News from NEPHO – JULY 2022 Edition


NEW PROVIDERS


  • Bhavna Abbi, MD of Lahey Outpatient Clinic Danvers, Rheumatology, 480 Maple Street Danvers, MA 01923 Phone: 978-304-8401 Fax: 978-304-8449. Anticipated start date: 8/15/2022
  • Lihi Tzur, MD of DermPhysicians of New England 83 Herrick Street Suite 3001, Beverly, MA Phone: 781-272-7022 Fax: 781-272-8786. Anticipated start date: 9/1/2022
  • Sophia Drinis, MD of Lahey Institute of Urology, Beverly 75 Herrick Street Suite 219, Beverly, MA 01915 Phone: 978-927-0714 Fax: 978-927-9135. Anticipated start date: 9/15/2022

PRACTICE CHANGES/UPDATES


  • Mauri Cohen, MD of Beth Israel Lahey Health Primary Care, 5 Federal Street Danvers, MA 01923, has announced he will be closing his panel to all patients effective 9/30/2022
  • Robert Tufts, MD, 480 Maple Street Suite 103, Danvers, MA 01923 has announced his retirement effective 12/31/2022
  • Carl Johnson, DO of Masconomet Healthcare Center, 123 High Street, Topsfield, MA 01983 has termed effective 7/14/2022
  • Deborah Shih, MD of Beth Israel Lahey Health Primary Care and Specialty Care Beverly Medical Associates, 30 Tozer Road, Beverly MA 01915 has closed her panel, except to existing patients effective 7/25/2022
  • Jennifer Lipman, MD of Beverly Pathology, 85 Herrick Street, Beverly, MA 01915 has termed effective 6/30/2022

SAVE THE DATE


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.

Coding and Billing Webinar – Overview of Problem List Clean-up
Date: Wednesday, August 10th @ Noon
Location: Teams Meeting
RSVP: Margaret.M.Doyon@Lahey.org

New Physician Orientation
Date: 
Tuesday, August 23rd @ 5:30 PM
Location: Teams Meeting
RSVP: Alycia.messelaar@lahey.org

Coding and Billing Webinar – ICD 10-CM 2023 Updates
Date: 
Wednesday, September 7th @ Noon
Location:
Teams Meeting
RSVP: 
Margaret.M.Doyon@Lahey.org

NP/PA Meeting
Date: Wednesday, September 21st @ Noon
Speaker: Eileen Duffey-Lind, MSN, CPNP
Topic: HPV and the Cancer Connection

RSVP: Alison.Wiklund@lahey.org


THE SCHWARTZ CENTER


The Schwartz Center is working to support caregivers, healthcare leaders and others and bring compassion to every healthcare experience. Here are some updates from their recent newsletter:

We are pleased to announce that we are working toward an exciting new affiliation with the Dr. Lorna Breen Heroes’ Foundation to create a comprehensive organization. Together, we will drive our healthcare system forward in supporting its most valuable resource: its workforce. We must change our healthcare system to better protect the well-being of the health workforce, so they can deliver high-quality, compassionate patient care.

Learn more about our plans to protect the well-being of the health workforce and join us for an info session as we plan the future at https://healingourhealthsystem.org/

Our Virtual Compassion in Action Healthcare Conference brought together hundreds of healthcare professionals, leaders and others like you who are committed to compassionate healthcare. We hosted an exchange of diverse thoughts and ideas around the critical importance of compassion in healthcare, particularly during this challenging time. 

If you missed it, you can still register and receive recorded access to sessions using this link

https://www.theschwartzcenter.org/


NO SURPRISE BILLING UPDATE


Please click here to view and download a practice checklist that the BILH General Counsel office developed in order to assist BILHPN’s participating physicians with compliance with the federal No Surprises Act. You can focus on the Federal requirements only for the time being. On Saturday, July 16, Governor Baker signed a law that delays the disclosure and notification requirements of the Massachusetts Patient’s First law until January 2025. This means that physicians will still need to comply with the Federal No Surprises Law, but will not need to comply with the Massachusetts requirements until January 2025. 

