you have the appropriate access level should you have any concerns. If you have any additional questions, please contact your Alycia Messelaar, Alycia.Messelaar@lahey.org .
You can now enter your PCP Select Change Form on the HealthTrio Portal. The instruction begins on page 4.
You can also file appeals online as well under Office Management Request For Claims Review. You can now upload your documents.
Here is the link of instructions for your PCP Select Change Form.
CMS – Medicaid
New FAQs – COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies
An updated document has been posted to the website. To view the document, click here.
Medicaid Massachusetts / MassHealth
COVID-19 Public Health Guidance and Directives
The COVID-19 Guidance and Directives has been updated. 1) DPH Guidance, July 6: Defining Aerosol Generating Procedures and Recommended PPE 2) DPH Guidance, July 6: Updated Comprehensive Personal Protective Equipment a) This guidance replaces Comprehensive Personal Protective Equipment guidance published on May 21 3) EOHHS Guidance, updated July 1: Notice of Dedicated Care Capacity at Nursing Facilities for Patients Who Do Not Have COVID-19 4) EOHHS Guidance, updated July 1: Notice of Dedicated Care Capacity at Nursing Facilities for COVID-19 Patients 5) BSAS Visitation Guidance effective July 1, 2020 6) BSAS Offsite Visitation Attestation Form effective July 3, 2020 a) This guidance replaces the BSAS visitation guidance issued June 6, 2020. For additional information and to view the notification, click here.
All Provider Bulletin 298: MassHealth Telehealth Policy
The purpose of this bulletin is to consolidate and restate, with some modifications, MassHealth’s current telehealth policy (as reflected in All Provider Bulletins 289, 291, and 294), and extend that policy through December 31, 2020. This extended policy will help ensure members retain access to covered services, promote social distancing, and mitigate the spread of COVID-19 both before and after the expiration of that state of emergency, enabling members to remain in their homes to reduce exposure and transmission, to the extent possible, and to preserve health system capacity. For additional information and to view the notification, click here.
Fallon begins CAQH pilot
Fallon Health is committed to increasing the accuracy of our provider directories. As we have shared previously, we are working through Health Care Administrative Solutions, Inc. (HCAS) and Council for Affordable Quality Care, Inc. (CAQH) to continue to improve the experience of providers and help members access the most up-to-date information when seeking care.
When a provider reviews, updates and attests to the demographic information through the CAQH ProView® tool, Fallon—as well as other health plans—receives the updates to make changes in our system. We began piloting this process with a small group of providers on June 30, 2020 and will be expanding access to more providers moving forward. Visit the following websites for the latest training videos, announcements and directory information:
Electronic (ACH) Payments and Remittance Advice Summary (RAS) Access
Providers have access to electronic payments, payment history, status and Remittance Advice Summaries at their fingertips with partner Payspan. Follow the steps in the attached to navigate the system and access the Remittance Advice Summaries. For additional information and to view the notification, click here and scroll to related title.
Sampling and Extrapolation Process
As part of the Program Integrity initiative, Fallon conducts post-payment reviews to validate payments Fallon Health has made. When there is a large volume of claims involved in a population, auditing the entire population is typically not viable. Pursuant to the CMS Program Integrity Manual (Chapter 8) for guidelines regarding Statistically Valid Random Samples (RVRS), a random sample of claims can be selected for the audit. When calculating the amount to be recovered, Fallon ensures that all improper payments are totaled and extrapolated to the claims universe from which the sample was drawn. If a provider is selected to be audited and there are questions regarding the sampling or extrapolation process, reach out to the contact on the request letter. For additional information and to view the notification, click here and scroll to related title.
EDI 276 Claim Status Inquiry Patient Identification Issue
Fallon has identified an area of opportunity for improved member matching criteria for the 276/7 responses. When making a claim inquiry using the 276/7 follow the member matching criteria. Fallon Health requires providers to use a unique Fallon Health member identification number found on all Fallon Health ID cards. These member ID cards each have a 13-digit number. Providers should also enter the member’s first name, last name, middle initial and any special characters found on the Fallon Health ID card. When following this process, providers will have more successful 277 responses when searching for claims. For additional information and to view the notification, click here and scroll to related title.
