News from NEPHO – JUNE 2020 Edition


Romi Bloom, M.D.
Massachusetts Dermatology Associates
900 Cummings Center Suite 311T
Beverly, MA 01915
978-225-3376 (F) 978-560-1245

Gabriel Merlin, M.D.
Coastal Orthopedic Associates
77 Herrick Street Suite 201
Beverly, MA 01915
978-927-3040 (F) 978-927-0443

Patrick Yegian, M.D.
Northeast Emergency Associates
85 Herrick Street
Beverly, MA 01915
978-922-3000 (F) 978-921-7011


  • Jacob Kriteman, MD of Garden City Pediatric Associates is retiring effective 7/31/2020
  • Robert Rokowski, MD of Lahey Cardiology, Beverly is terminating his affiliation effective 8/3/2020
  • Melissa Sherman, MD of Essex County OB/GYN Associates will be providing coverage at Lynn Women’s Health
    280 Union St Floor 3, Lynn, MA 01901  781-596-3800  Fax: 781-596-3830

SAVE THE DATE                                                   

Date: Thursday, July 30, 2020 @5:30 p.m.
Location: GoogleMeet
RSVP: or 978-236-1784

E/M Updates/Review Telehealth Coding and Billing
Date: Wednesday, July 29, 2020 @ 10:00 a.m.

Have Practice Prepared for 2021 E/M Updates
Wednesday, August 19, 2020 @ 10:00 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 POD/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 virtual meetings.

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

2020 NECoMG ANNUAL MEETING SUMMARY                         

The Annual Meeting was held on Thursday, June18th at 7:00a.m. The meeting was held virtually. The meeting details include the following:

  • There were over 150 attendees
  • The following physicians have been voted to another 3 year term as Board of Directors:
    • Dr. Pierre Ezzi
    • Dr. James Maguire
    • Dr. Robert Cipolle

Our guest speaker was Dr. Alexa Kimball, CEO and President of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center.  She also serves on the BILHPN Board of Directors as Co-Chair with Phil Cormier.

Dr. Kimball discussed the current financial stability of the BILHPN system and future focused goals.  She recognized the hard work that has been happening across the system and thanked the physicians for their continued efforts in caring for patients during COVID 19.

She did touch upon the Telehealth service expansion and reviewed the CMS and payer restrictions that were lifted due to COVID 19. She mentioned the importance of staying on track with HIPAA compliance during this timeframe. She provided an update on the quality and efficiency changes that will be coming from Medicare and Commercial payers as we progress forward into 2021.

The Annual Meeting attendance was tracked by having physicians complete an online evaluation form that was sent to all physicians after the meeting. The evaluation form included a section to allow for questions. The questions included the following items: quality of the virtual meeting, recent practice reopening updates, feedback to improve the Annual Meeting, requests for future material/ presentations.

NEPHO will analyze all responses and follow up on the questions.


AllWays Health Partners

Revised Provider Payment Guidelines: Preventive Services U.S. Preventive Services Task Force Recommendations

The Provider Payment Guidelines have been revised. Updated Preventive Service Grid. To view the entire guideline,
click here.

Revised Provider Payment Guidelines: Laboratory & Pathology Services

The Provider Payment Guidelines have been revised. Added COVID19 specimen collection codes G2023-G2024 and C9803. (Separately reimbursable during the Covid-19 State of Emergency only). Added Reimburse COVID-19 specimen collection (Separately reimbursable during the Covid-19 State of Emergency only). To view the entire guideline, click here.

Blue Cross Blue Shield of Massachusetts

COVID-19-We’re extending our prior authorization waiver

All providers caring for our members

We understand that this is a trying time for all medical care providers due to COVID-19. To better support you, we’ll continue 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, you will need to submit authorizations.

This applies to all products, excluding the Federal Employee Program (FEP).

