News from NEPHO – MAY 2020 Edition


Lori Jurgens, DDS
Salem Peabody Oral Surgery
6 Essex Center Drive Suite 112A
Peabody, MA 01960
978- 531-1450  (F) 978-531-9984


  • William Pultar, DO of Blackburn Primary Care has retired effective 5/20/2020
  • Thomas Carbone, MD of Cape Ann Pediatrics has retired effective 3/14/2020
  • The following providers have migrated to new EHR systems
    • Henry Frissora, MD of Henry Frissora, MD has changed to Epic Community Connect effective 4/8/2020
    • Betsy August, MD of Northeast Medical Physicians Group OB/GYN Salem has changed to Lahey Epic effective 4/6/2020

SAVE THE DATE                                                   

Click here to read Dr. Kimball’s Bio and the Bios of this year’s Board of Directors candidates

NP / PA Meeting – CME approved
Date: Wednesday, June 17, 2020 @12:00 noon
Place: Google Meet (More information to follow)

Date: Tuesday, June 30, 2020 @7:30 a.m.
Place: Google Meeting
RSVP: or 978-236-1784

All meetings will be conducted using Google Meet
(contact if you wish to attend)

Date: Wednesday, June 3, 2020
@ 11:00 a.m. – 12:00 noon

Date: Wednesday, June 10, 2020
@ 10:00 a.m.- 11:00 a.m.

Date: Wednesday, June 17, 2020
@ 10:00 a.m.- 11:00 a.m.

Date: Wednesday, June 24, 2020
@ 10:00 a.m.- 11:00 a.m.

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 IPA meetings.   Due to the COVID-19 directive from Governor Baker, regarding social distancing for meetings we will be providing conference call information and links for upcoming meetings.

A COVID-19 tab is provided on our site which we hope you will visit to read the latest updates and the various helpful links regarding the coronavirus.

Support our frontline medical colleagues by staying home and staying safe!


Nurses Week was celebrated May 6th to May 12th 2020.  The celebration  took place in a different environment due to COVID-19.

Nurses did not share the team lunch, did not receive small gifts, and did not share face-to-face gratitude.

The world has received a front  view of the nurse’s role during COVID-19. Whether the nurses are behind a mask and face shield or in their homes, the contribution of nurses during COVID-19 has been unlike anything in history.  Accolades of gratitude have been witnessed by neighborhood private “parades”, news stories and military flyovers, but the most important gift a nurse can receive is when a patient says Thank You, either verbally or simply by the look in their eye.

L-R: Betsey Boccuzzi, Karen Keveny, Amy Gibbs, Jean St. Peter, Diane Hannify-Broughton, Sharon Gard, Karen Richard (not pictured Erin Higgins)

Let us all stay safe and well, Kenneth King


Once again, Leapfrog awarded Beverly Hospital an A for Quality and Safety.  See the attached article,  Beverly Hospital is only one of 32 hospitals out of 2600 nationally that have earned a grade A 17 consecutive times since 2012.


Blue Cross Blue Shield of Massachusetts

Medical Policy Announcements

BCBSMA posted a list of policies which include the following: 1) New and revised policies; 2) Clarified policies; 3) Retired policies. A full draft version of each policy is available only by request, to ordering participating clinician providers, one month prior to the effective date of the policy. To request draft policies, contact Medical Policy Administration at To view the list, click here.

Boston Medical Center Health Net Plan

COVID-19 Resources 

Boston Medical Center Health Net Plan has posted the attached page that contains the most up-to-date policies and coverage relating to COVID-19. Boston Medical Center Health Net Plan will update this page as information evolves. On May 7, 2020 number 3 Telehealth section has been updated along with number 6 Prior Authorization.  To view the updates, click here.

CMS – Medicare

Opioid Treatment Programs (OTPs) Medicare Billing and Payment Fact Sheet

Beginning January 1, 2020, Medicare will pay Medicare-enrolled Opioid Treatment Programs (OTPs) to deliver opioid use disorder (OUD) treatment services to Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) is now accepting and processing OTP enrollment applications. For more information on how to enroll as an OTP provider, review the Opioid Treatment Programs (OTPs) Medicare Enrollment Fact Sheet. For additional information, click here.  Posted to the website 5/19/2020.