Changes to Claim Reversals on the EDI 835 Remittance Advice
Effective August 26, 2020, Fallon Health is making a change to the coding of its Electronic Data Interchange (EDI) 835 Remittance Advice. As requested by providers for ease of posting claim reversals, Fallon Health is updating its core code to route Reversal claims through the same Claim Adjustment and Service Adjustment Segment (CAS) logic used for Original and Adjustment claims to determine the Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). The Reversal claim will now have a CAS segment that matches the same CARC/RARC present on the claim it is reversing. For additional information and to view the notification, click here and scroll to related title. Posted to the Connection July 2020 Newsletter.
Revised Telemedicine Payment Policy
The Payment Policy has been revised. Added Preventive visits and COVID-19 Remote Patient Monitoring. To view the entire policy, click here.
COVID-19, HEDIS 2020 and Pay for Performance
As expected, Fallon’s HEDIS hybrid measures were compromised due to the challenge of accessing charts for abstraction while administrative measures, those calculated by claims alone, were not impacted. Fallon Health has opted to rotate all of its hybrid measures and report HEDIS 2019 rates to NCQA. In an effort to be fair and equitable to providers — its provider community—Fallon Health intends to take the same approach with the Pay for Performance program. Fallon Health’s plan is to calculate P4P settlements using HEDIS 2019 rates for hybrid measures and HEDIS 2020 rates for those measures calculated using only claims. Additionally, NCQA is unsure at this point if they will be able to calculate national percentiles for 2020. For additional information and to view the notification, click here and scroll to related title.
Revised Aging Service Access Points (ASAP) Payment Policy
The Payment Policy has been revised. Update Policy and Billing and Coding sections related to COVID-19 temporary retainer payments. To view the entire policy, click here.
Tufts Health Public Plans
As previously communicated, and effective July 18, 2020, Tufts Health Provider Connect, the secure Provider portal previously used for all Tufts Health Public Plans products, will be replaced by the secure Provider portal utilized by Tufts Health Plan’s other lines of business (Commercial products [including Tufts Health Freedom Plan] and Senior Products). This change applies to Tufts Health Direct, Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs) and Tufts Health Unify.
Note: Providers whose Tufts Health Public Plans contracts include Tufts Health RITogether will continue to use Tufts Health Provider Connect for Tufts Health RITogether members until further notice.
Tufts Health Provider Connect claims data for Tufts Health Public Plans Massachusetts products from on or after April 26, 2019 will be available on the secure Provider portal. For more information, including how to access claims data for members of Tufts Health Public Plans Massachusetts products before April 26, 2019 if necessary, refer to the FAQs on Tufts Health Plan’s public Provider website.
For more information on this change, refer to the article and the FAQs on Tufts Health Plan’s public Provider website.
If you have any questions, feel free to reach out to Alycia Messelaar, Alycia.Messelaar@lahey.org.
Tufts Health Plans
Updates have been made to the COVID-19 Provider specific landing pages with coverage continuation or end date information. These policies have been put in place in connection with the COVID-19 crisis and are not intended to be permanent changes. For any policy without an end date listed or for which it states “until further notice,” we continue to evaluate Tufts Health Plan policies with the state emergencies and other regulations in mind, and will aim to provide at least four weeks’ notice in advance of any termination the policy. Please check our website for this updated information.
Other updates are listed below:
- Telehealth/Telemedicine: Updated billing guidelines posted 6/29/20
- Pre-Payment Billing Review Programs: Updated content posted 6/22/20
- COVID-19 Laboratory Diagnostic Testing: Home testing kits information added 6/17/20
Tufts Health Plan:
Refer to Coronavirus Updates for Providers.