The document also includes a reference chart to help guide providers on which requirements of the federal and Massachusetts laws apply, depending on the insurance status and location/service a patient is seeking. For example, the bulk of the obligations a provider that never provides items/services in connection with a patient visit to a Hospital or ASC will have are under the Massachusetts not the federal law (i.e., a large portion of the federal law (i.e., the prohibition on balance billing) would not apply to such a provider).


PAYOR UPDATES


Payor Medical Policy Update
Blue Cross Blue Shield of Massachusetts Expanding Telehealth Payment Parity for Mental Health Services

Effective 07/08/2022 In an effort to continue to increase access to mental health services for members, BCBSMA is pleased to announce an update to telehealth reimbursement. Effective for dates of service on or after August 1, 2022, when a claim includes a primary/principal diagnosis code only of F01 through F99 (indicating the primary nature of the visit is mental, behavioral, or neurodevelopmental disorders), we will reimburse telehealth at the same rate as in-person visits for all providers, regardless of specialty. To view the complete notification, click here.

Blue Cross Blue Shield of Massachusetts Medical Policy Announcements

Effective 10/01/2022 This document announces new medical policy changes that take effect October 1, 2022. For additional information and to view the notification, click here.

Blue Cross Blue Shield of Massachusetts Authorization Requirements by Products

Effective 07/01/2022 BCBSMA has posted an updated Authorization Requirements by Products. To view the complete list, click here.

Blue Cross Blue Shield of Massachusetts
Online Services extension

To allow more time for you to set up patient data and start submitting claims on ConnectCenter, BCBS will be removing the claim submission feature in Online Services on a rolling basis. To view the complete notification, click here

Fallon Coding Corner: Coding Updates

Effective 09/01/2022 Fallon Health has posted an updated list of Coding updates, effective September 1, 2022. For additional information and to view the entire list, click here and scroll to related title.

Harvard Pilgrim Health Care COVID-19 Information and Resources (COVID-19/Telemedicine/Telehealth)

Effective 07/01/2022 Harvard Pilgrim Health Plan has updated the Latest Updates as follows: Removed previously end dated policies related to prior authorization and concurrent review; streamlined existing COVID-19 Treatment information; added information regarding Harvard Pilgrim’s new Telehealth/Telemedicine Payment Policy, effective for dates of service on or after September 1, 2022. For additional information and to view the notification, click here.

Harvard Pilgrim Health Care COVID-19 Testing, Treatment& Vaccine Coding (COVID-19)

Effective 07/07/2022 Harvard Pilgrim Health Care has updated the COVID-19 Testing, Treatment & Vaccine Coding guide. For additional information and to view the notification, click here.

Harvard Pilgrim Health Care Payment Policy Update: Interim Telemedicine/Telehealth Payment Policy (COVID – 19 Pandemic)

Effective 09/01/2022 Harvard Pilgrim Health Care has updated the Payment Policy as follows: Added services on or after 9/1/2022 provider should refer to the Telehealth/Telemedicine Payment Policy. For additional information and to view the notification, click here.

Medicare

 

Claims Processing Instructions for the New Hepatitis B Vaccine Code 90759

Effective 07/05/2022 CMS pays for the new Hepatitis B vaccine provided on after January 11, 2022. Starting July 5, CMS process claims for HCPCS code 90759 and price the vaccine per the average sales price drug pricing file. Coinsurance and deductible don’t apply. For additional information, click here.

Medicare  MLN Connects Special Edition: CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care

Effective 07/07/2022 On July 7, CMS issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care — particularly in rural and underserved areas. These proposed changes play a key role in the Biden-Harris Administration’s Unity Agenda — especially its priorities to tackle the nation’s mental health crisis, beat the overdose and opioid epidemic, and end cancer as through the Cancer Moonshot — and ensure CMS continues to deliver on its goals of advancing health equity, driving high-quality, whole-person care, and ensuring the sustainability of the Medicare program for future generations. For additional information, click here.