List of Telehealth Services: Covered Telehealth Services for PHE for the COVID-19 Pandemic Update 4/30/2020

List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth. The coding list has been expanded to add temporary additions for the PHE for the COIVID-19 pandemic added 4/30/2020. To view the update, click here.

Fallon Health

Federal Guidance Suspends Some Health Plan Timelines for Employees During Pandemic (COVID-19)

The COVID-19 pandemic—and resulting declaration of national and state emergencies—continues to have an impact on health plans and commercial insurance coverage. Recently, federal regulators temporarily suspended limits on timelines that commercial members and employer groups must normally adhere to for certain types of actions. This suspension is in place to ensure that individuals who might have missed key deadlines during the COVID-19 outbreak will not have a loss or lapse of their group health coverage or a denial of a valid claim for benefits. For additional information and to view the notification, click here.

COVID-19 FAQ for Providers (Telehealth/Telemedicine) (Updated)
Fallon Health has revised the COVID-19 FAQ for Providers, effective May 4, 2020. To view the FAQs, click here.

Harvard Pilgrim Health Care

Improving Documentation Specificity for Alzheimer’s Disease and Dementia
For additional information and to view the notification, click here.

Tufts Health Plans

Coronavirus (COVID-19) Updates for Providers – Telehealth/Telemedicine
Last updated 5/15/2020: Most claims related to COVID-19 will be reprocessed by May 26, 2020. To view the complete notification, click here to expand Prior Authorization and Notification Flexibility section.

Tufts Health Public Plans

Due to the high number of Tufts Health Public Plan (THPP) employees working remotely during this time, please send appeals for THPP claims to email address: Please note: you will not get a confirmation email but you will have the email trail of the request and follow ups tied to the appeal submission.


Please reach out to Alycia Messelaar at  978-236-1784 or 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.

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 NEPHO website by clicking here .

Click here to find links to COVID-19 specific health plan materials and updates. If you have questions or concerns, please reach out to Alycia Messelaar,

Dear colleagues,
Attached you will find a list of practices who are scheduling in-person office visits and/or TeleHealth visits at this time. To view the list click here.

If your practice is not listed, your office manager may have overlooked the Practice Operations and Patient Flow Survey previously sent by the PHO on May 12, 2020. Please take a moment to complete the survey in order to share your practice information with other NEPHO practices. The link is:  

We will continue to update you as additional practices begin to reopen.

Stay safe and thank you for all you do!

Alycia A. Messelaar, Manager, Provider and Payor Relations
Northeast PHO, 500 Cummings Center – Ste. 6500, Beverly, MA  01915
   F: 978-236-1777,

Take a moment to look at what other practices are doing to adapt to the changes ahead. During this time it is important to remember that although you cannot change what’s going on around you – you can start changing what’s going on WITHIN YOUR PRACTICE.  Click here to view the results from the Practice Operations and Patient Flow Survey for a look at how the NEPHO community is changing the way they operate.
Please reach out to Alycia Messelaar with thoughts or ideas of how we can better serve our patients during this time and bring a sense of ease as we move forward.


Population Health Patient Outreach Program

Carol Freedman provided a summary of ongoing outreach efforts by BILHPN Medicare and NEPHO Commercial Care Managers, BILH Primary Care office based outreach and with focus on new NEPHO outreach efforts for diabetes and hypertension patients.

The focus of the outreach is for general assessment, to check for need of appointment and to inform patients about the telehealth visit options that are available.  Responses by patients have been very positive. Data for outreach through April shows a near fifty percent reach rate for connecting with patients. Care is being taken to avoid duplication of effort.

Quality and Patient Experience

PHQ -9 > 9 Outreach:  Liz Isaac provided an update that work is being done to identify patients who had PHQ-9 greater than 9.  Data is provided to  practices so they can outreach to these patients and schedule a Telehealth visit as appropriate.   Currently the reporting is limited to EPIC practices. (Care is being taken to avoid duplication of efforts.)