Coronavirus (COVID-19) Updates for Providers – Telehealth/Telemedicine
Last updated 7/16/2020 with additional COVID-19 Laboratory Diagnostic Testing codes and policies. To view the complete notification, click here and expand Prior Authorization and Notification Flexibility section.
Imaging Services Payment Policy Update
Policy reviewed by committee; removed NIA prior authorization requirements to redirect to landing page; consolidated individual Commercial, Senior Products and Tufts Health Public Plans policies into one document; updated policy to reflect existing processes for claim edits for all lines of business. To view the complete policy, click here.
ClaimCheck Software Removed from Claims Processing System
Effective June 2020, Tufts Health Plan made the decision to remove ClaimCheck, the primary code auditing software for medical claims. Tufts Health Plan now exclusively uses the code auditing vendor Cotiviti. Note: This change impacts the message codes providers see on claim lines. To view the complete notification, click here.
Avoiding Administrative Claim Denials
The attached is a list of administrative claim denials that Tufts Health Plan providers may receive when submitting claims, along with tips on how to correct/avoid them. To view the complete list, click here.
Please reach out to Alycia Messelaar at 978-236-1784 or
Alycia.Messelaar@lahey.org to keep NEPHO informed of changes in practice schedules due to COVID-19 (office closures, limited office hours, scope of appointment, telehealth use, phone line to reach staff, etc.) or if you have questions about other practice schedules.
Click here to access a list of practices who are scheduling in office visits and/or TeleHealth visits at this time.
Please take a moment to review your practice information and reach out to Alycia Messelaar, Alycia.Messelaar@lahey.org with update requests.
The Northeast PHO is here to ensure you are not alone and that we are in this together. We are doing our best to keep your practice as updated as possible with all things COVID-19. Please take a moment to visit the COVID-19 tab on the by clicking here .
Click here to find the most recent links to COVID-19 specific health plan materials and updates. Please note, we have included health plans that NEPHO does not contract with in an effort to help keep you well informed of current COVID-19 updates we have been made aware of. If you have questions or concerns, please reach out to Alycia Messelaar, Alycia.Messelaar@lahey.org .
Beth Israel Deaconess develops tool to help users find the right mental health app
Katie Adams – Wednesday, July 15th, 2020
Researchers at Boston-based Beth Israel Deaconess Medical Center have developed a tool to help users sort through almost 200 different mental health apps to find one that best meets their needs and preferences.
The tool allows users to sort through nearly 200 mental health apps. They can filter the apps based on qualities they deem important, such as price, clinical research to support efficacy, privacy settings, and services and features offered.
Beth Israel’s team of developers made sure the tool did not include ratings or rankings for the apps, as these often reinforce a “one size fits all” mindset that they believe cannot be applied to an individual’s mental health service preferences. Instead, they designed the tool to take into account each user’s unique preferences, which mimics the way patients are treated in a clinic.
The tool emerges at a time when Americans’ interest in mental health apps is surging, as many are faced with grief and stress brought on by the pandemic and national unrest. The 20 most popular mental health apps experienced a 29 percent increase in downloads in April, according to market intelligence firm Sensor Tower.
How do you choose the right app?
There are over ten thousand apps targeting mental health conditions available for download and use today. These apps offer a range of possibilities for mental health, with the potential for symptom monitoring, therapy-inspired exercises, psychoeducation, and connection with a clinician or peer. Although an app can often be useful in care, it is important to be cautious about app selection, especially when it comes to app privacy, data use, and effectiveness.
The United States Food and Drug Administration (FDA) has taken a “hands-off” approach towards regulating apps. This lack of oversight means that not all available apps are safe and effective, and some may even pose significant dangers to users.
- Many claims made by apps have not been evaluated in feasibility or efficacy trials.
- Apps may offer incorrect or misleading information, including potentially harmful recommendations. In December 2019, a study of apps for depression and suicide prevention found that nonexistant or inaccurate suicide crisis helpline phone numbers were provided by apps downloaded more than 2 million times.