Medicare  Following President Biden’s Executive Order to Protect Access to Reproductive Health Care, HHS Announces Guidance to Clarify that Emergency Medical Care Includes Abortion Services

Effective 07/01/2022 The U.S. Department of Health and Human Services (HHS) announced new guidance and communication to ensure all patients — including pregnant women and others experiencing pregnancy loss — have access to the full rights and protections for emergency medical care afforded under the law. This announcement follows President Biden’s executive order on reproductive health. For additional information, click here.

Tufts Health Plan New Telehealth Payment Policy to Replace Temporary COVID-19 Policy 

Effective 09/01/2022 In the early days of the COVID-19 pandemic, Tufts Health Plan instituted an interim payment policy to address the unique needs of our providers and members during the unprecedented public health crisis. The Temporary COVID-19 Telehealth Payment Policy was developed to temporarily replace the previously existing policy, expand the scope of coverage during the pandemic, and offer guidance on coverage and billing. For dates of service beginning Sept. 1, 2022, this interim policy will be retired, and Tufts Health Plan’s new, Telehealth/Telemedicine Payment Policy will take effect. For additional information and to view the entire notification, click here

Tufts Health Plan Preventive Services Payment Policy Update

Effective 07/07/2022 Added codes 0073A, 0074A, 0083A, 0111A, 0112A, 91305, 91307, 91308, 91311, K1034 to covid section. To view the complete notification, click here.

Tufts Health Plan Correct Coding Updates for COVID-19 Specimen Collection (All Products)

Effective 09/01/2022 Tufts Health Plan is updating the Laboratory and Pathology Payment Policy to reflect correct coding related to specimen collection for COVID-19 testing. As a result, effective for dates of service beginning Sept. 1, 2022, the following billing and reimbursement practices will apply. HCPCS codes G2023 or G2024 for COVID-19 specimen collection will only be reimbursed when billed by an independent clinical laboratory, and HCPCS code C9803 should be reported when COVID-19 specimen collection occurs during a hospital outpatient clinic visit. For additional information and to view the entire notification, click here.

Tufts Health Public Plan Tufts Health Public Plans Reminder: EFT Through Payspan in August (Tufts Health Public Plans Products)

Effective 07/01/2022 Tufts Health Plan will use Payspan Health for electronic funds transfer (EFT) and distribution of paper checks for the Tufts Health Public Plans products. Previously, Change Healthcare provided these services for Tufts Health Public Plans products. Payspan offers providers a self-service environment to manage their electronic payments and review current or past Payspan payments. Providers will be able to direct payments electronically to a bank account and can access the 835 electronic remittance advice (ERAs) and explanation of payment (EOPs) for claims processed directly through the Payspan portal. For additional information and to view the entire notification, click here.

 


PHARMACY UPDATES


Blood Glucose Monitors and Continuous Glucose Monitoring Devices

Please see the BILHPN 2022 May Pharmacy newsletter under Blood Glucose Monitoring Series, Part 2: Continuous Glucose Monitoring (CGM) for detailed health plan and patient assistance information for both blood glucose meters and CGM monitoring devices. Click on website and health plan links within the newsletter to access valuable information.

   

In case you missed it: LHMC Grand Rounds recently (6/3/22) presented “SGLT2 Inhibitors and Beneficial Effects on the Heart and Kidney.” Speakers were Dr. Mary Beth Hodge from the Department of Endocrinology, Dr. Alin Anni Joseph from Department of Nephrology and Dr. Richard Patten from the Department of Cardiology, Tufts Medical Center. The presentation was recorded and the link is below.

SGLT2 Inhibitors are one of the newest agents available for management of diabetes but have other, significant downstream effects on the heart and kidneys and have been a revolutionary new tool available. Please see SGLT2 inhibitor prescriber pearls document for your reference.

Objectives of the presentation:

  • To understand the mechanisms of action of SGLT2 inhibitors
  • To learn about the benefits of SGLT2 inhibitors beyond control of hyperglycemia that extend to chronic kidney disease and cardiovascular disease risk reduction
  • Become familiar with how to prescribe SGLT2 inhibitors and their side effects

Click here to view the presentation. 