What this means

  • You still need to notify us of all inpatient levels of care and submit the appropriate supporting documentation.
  • While this notification-only requirement is in place, we will not perform medical necessity reviews for inpatient levels of care.
  • Timely notification helps us to facilitate optimal care coordination, mobilize additional services to support transition-of-care and discharge planning, and ensure claims processing.
  • This is an extension to the waiver that we announced on March 24 and was set to expire June 23, 2020. See COVID-19: Latest news (March 24).

Commonwealth Care Alliance

As you know, the 2019 Novel Coronavirus Disease (COVID-19) outbreak has presented a public health emergency across the world. Commonwealth Care Alliance (CCA) remains committed to working with our provider partners to provide the highest quality, individualized care to the members we so proudly serve. We are also working to help enable our members to remain in their homes to help reduce COVID-19 exposure and transmission, and to preserve health system capacity for the duration of this public health emergency.   To mitigate the impact of the coronavirus outbreak on funding to healthcare providers, MassHealth and CMS have released numerous bulletins and notifications to temporarily compensate providers for costs associated with COVID-19.

CCA has been actively working to ensure all COVID-related reimbursement changes are accounted for and configured correctly. There have been significant changes released by CMS and EOHHS, therefore it is important that we are diligent in our review and implementation. We have begun disbursing funds to providers and all COVID related changes are underway in our claims system. CCA has also conducted an impact analysis and will ensure all related claims are reprocessed. All retroactive adjustments for previously paid COVID claims impacted by rate increases will be adjudicated by mid-July. There is no further action needed on your part. CCA will continue to process COVID claims for rate increases, in accordance with the guidance and timelines issued by CMS and MassHealth, until we receive further guidance.

For subsequent claims, CCA will reprocess payments to reflect all current rate increases in a timely manner. Providers will not be required to resubmit claims and no further action will be needed to receive COVID rate adjustments.

Please check the CCA Provider page daily as we will continue to provide updates to the Provider Billing FAQs as they become available.

If you have any questions or concerns with this timeline, please contact CCA’s Provider Relations Department at or phone Claims: (800) 306-0732 directly.

Thank you for your continued support and the quality of care you provide to CCA members as we work through the challenges of COVID-19.

CMS – Medicare

MLN Booklet: How to Use the Medicare National Correct Coding Initiative (NCCI) Tools 

An updated booklet has been posted to the website.
To view the booklet, click here.

COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (includes Telehealth/Telemedicine) – Updated 06/16/2020 

Updates with additional questions and answers have been added throughout the document. To view the notification, click here.

Fact Sheet: Hospitals: CMS Flexibilities to Fight COVID-19 (Telehealth/Telemedicine) – Updated 06/12/2020

An updated document has been posted to the website. To view the document, click here.

Fallon Health

Now Covering Telehealth Well Visits (COVID-19) (Telehealth/Telemedicine)

Well visits are designed to give patients the opportunity to talk with their doctors about how to improve their health and prevent disease. Given the importance of these preventive care visits, Fallon is covering well visits via telehealth with no member cost-sharing until regulatory guidance is rescinded or until Governor Baker’s Emergency Order is ended, whichever is first. Being able to have well visits virtually helps people keep up with their necessary care, although some aspects of a well visit, such as immunizations, lab services or certain screenings, need to be provided in person rather than by telehealth. For additional information and to view the notification, click here.

Harvard Pilgrim Health Care

GIC Product Updates 

The 2020-2021 plan year for Harvard Pilgrim and the Group Insurance Commission’s (GIC’s) Primary Choice HMO and Independence Plan POS begins on July 1, 2020. There were no changes to the provider tier assignments for the 2020-2021 plan year. Providers received their tier assignment notifications in late February 2020. Because Primary Choice is a limited-network product, some of Harvard Pilgrim’s contracted providers do not participate in the Primary Choice network. For additional information, click here.  Posted to Network Matters, June 2020.

New Access America Value Product 

Harvard Pilgrim is introducing a new product offering known as Access America Value, which will be available as of July 1, 2020 for fully insured or self-insured multi-state employer groups based in Massachusetts, New Hampshire, and Maine with 150 or more eligible employees. For additional information, click here. Posted to Network Matters, June 2020.