- Without stringent regulations, some apps may not securely protect the personal information that they collect. A 2018 analysis of mobile health apps revealed that 80% of apps shared health-related data with third parties, and only 50% of apps shared data securely.
When trying to find a safe and effective app in light of these dangers, many users turn to app store metrics like stars and numbers of downloads. These app store metrics, however, can be misleading. The app store score is not strongly correlated with clinical utility, and even the most popular apps (those with more than 10,000 downloads) have been shown to have strikingly low engagement, hampering therapeutic effectiveness. Although numerous app evaluation models have emerged in the attempt to help users find a safe and useful app, static lists and rankings of “best” apps can also be misleading, as they fail to account for both the continuous updates that apps undergo and the substantial variation among individuals: just as there is no one “best” medication or “best” form of therapy, different people react to and use apps differently and have varying clinical needs.
So how DO you choose an app? The best way is to start by identifying user priorities: how do they want to engage with the app? What features do they desire? Is there a particular standard of privacy they seek? Recognizing that app choice is a personal decision based on many individual factors, the goal of this database is to equip users with the information necessary to make a decision based on the app characteristics that matter most to them. Each app’s entry in the database is informed by 105 objective questions based on the American Psychiatric Association’s App Evaluation Model, which introduces Accessibility, Privacy & Security, Clinical Foundation, Engagement Style, and Interoperability as major categories to consider.
IPA/POD MEETINGS SUMMARIES
- Dr. Joseph Peppe invited meeting attendees to discuss topics of their interest related to
- Dr. Peppe shared how many practice meetings have been completed to date and who attended from the practice.
- Various topics were addressed and feedback has been positive.
- Dr. Peppe asked for feedback on number of meetings and about use of Google Meets as a venue.
- Carol Freedman shared that the Diabetes Care Collaboration Pilot will be relaunched.
- The pilot will be relaunched with one practice with the goal of exploring pre-visit planning for diabetes patients. Population Health will provide the most recent A1c, BP, and status of cancer screenings in advance of provider visit. Detail on next steps, process, and metrics was also shared.
- Dr. Peppe shared performance data on 2019 NEPHO dashboard compared to 2018.
- He also shared detail on NEPHO commercial performance compared to LCPN for 2019 vs 2018 and highlighted drivers of pmpm changes.
- Dr. Peppe shared his findings from a drilldown of 2019 high cost cases.
Reporting and Quality
- Liz Isaac shared the preliminary January through December 2019 PCP Risk Share Report Card. The report card will be finalized toward end of the year with 120 day claims runout and gate scores incorporating BCBS decision on appeals and exclusion data that NEPHO Quality will submit to BCBS in August.
- A sample of the LCPN PCP Dashboard was shared to highlight that LCPN has updated and distributed this report to all units for first quarter 2020. The dashboard shows PCP comparison to LCPN aggregate for various performance metrics. NEPHO will distribute the report to PCPs via email in the upcoming weeks.
- Liz shared the NEPHO Quality dashboard for BCBS PPO to kick start discussions and solicit feedback on ways to improve quality measure performance regardless of payer.
- NEPHO gate score performance lags behind the other LCPN units. Though it was hoped that efforts directed at improving BCBS AQC HMO performance would translate to improved performance on other payer quality programs, this has not materialized.
- There is a need for systems and processes and efforts all year long to improve performance and minimize dependence on “working the lists.”
- Liz shared reflections compiled by Press Ganey from 1 million telehealth surveys.
- Patients highly rate their experience with and loyalty to providers, while down rating the technical and process aspects of telehealth visits.
- The exception is families of pediatric patients who highly rate all aspects of the virtual visit.
- Dr. Peppe provided an update and next steps on the Serious Illness Grant that has been awarded to NEPHO and funded at 100%.
- August POD and IPA meetings have been canceled.
- There are 2 sessions planned for August 11th, 12 noon and August 19th, 12 noon for the Primary Care Quality Meeting for office managers and practice quality contacts. Content will be same for both sessions.
- Practice Specific Meetings will be held in lieu of POD meetings in September.