Liz shared that Press Ganey (PG) has developed a Telehealth survey to gather patient experience specific to Telehealth visits.  In person visits will continue to be surveyed using original Medical Practice surveys.  Currently there is no additional cost or change in contract language for use of the Telehealth survey.  Outreach to practices is happening to set up  PG visit files to identify Telehealth visits.  A copy of the PG Telehealth survey was shared.

MHQP and plans for Telehealth Survey: MHQP is seeking provider input on a Telehealth survey they are developing to gather patient and provider experience.

For an update on NEPHO Transparency Pilot, Liz shared that the next step is to identify a timeline to re-schedule a meeting with BILH Marketing that had been postponed due to COVID-19.  Star ratings and patient feedback by provider from surveys will be sent through email.


Year to date meeting attendance was provided.  Adding 1 to the POD Meeting column represents the total meetings attended.  PCPs received credit for March Open Meetings as the meetings were cancelled in compliance with BILH’s mandate regarding social distancing and in-person  meetings due to COVID 19.

Future Care

Dr. Peppe invited discussion on how care will be provided in the future.  Dr. Peppe shared a slide that predicts COVID 19 waves and impact on Acute, Chronic and Population Health care.   Outreach efforts will have to ramp up but how to do so safely is one of multiple considerations.


Pharmacy Update

BILH COVID-19 Treatment Guidelines have been updated as of May 13, 2020.  Included in this comprehensive document are the following:

  • A summary flow chart by level of care
  • Considerations for Experimental COVID-19 Therapeutics
  • Patient-Specific Supportive Care and Therapeutics
  • Agents not currently recommended
  • Concomitant Medication Considerations (e.g. Statins, ACEI / ARBs, Inhaled Steroids and NSAIDS)
  • Special Population Characteristics

In addition, other links such as the  Liverpool COVID-19 Drug Interactions and  UCSF Protease inhibitor drug interactions sites.

For questions or more information contact Carol Freedman, NEPHO Pharmacy Manager 978 236 1774 or


Patient Outreach Update

In a collaborative effort, the NEPHO Pharmacist and Health Coach continue outreaching to at-risk patients across all commercial payers in an effort to prevent the deterioration of chronic conditions such as Diabetes and Hypertension.  As of 5/19/20, 468 patients have been reviewed, 216 patients outreached, and 106 reached, resulting in a 49% reach rate.  35% of the reached patients have been referred to PCPs and 9% to the NEPHO Pharmacist and Specialists.

Patients who had appointments cancelled without being rescheduled and some in need of assistance due to job and or insurance changes were identified and assisted.  In addition, the need for follow up for services were facilitated when ordered by primary care providers (e.g. CGM devices)

We will continue assessing our patient’s risk factors and the current state of their condition as well as inquiring about medication refill/renewals needs, and educating patients about existing resources and the availability of Telehealth and Telephone visits with PCP.

If you have any questions please reach out to Carol or Lucia.

Carol Freedman RPh, MAS, BCGP
NEPHO Clinical Pharmacist
Mobile: 978 380 4089

Lucia Kmiec
NEPHO Health Coach
Mobile: 978-880-2318


OPTUM Newsletter – May 2020 Focus: Rheumatoid arthritis

Overview of Evaluation and Management (E/M) Changes Coming in 2021

E/M changes are coming in 2021. The changes focus on documentation-related updates for office/outpatient E/M visits (CPT codes 99201 through 99215). The following changes will be effective January 1, 2021:

  • Deletion of level outpatient visit CPT code 99201: Code 99201 Office or other outpatient visit for the evaluation and management of a new patient, will be deleted due to low utilization.
  • History and exam will not be a necessary element of office/outpatient E&M code selection: History and exam elements will no longer be factored into office/outpatient E&M code selection, though they will be necessary to report the office/outpatient E&M service. Instead, the codes will be selected either by total time or by level of medical decision-making.
  • “Time” definition has changed: The definition of time associated with 99202-99215 has been changed from “typical face-to-face time” to “total time spent on the day of the encounter.” Starting 2021, physicians will no longer need to establish how much time was devoted to counseling and coordinating on the day of the encounter. The time values associated with each office/outpatient E&M code will reflect the total time spent on the day of the visit.
  • Revisions to the MDM elements associated with codes 99202-99215: There will be changes to the language of the MDM elements:
    • “Number of Diagnoses or Management Options” will change to “Number and Complexity of Problems Addressed”
    • “Amount and/or Complexity of Data to be Reviewed” will change to “Amount and/or Complexity of Data to be Reviewed and Analyzed”
    • “Risk of Complications and/or Morbidity or Mortality” will change to “Risk of Complications and/or Morbidity or Mortality of Patient Management”
  • Additional E/M documentation changes: Guidelines for hospital observation, hospital inpatient, consultations, Emergency Department, nursing facility, domiciliary, rest home, custodial care, and home E&M services will not change.
  • Guideline Update for Office or Other Outpatient codes 99202-99215:
    • Adding new guidelines that are applicable only to Office or Other Outpatient codes 99202-99215; adding a Summary of Guideline Differences table of the differences between the different sets of guidelines.
    • Adding a MDM table applicable to codes 99202-99215.
    • Adding guidelines for reporting time when more than one individual performs distinct parts of an E/M service.
  • Changes to Prolonged Services: Proposed updates include:
    • Revising codes 99354 and 99355 to exclude reporting of Office and other Outpatient Services codes.
    • Revising code 99356 to include observation.
    • Adding a new code to report prolonged office or other outpatient E/M services.
  • These updates will have implications for documenting E/M services and assigning codes. Payers, including Medicare, have their own set of guidelines for claim submission.  Physicians need to be knowledgeable about payer guidelines and policies to ensure accurate CPT coding and error-free claim submission.
  • Implement Changes Effectively:
    • Designate a practice/project lead
    • Allow for preparation time
    • Educate team on coding and documentation changes
    • Connect with your EHR vendor
    • Update practice policies and workflow documents
    • Understand Medicare and commercial payer requirements
    • Review the potential practice financial impact related to changes
    • Have an understanding of RVU updates and fee schedule changes
    • Review documentation changes with your medical malpractice liability insurer
    • Stay compliant with federal and state regulations

Please contact Shawn Bromley at 978-236-1704 and/or if you would like to discuss a plan to get your practice ready for the E/M changes coming January 1, 2021.


Blackburn Medical1 Blackburn Drive
• Dr. Jay Isaac is superb!

Cape Ann Medical Center – 1 Blackburn Drive
I’ve been especially happy with the contacts Dr. Janet Doran and her assistants have initiated during the
XCOVID-19 crisis.

Garden City Pediatrics – 83 Herrick Street
• Dr. Sheryl Silva is an attentive, knowledgeable, down to earth provider who relates well to children and parents alike.
• Dr. Suzanne Graves recently saw my daughter when she had an urgent issue. We saw 3 providers at GCP, and they were
Xall attentive, caring and knowledgeable.

Lahey Primary Care, Beverly  – 30 Tozer Road
• Dr. Susan Deluca has been my PCP for years. She is the best doctor!
• Dr. Neeraj Mahajan is a consummate professional – caring and thorough. A great MD.

Lahey Health Primary Care, Gloucester 298 Washington Street 4th Floor
Many years my wife and I have seen Dr. Victor Carabba – wonderful doctor who I have sent many friends to!
• Dr. Karen Damico was exemplary!

Lahey Health Primary Care, Gloucester  – 298 Washington Street 1st Floor
• Dr. Amy Esdale is so efficient, so respectful, so prompt, so engaging.

Lahey Primary Care, Hamilton 15 Railroad Avenue
I am 100% confident in Dr. Laurence Gordon and his staff, so happy with these guys.

Lahey Primary Care, Manchester192 School Street
• Dr.  Nicholas Avgerinos is thoughtful kind, intelligent and well suited to his role as a PCP.
• Dr. Jana Oettinger and her office staff are terrific; office is run very efficiently.

North Shore Pediatrics 480 Maple Street
We absolutely love this practice. We have complete trust in Dr. David Danis and all the NP’s.
We are so happy with Dr. Lance Goodman and the care at this practice and feel so comfortable with them.

Thomas Pearce, MD  279 E. Main Street
• Dr. Thomas Pearce and his staff are very helpful all the time.

Candace Thompson, MD  9 E. Drive Osman Babson Road
• Dr. Candace Thompson is never rushed and is very patient answering questions and giving me the time to talk.