- Lina Irshaid, MD of Beverly Pathology, 85 Herrick Street Beverly, MA 01915 Phone: 978-922-3000 Fax: 978-921-7024. Anticipated start date: 7/1/2022
- Nicholas Martin, MD of Beverly Radiological Associates, 85 Herrick Street Beverly, MA 01915 Phone: 978-922-3000 Fax: 978-927-3534. Anticipated start date: 10/1/2022
- Alison Levy, 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
NEWS FROM NEPHO
JUNE 2022 EDITION
IN THIS ISSUE:
- Paul Greenfield, MD of Northeast Eye Care, 80 Lindall Street Suite 3 Danvers, MA 01923, has announced his retirement effective 9/30/2022
- Andrew Ober, MD of Asthma and Allergy Affiliates, 114 R Highland Ave Salem, MA 01970, has announced his retirement 12/30/2022
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
New Physician Orientation
Date: Tuesday, August 23rd @ 5:30 PM
Location: Teams Meeting
Coding and Billing Webinar – ICD 10-CM 2023 Updates
Date: Wednesday, September 7th @ Noon
Location: Teams Meeting
Date: Wednesday, September 21st @ Noon
Speaker: Eileen Duffey-Lind, MSN, CPNP
Topic: HPV and the Cancer Connection
A NIGHT OUT WITH IMANE
On behalf of President-Elect Dr. Deepa Jhaveri and the team at the IMANE:
Indian Medical Association of New England (IMANE)
A non-for-profit organization supporting professional & social opportunities for medical professionals of Indian Origin. For more information about us please visit our website www.imanemd.org
Join us for a casual night of networking with Medical Professionals and friends and meet the IMANE team. Enjoy drinks, a delicious dinner, and casual conversation!
This would be a great opportunity to meet new colleagues from the North Shore and celebrate everything we do as healthcare professionals.
IMANE team members look forward to meeting you!When?
Wednesday July 20th, 2022
6:00pm – 9:00pm
Holi Indian Restaurant
20 North Road
Bedford, MA 01730RSVP is required and spots are limited!To RSVP, please go to:
For questions, please email email@example.com
NO SURPRISE BILLING UPDATE
Dear NEPHO Providers and Practice Administration,
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 and certain related provisions under the Massachusetts Patients First Act. The Massachusetts law will not become effective until August 1, 2022 and we have been working with BILH Government Affairs and the Massachusetts Medical Society on advocacy to extend that deadline and/or pass legislation to align the Massachusetts law with the federal law provisions (which to a certain extent conflict).
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||Medical and Payment Policy Update|
|Blue Cross Blue Shield of Massachusetts||Prior Authorization for Rx Infant Formula Suspended Until Aug 18
Due to the current supply chain issues affecting infant formula nationwide, the Division of Insurance has instructed insurers to relax prior authorization requirements for prescription infant formula for 90 days. For this reason, BCBSMA will suspend the prior authorization requirements noted in Pharmacy Medical Policy 304, Special Foods, effective immediately until August 18, 2022. To view the complete notification, click here.
|Blue Cross Blue Shield of Massachusetts||Authorization Requirements by Products
BCBSMA has posted an updated Authorization Requirements by Products. To view the complete list, click here.
|Harvard Pilgrim Health Care||Payment Policy Update: Cardiology and Cardiovascular Surgery
Harvard Pilgrim Health Care has updated member age for coverage of Cardiac stress tests or stress echocardiography testing and removed cardiac stress tests and other information from provider billing guidelines; administrative edits. To view the complete policy, click here.
|Harvard Pilgrim Health Care||Formulas and Enteral Nutrition
Prior authorization will not be required for pediatric or infant formulas for 90 days. To view the complete policy, click here.
|Medicaid||Complete Medicaid NCCI Edit Files for Calendar Quarter Beginning July 1, 2022
1) 2022 Q3 NCCI PTP Edits and 2) 2022 Q3 NCCI MUE Edits. To view the notification including links to the files, click here.
|Medicaid||Medicaid Change Report File: Edits Effective July 1, 2022
The Medicaid Change Report files contain only the changes made in the Medicaid NCCI edit files from the previous calendar quarter. To view the zip files, click here.
|Medicare||Booklet: Medicare Preventive Services
Learn codes and coverage information. To view the booklet, click here.
|Medicare||Medicare posted new Remote Physiological Monitoring and Cardiovascular Monitoring Service billing information. Please click here for more information about codes and billing details.|
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 the Department of Nephrology and Dr. Richard Patten from the Department of Cardiology, Tufts Medical Center. The presentation was recorded and the link is below.