BILHPN Newsletters:

Each month the BILHPN Pharmacy Team publishes a valuable newsletter with current pharmacy related issues. You can access them by using the www.nepho.org Website under Pharmacy Resources*

*please note, a password is now required to log into Pharmacy Resources on the www.nepho.org website. If assistance is needed, please contact Alycia Messelaar at Alycia.Messelaar@lahey.org.

For more information please contact Carol Freedman at carol.freedman@lahey.org or at 978-380-4089.


PROVIDER RELATIONS


Things are constantly changing with 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 at alycia.messelaar@lahey.org for such requests. We are here to help bring ease to both the practices and the patients you serve. 


Virtual Networking videos from NEPHO providers can be found at https://www.nepho.org/virtual-networking/.

Please reach out to Alycia Messelaar at alycia.messelaar@lahey.org if you are interested in being featured in a Virtual Networking video. 


Please reach out to Alycia Messelaar at alycia.messelaar@lahey.org to keep NEPHO informed of changes in practice schedules due to the current resurge of 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 for the PDF version of the updated PHO Directory as of July 2022. For your convenience click here for the separate Specialists Only PDF directory to refer to as needed.

Please share this directory with your office by printing or showing them how to visit us online for an easy to use directory search tool.

Note: Primary care providers (PCPs) in the BILH Performance Network no longer need to submit an administrative referral to refer Blue Cross Blue Shield of MA, Harvard Pilgrim Health Care, or Tufts Health Plan members to a specialist in the BILH Performance Network. Please reach out to Alycia Messelaar, Alycia.Messelaar@lahey.org, regarding questions pertaining to providers within the BILHPN Network. 

As a reminder, it is important to use the NEPHO Physician Directory when referring to a specialty physician. 


Here at the PHO, we completely understand how overwhelming it can be to stay on top of all the email communications that are being sent on a day-to-day basis. In an effort to keep you well informed, below you will find a highlight of key memos that have been sent out over the last month – Just in case you missed it!

  • Monthly BILHPN Pharmacy Newsletters
  • 2022 ACO MIPS
  • From the Northeast PHO Quality Team: Evening Diabetes Clinics
  • TeleHealth FAQ’s in follow up to April 2022 BILHPN BCBS Telehealth Payment Policy training
  • Update on COVID-19 Ambulatory Therapeutics
  • We need your help: COVID-19 Business Impact Survey

Please reach out to Alycia.messelaar@lahey.org for a specific communication that you are unable to find.


CODING TIP OF THE MONTH


OPTUM NEWSLETTERJuly- Focusing on Arthritis (rheumatoid, osteo and psoriatic)


Evaluation and Management (E/M) Services will have updates coming in 2023. The updates will be effective January 1st, 2023. E/M had an overhaul in 2021 with Outpatient services and the following areas will now be following in line.

E/M service Proposed changes
Inpatient and Observation Care Services Deletion of the following codes:
Observation care discharge: 99217
Initial observation care: 99218-99220
Subsequent observation care: 99224-99226
Revision of the following codes to include observation care services, and revision of subsection headings and guidelines:
Initial hospital care: 99221-99223
Subsequent hospital care: 99231-99233
Observation or inpatient care: 99234-99236
Hospital discharge management: 99238-99239 
Consultations  Deletion of the following codes: 
Office or other outpatient consult (lowest level): 99241 
Inpatient consultation (lowest level): 99251 
Revision of the following codes including headings and guidelines: 
Office or other outpatient consult: 99242-99245 
Inpatient consultation: 99252-99255 
Emergency Department Services  Revision of the following codes and guidelines: 
Emergency department: 99281-99285 
Nursing Facility Services  Deletion of the following codes: 
Other nursing facility services: 99318 
Revision of the following codes and subsection guidelines: 
Initial nursing facility care: 99304-99306 
Subsequent nursing facility care: 99307-99310 
Home and Residence Services  Deletion of the following codes: 
Domiciliary, rest home, or custodial care services new patient: 99324-99328 
Domiciliary, rest home, or custodial care services established patient: 99334-99337 
Domiciliary, rest home, or home care plan oversight: 99339-99340 
Home services new patient (moderate to high): 99343 
Revision of the following codes including headings and guidelines: 
Home services new patient: 99341-99345 
Home services established patient: 99347-99350
Prolonged Services  Deletion of the following codes: 
Prolonged service with direct patient contact: 99354-99357 
Revision of the following codes including headings and/or guidelines: 
Prolonged service with or without direct patient contact on the date of an office or other outpatient service: 99417 
Cognitive assessment and care plan services: 99483 