Tufts Health Plans

Tufts Health Plan is aware that some telehealth claims may not yet be processing in accordance with policies put in place in response to COVID-19. We are actively addressing the issue and apologize for any inconvenience. Once the issue is resolved, we will email you.

As a reminder, providers who accepted member cost share for any telehealth services provided to members for dates of service on or after March 6, 2020 until further notice, will need to refund the member or, if the member agrees, add a credit on their account. We apologize for any inconvenience.

As of June 17, 2020, the Tufts Health Plan and Tufts Health Freedom Plan public Provider websites have been updated with the following information:

  • Prior Authorization and Notification Flexibility
    • Concurrent review is suspended for all post-acute hospital inpatient services until July 20, 2020.
    • Concurrent review is suspended for all urgent/emergent hospital inpatient services until July 20, 2020.
    • Prior authorization requirements are suspended for any scheduled surgeries or admissions at hospitals through June 30, 2020.  All prior authorization requirements and concurrent review will be reinstated for services occurring on or after July 1, 2020.
  • New Billing Guidelines for Adult Day Health Providers for Tufts Health Unify and Tufts Health Plan Senior Care Options (SCO)
  • Behavioral Health: Content added to the additional resources section

As the COVID-19 situation continues to unfold, updates will continually be posted on the Tufts Health Plan and Tufts Health Freedom Plan public Provider websites.  Please check back regularly.

Group Insurance Commision (GIC) Navigator and Spirit Plan Changes: GIC Navigator Tier Design 

Effective July 1, 2020, there will be no change to existing provider organization/IPA or hospital system tiers; however, any change to an individual provider’s contract affiliation may result in a change in that provider’s tier. Providers and members can refer to GIC Navigator and Spirit Tiering Information on Tufts Health Plan’s public Provider website to verify provider and hospital tier placement by product. GIC Navigator Tier Design: Providers and hospitals will continue to be placed in one of three tiers for the GIC Navigator plan. PCPs and specialists will continue to be tiered, and providers and hospitals falling under the same contracting provider system will be placed in the same tier. To view the complete notification, click here.  Posted to the Provider Update, May 2020 Newsletter.

Payment Policy Update: Opioid Replacement Therapy and Medication Assisted Treatment 

Updated billable codes for buprenorphine/naloxone for Tufts Health Together members per MassHealth MCE Bulletin 28, effective for dates of service on or after June 1, 2020. To view the complete guideline, click here.


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 (this file is large so you must enlarge the document) and then find links to COVID-19 specific health plan materials and updates. If you have questions or concerns, please reach out to Alycia Messelaar,

Please take a moment to review your practice information and reach out to me directly if the status has changed.

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.

NEPHO will continue to update you as additional practices begin to reopen.  Contact Alycia Messelaar with any practice changes.
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
978-236-1784   F: 978-236-1777,

As patients slowly return to the offices and hospital for services, we wanted to share some resources to help ensure patients are receiving the care they need.

Recent feedback from patients shows that the patients want to hear from their PCPs that it is safe to resume care and that the hospital is safe for them.  Please consider calling your patients or sending emails or letters to your patients.
Many of our PCP and specialist offices have seen an increase in scheduled appointments after sending a global message to their patients or in response to phone calls to help schedule appointments for physician services or hospital care.

There are helpful resources available to communicate the BILH safe-care message:

1)  Website with helpful materials

2)  attached letter that was included in a recent CMO message

Please let us know if there other resources or tactics you have found helpful and we can share these with other practices.



Why Early Referral to Palliative Care is Best Practice

Early Palliative Care Referral incorporates the principles of patient-centered care, evidence based practice, and shared decision making. Palliative Care Teams act to enhance the  care and support of patients and caregivers, increase patient /family satisfaction, and prevent “crises”-ER admits.  These principles help in decreasing hospital lengths of stay.

Palliative Care is appropriate for any patient with a serious illness. The purpose of palliative care is to relieve symptoms and improve the quality of life for the individual. Unlike Hospice, Palliative Care does not require a DNR (do-not-resuscitate order) or No Code order and treatment for chronic conditions can continue.  Our healthcare system has an active Palliative Care Team. BILHAH Palliative Care and Hospice can accept referrals in our home hospitals and in the patient’s home.