Diabetes Management and Nutrition
According to the American Diabetes Association (ADA), “What can I eat?” is the #1 question asked by people with diabetes when they are diagnosed.
The American Diabetes Association created a consensus report which reviewed hundreds of research articles with a panel of scientists, doctors, nutritionists, endocrinologists and diabetes educators to see what dietary patterns work well for people with diabetes. Everyone’s body responds differently to different types of foods and diets, so there is no single “magic” diet for Diabetes. But your patients can follow a few simple tips to find out what works for them to manage their blood sugar.
You can see the ADA’s quick-tips on this video
For the full ADA consensus report click here
The ADA Certified Diabetes Care Center at Lahey Outpatient Center in Danvers and Addison Gilbert Hospital in Gloucester offers comprehensive programs for the management of Diabetes. The Certified Diabetes Care and Education Specialists (CDCES) follow National Standards for Diabetes Self-Management Education.
Some of the services include but are not limited to:
- The Diabetes Care Clinic is staffed with Registered Nurses and Registered Dietitians who are Certified Diabetes Care and Education Specialists. The specialists will identify key educational components to self-manage your diabetes.
- Diabetes Group Classes include a 9 week program led by a Certified Diabetes Care and Education Specialist that covers the most recent technologies and therapeutics available including Continuous glucose monitoring (CGM’s), latest advances in insulin delivery and pump therapy.
- Gestational Diabetes patients are managed from diagnosis to delivery and thereafter as needed. This multidisciplinary approach includes glucose monitoring, nutrition and diabetes counseling.
Diabetes Care Center
Lahey Outpatient Center, Danvers
Diabetes Care Center
Addison Gilbert Hospital
As the NEPHO Health Coach I am more than happy to help your patients navigate the system by facilitating appointments or helping with accountability when needed, as a complement to your care and the services the DCC offers.
NEPHO Health Coach
In-person Routine and Preventive Visits
NEPHO practices are beginning to open their offices for in-person routine and preventive visits, a welcome development in the Massachusetts recovery from the COVID-19 pandemic. Yet it is not just business as usual. Because the practices must ensure the safety and health of both patients and practice employees, social distancing, masks, and intensive cleaning between patient visits all mean there is more for our practices to do with fewer staff members in many cases.
Now that routine preventive screenings such as mammograms, pap smears and colonoscopies are once again being scheduled, the Quality Team would like to assist our PCP practices in reaching out to their patients who are due for one or more cancer screenings in 2020. The Team has been working with BILHPN to develop a series of reminder letters that may be mailed or sent through the My Lahey Chart portal of the EPIC EMR, and easily adapted for use for nonEPIC EMR practices and their patients. Some of the ways in which the Quality Team can assist are as follows:
- Send reminder letters to patients due for a colonoscopy, offering to help them schedule one or send them a FIT/Cologuard if they prefer. The Quality Team would follow up on any outstanding tests.
- The Quality Team can send reminder letters to patients due for pap smears in 2020 asking them to contact their PCP to schedule screening. We are fortunate to be able to collaborate with Essex County OB/GYN and have already sent a list of those patients who have their pap smears at Essex County OB/GYN requesting that they reach out to schedule.
- Health Coach Lucia Kmiec, who has access to schedule screening mammograms at Beverly Hospital, Women’s Health Center, Addison Gilbert Hospital and Lahey Outpatient Center in Danvers, will call patients due for mammograms to facilitate scheduling.
NEPHO Quality Analysts Jennifer Andersen and Laureen Viel will be contacting PCP office managers regarding the above mentioned opportunities as well as other means by which the Quality Team might assist in reaching year end goals for quality performance.
The NEPHO Quality Team will hold two more Primary Care Quality Meetings next month on Tuesday, August 11th at 12 noon and Thursday, August 13th at 12 noon. The topics will be the same at both meetings and will include the NEPHO outreach efforts mentioned above. A “Hold the Date” notice was sent to all office managers and office Quality contacts on Friday 7/17/20.