Detailed Overview of Updates:

Inpatient and observation:
The observation services codes will be deleted and language added to the initial and subsequent inpatient services codes to include those observation services.

Consultation:
Very similar to what we saw in 2021 with the deletion of the lower level office and other outpatient services codes, the lower level consultation codes will be deleted with revisions to the headings and guidelines. 

Emergency department: 
There are language revisions for the code description and revisions in the guidelines will be effective January 1st, 2023.

Nursing facility services: 
The annual nursing facility assessment code will be deleted and there will be language revisions of the code description and guidelines for initial and subsequent nursing care codes.   

Home and residence services: 
This section will overlap with services and locations: domiciliary, rest home, boarding home, assisted living, custodial care, home care plan, and home services. The changes combine all residence locations under one section for home services.   

Prolonged services: 
Prolonged services codes with direct patient contact (face-to-face) in the outpatient, inpatient and observation setting will be deleted with a revision of the prolonged service with/without direct patient contact on the date of an office or other outpatient service code, 99417. 

Please reach out to Shawn Bromley, shawn.m.bromley@lahey.org and/or 978-236-1704 if you would like to set-up an education with your practice/providers to review the new E/M 2023 updates.


PATIENT EXPERIENCE COMMENTS


Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road 

  • I have full trust and confidence in Dr. Deborah Shih.

Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center

  • Dr. Pierre Abou-Ezzi and his staff are wonderful very respectful and extremely professional they always go over and above with my annual check up visits.

Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center

  • Outstanding medical practice. Dr. Andrew Lenhardt is the best!!!!
  • The office and staff and Dr. Daniel McCullough worked as a ‘Team’ in addressing all my needs throughout the visit and followed up on what was needed by me before leaving the office. Would highly recommend this doctor to those in need of a family doctor.

Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street

  • This was my first visit with this provider. It was for a physical. I was very pleased with the visit and found Dr. Kristina Jackson to be personable, informative, kind, a good listener. 

Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street

  • Dr. Mauri Cohen and his staff have provided excellent and attentive medical care to me for many years. 
  • I was very comfortable with the entire staff. Dr. Brent Fryling makes you feel very comfortable and doesn’t talk down to you. I would highly recommend this office.
  • I get great care and respect from Dr. Brent Fryling always.

Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor

  • Dr. Victor Carabba always is empathetic towards my health issues and is very thorough in explaining things to me.

Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue

  • I love Dr. William Medwid – he’s the best. He always makes me feel comfortable talking about anything & has great compassion & advice.

Beth Israel Lahey Health Primary Care, Manchester – 195 School Street

  • Dr. Jana Oettinger is very caring, kind, knowledgeable, efficient, skilled and thoughtful.  I’m very happy with the care she provides.

Blackburn Primary Care, Gloucester – 1 Blackburn Drive

  • Dr. Jay Isaac – The best overall medical care I have ever had. Thorough, thoughtful, responsive, compassionate.

EMTAR, South Hamilton – 205 Willow Street

  • Dr. Michael Edwards and the entire staff are always friendly and professional.  But more importantly the there is a sense of comfort and genuine caring. I always feel that I am getting the best care and information available.

Essex County Primary Care, South Hamilton – 42 Ashbury Street

  • Dr. Nicholas Avgerinos and staff were attentive and informative during my visit. They responded to all of my questions and provided thoughtful responses.

North Shore Pediatrics, Danvers – 480 Maple Street

  • Dr. Maureen Mathews – Always nice people, either on the phone or in office & everyone always helps!