Covid-19 has changed everything in our personal and professional lives. For the care of patients with serious illness, it has brought into sharp focus the need for conversations about goals of care. The added presence of the Covid-19 virus and the possibility of a seriously ill patient contracting the virus provides a need and an ethical responsibility to discuss goals of care. The Center to Advance Palliative Care provides a mobile friendly toolkit. Click here to be directed to the website.

During Covid-19 we have a heightened need to have these conversations with patients and make sure all patients have a health care proxy.  Ask the Patient what matters most to them right now.  Ask the Patient what they would like to do if they become seriously ill with the Covid -19 virus. Use this guide from Ariadne Labs and the Conversation Project as a guide.

To refer to the Palliative Care team call:  Intake contact   781-756-2488
Donna Silva, Executive Director Hospice and Palliative Services at Beth Israel Lahey Health At Home
Karen A. Richard RN, MSN-NLHA,CCM   978-236-1770  or


Introduction and Future Care Planning Discussion

  • Dr. Joseph Peppe began the meeting by describing the original design of the Practice Specific Meetings.
  • As originally designed, the intent was to meet with practice colleagues on site to review key goals and activities and collective opportunities.
  • Due to current events, the meetings were converted to Google Meet virtual meetings.
  • Dr. Peppe reviewed what has changed and what has not changed post COVID 19 and invited discussion on considerations for today’s and tomorrow’s planning.
  • Dr. Peppe reviewed the 2020 PHO workplan prior to COVID 19 and the adapted work plan post COVID 19.

Population Health

  • Carol Freedman, RPh provided an update on expanded patient outreach activities.
  • Carol shared data related to the outreach efforts during the past months and invited feedback and suggestions for the outreach efforts.

Patient Experience

  • Liz Isaac shared telehealth reflections from Massachusetts Health Quality Partners’ telephone survey of patients and clinicians.
  • There are patient conditions and situations where telehealth may be a better option than in person visits.
  • Conversely, patients expressed concerns that telehealth may lead to missed diagnoses or incorrect treatment plans, and raise equity issues for patients with limited data or phone minutes.


Please watch Dr. John Torous, Director of Digital Psychiatry at Beth Israel Deaconess Medical Center, talk about the role of telehealth and technology in Mental Health therapies and care during the time of Coronavirus and beyond:

To access Dr. Torous’ paper “Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow” please click here:

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


OPTUM Newsletter – June 2020 Focus – Dementia

Risk Adjustment Coding Capture Guidance for Telehealth Services

CMS allows Medicare Advantage organizations and other organizations that submit diagnoses for risk adjusted payment to include diagnosis captured during a Telehealth visit when those visits meet all criteria for risk adjustment eligibility (Same as Face-to-Face visit). Diagnoses resulting from telehealth services can meet the risk adjustment Face-to-Face requirement when the services are provided using and audio/video interactive real-time communication. The inclusion of diagnoses for risk adjusted payment when using Telehealth will allow for a more accurate calculation of patient risk adjustment scores.

Here are a few examples detailing how to better support documentation and risk adjustment coding for chronic conditions during a Face-to-Face visit and Telehealth visit:

  • Document plan of care for chronic conditions, condition status
    • Example: A Fib I48.91 – heart rate within normal limits, converting back to normal sinus rhythm, apixaban is helping to regulate heart rate
  • Chronic conditions need to be captured/recaptured annually
    • Example: Depression (F33.8) or depression in remission (F33.4), Opioid dependence (F11.20) or opioid dependence in remission (F11.21)
      • Depression: when depression has stabilized coding depression in remission would be appropriate
  • Chronic conditions should be discussed and documented during a new patient visit
    • Example: New patient visit with the following chronic conditions: Hypertension I10, CKD state 3 N18.3, Recurrent depressive disorder F33.8, Opioid dependence in remission F11.21
  • Document confirmed chronic conditions to their highest specificity
    • Example: Diabetes with CKD stage 3: E11.22, N18.3 (1st code diabetes with chronic kidney disease then code chronic kidney disease)