If you have any questions about your patient lists please email Jennifer Andersen at Jennifer.firstname.lastname@example.org or Laureen Viel at email@example.com.
CODING TIP OF THE MONTH
OPTUM Newsletter – July 2020 – Focus High blood pressure (BP) and stroke
Get Your Practice Prepared for the 2021 Evaluation and Management (E/M) Updates
The 2021 E/M updates will provide significant potential to give physicians more time to spend with their patients by reducing the documentation burden. The focused changes include:
- Eliminating history and physical exam elements for code selection
- Allowing physicians to choose whether their documentation is based on MDM or total time spent
- Modifying MDM criteria to move away from simply adding up tasks to focus on tasks that affect the management of a patient’s condition
NEPHO is working to help support practices implement the 2021 E/M updates. Centers for Medicare and Medicaid Services (CMS) has confirmed the new direction, which would mark the first significant revision to the E/M code set from Medicare in more than 20 years. Because E/M services are at the heart of practice revenue, these changes will have an impact to current E/M payment policies and documentation guidelines. Practices need to understand updates to be fully prepared by the effective date of January 1, 2021.
NEPHO’s Education Plan for E/M 2021 Updates:
- Monthly Webinars Focused on the Following Areas:
- E/M Updated Guidelines Overview
- Medical Decision Making (MDM) Table Updates
- Complexity of Problems Addressed Review
- 2021 MDM Terms and Definitions
- Prolonged Services Update
- Staying Compliant
Practices are encouraged to start planning now for the operational, infrastructural, and administrative workflow adjustments that will result from this E/M overhaul. NEPHO has put together the following checklist to help practices make a plan for implementation of E/M updates:
- Identify a Project Lead
- Schedule Practice Team Preparation Time
- Update Practice Procedures
- Consider Coding Support
- Have an Awareness of Medical Malpractice Liability
- Guard Against Fraud and Abuse Law Infractions
- Update your Practice Compliance Plan
- Meet with your Electronic Health Record (EHR) Vendor
- Assess the Potential Financial Impact
- Understand Employer and Payer Guidelines
Please reach out to Shawn Bromley at firstname.lastname@example.org or 978-236-1704 if you would like to set up time to discuss next steps in making a practice plan to prepare for the new E/M changes coming 2021.
PATIENT EXPERIENCE COMMENTS
Cape Ann Medical Center – 1 Blackburn Drive
- Dr. Shawn Pawson is one of the most knowledgeable and caring physicians I’ve ever seen.
Cape Ann Pediatrics – 298 Washington Street
- Dr. Jeffrey Stockman and Cape Ann Pediatricians are amazing.
Garden City Pediatrics – 83 Herrick Street
- Dr. Suzanne Graves is the best! Always a great experience at Garden City. The nurses are fantastic.
- We love Dr. Elizabeth Humphreys – she always goes above and beyond, especially during COVID!
Lahey Primary Care, Beverly – 30 Tozer Road
- Dr. Gail Ellis is always professional caring interested and helpful and patient!
Lahey Primary Care, Danvers – 480 Maple Street
- This was my first telehealth appointment with Dr. Kristina Jackson and I was very
impressed by how quickly I got to speak to my doctor and how easy it was!
- Dr. Tina Waugh and her staff are excellent and thorough, always.
Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor
- Dr. Victor Carabba is an excellent primary care physician very compassionate
Lahey Primary Care, Hamilton – 15 Railroad Avenue
- Dr. Hugh Taylor is great! I’ve seen him for about 30 years.
Lahey Primary Care, Manchester – 192 School Street
- Dr. Nicholas Avgerinos is my PC. He’s very smart, has a great bed side manner. Very good doctor!
North Shore Pediatrics – 480 Maple Street
- I could not ask for a better pediatrician then Dr. Lance Goodman. He’s terrific!
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 winner is:
Kim Hoar, Danvers Family Doctors, PC was nominated for going above and beyond with help supporting Quality Metrics and working with NEPHO on a variety of projects.
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.