The following grid highlights the Top 10 Risk Adjustment Condition Categories that are being captured during a Face-to-Face visit versus a Telehealth visit. This provides an overview of the chronic condition focus during each patient visit type:
When providers capture chronic conditions accurately they support quality patient care and risk adjustment coding. The use of Telehealth for management of chronic conditions and risk adjustment coding capture can benefit both the patient and providers in the following ways:

  • Treatment Plan Management: The treatment of chronic conditions sometimes involves changes to the patient’s lifestyle. Weight management, smoking cessation, conditions specific dietary changes, and other behavioral changes all support patient healthy living. Using telehealth to conduct visits helps to stay on top of the treatment plan management and will increase the changes for a positive impact on the patient health outcome.
  • Medication Management: Patients with chronic conditions often need more than one medication. Telehealth medication management takes the burden of multiple visits off the patient, making it easier for them to balance their need for treatment.
  • Triage: There are times chronically ill patients react by seeing providers very frequently, while other patients ignore new symptoms until they become serious. The option to have a Telehealth visit to determine if a symptom is normal or needs more attention. This triage can help support the provider in making an appropriate clinical decision. This will help address issues in a timely manner.

While the risk adjustment eligibility for telehealth visits is close to that of in person visits, there are some key limitations to the video visit:

  • Most in-person diagnostic tests, such as PAD testing or spirometry, are not being performed
  • Blood pressure, BMI, and other portions of the physical exam are infrequently documented
  • Some tests can be mailed to members, such as a FIT kit, but delivery returns drive the completion to document

Capturing a patient’s true health status is an ongoing effort for the providers. Diagnosis capture helps support the patient’s health status and ensures their risk score is accurate for their health care delivery.  Risk adjustment coding capture needs to continue to be a focused effort by providers during a Face-to-Face visit or a Telehealth Video visit to complete the patient’s true health story.

Please reach out to Shawn Bromley at and/or 978-236-1704 if you would like to review risk adjustment coding capture in more detail.



Danvers Family Doctors – 140 Commonwealth Avenue
• Dr. Subroto Bhattacharya is a great doctor! Very kind and caring!

Garden City Pediatrics – 83 Herrick Street, Suite 1003
We love Dr. John Dean and everyone @ Garden City.  Always a great experience.
XThank you for caring for our children!
Both my children and I love Dr. Eric Sleeper.  He really made me feel as though
XI’m doing everything I can to keep my children safe during this pandemic.

Lahey Primary Care, Danvers – 5 Federal Street
• Dr. Mauri Cohen is caring and the best.  It is this office and their incredible staff that keeps me at Lahey.

Leonard Horowitz, MD – 7 Federal Street
• Dr. Leonard Horowitz is very patient, considerate, and thoughtful; always listens to our concerns
Xand gives us a lot of confidence.

North Shore Pediatrics – 480 Maple Street
My children have been patients of Dr. David Danis since they were born.  I would not change anything!
• Dr. Shannon Dufresne is wonderful. She’s friendly, calm, gentle and addresses concerns professionally.

Candace Thompson, D.O. – 9E Osman Babson Road
• Dr. Candace Thompson is very professional – very caring and easy to talk to.


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:

Heidi Skeffington and Robyn Santos, Northeast Dermatology Associates for assisting referral management with redirecting patients and scheduling dermatology appointments.

Melissa Smith, RN, North Shore Pediatric Associates for Patient Experience  “Melissa is excellent. . . she always calls in a timely manner with answers to any of my questions – very informative!”

Lauren Capezzuto, LPN, North Shore Pediatric Associates for Quality – “Going above and beyond with help supporting Quality metrics and working with NEPHO on many other 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.

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

L-R: Heidi Skeffington, Robyn Santos and Dr. David Greenstein
Pictured L-R: Dr Thomas Seman, Melissa Smith RN, Lauren Capezzuto LPN, Dr Lance Goodman