06-3-22 SGLT2.mp4 (please note, you may need to download the link).
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
Antidepressant Medication Management Tools
For assistance with Choosing and Switching Antidepressants or Combining and Augmenting Antidepressants, please review the charts created by Prescriber / Pharmacy Newsletter. In addition, there is a convenient chart for Antidepressant Dosing Guidelines.
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*.
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 firstname.lastname@example.org for such requests. We are here to help bring ease to both the practices and the patients you serve.
Please click here to take a moment to read the Provider Spotlights!
Virtual Networking videos from NEPHO providers can be found at https://www.nepho.org/virtual-networking/.
Please reach out to Alycia Messelaar at email@example.com if you are interested in being featured in a Virtual Networking video.
Please reach out to Alycia Messelaar at firstname.lastname@example.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.
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 BILH Pharmacy Newsletters
- Call for Focus Groups: Controlling TME
- Pediatric and Adolescent Referral Guide
- Laboratory Specimen Collection Sites – June Update
- Grant Opportunity for Businesses in MA with fewer than 100 employees
- Boston Children’s Hospital – COVID Vaccine Clinic for Kids 6 Months and Older
Please reach out to Alycia.email@example.com for a specific communication that you are unable to find.
CODING TIP OF THE MONTH
OPTUM NEWSLETTER – June – Focusing on Dementia and Alzheimer’s Disease
2022 COVID 19 Coding Updates
ICD-10 CM Updates Effective April 1, 2022
- Z28.310 – Unvaccinated for COVID-19
- Z28.311 – Partially vaccinated for COVID-19
- Z28.39 – Other under immunized status
HCPCS 2022 Code Updates
- 0001A Administration Pfizer first dose
0002A Pfizer second dose
Report with Pfizer vaccine 91300
- 0011A Administration Moderna first dose
0012A Moderna second dose
Report with Moderna vaccine 91301
- 0021A Administration of AstraZeneca first dose
0022A AstraZeneca second dose
Report with AstraZeneca vaccine 91302
- 0022A Administration Janssen single dose
Report with Janssen vaccine 91303
- 0041A Administration Noravax first dose
0042A Noravax second dose
Report with Noravax vaccine 91304
The new technology with anatomical region PCS CPT Code updates include:
- XW013V7 Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group 7
- XW013W7 Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7
- XW023V7 Introduction of COVID-19 vaccine dose 3 into muscle, percutaneous approach, new technology group 7
- XW023W7 Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7
Sneak Peek 2023 ICD-10 CM Coding Updates
There are approximately 1,176 new diagnoses codes for FY2023. Here is a breakdown of what to expect October 1, 2022:
- New Hemolytic uremic syndrome codes (D59-) MCC
- Von Willebrand disease (D68) (CC) has been expanded to code to type.
- There are several new thrombocytopenia codes (D75)
- Metabolic acidosis (E87) (CC) has been split into three codes, acute, chronic or other
- Vascular dementia (F01), Dementia (F03) and Dementia in other diseases (F02) have all been expanded to accommodate types by severity and are CCs
- Alcohol and drug use codes (F10-19) have new choice for unspecified in remission
- Limb girdle muscular dystrophy now has codes for different types of named dysfunctions (G71.0-)
- New code for Postural orthostatic tachycardia syndrome [POTS] G90.A
- Arteriosclerosis of various sites now have new codes for “with refractory angina pectoris” (I25.7) (CC)
- Two new pericardial and malignant pericardial effusion codes
- New code I47.20 for ventricular tachycardia, unspecified
- Expanded codes for various sites of aorta dissection and aneurysm with & without rupture (I71.-) (MCC)
- New code K76.82 for hepatic encephalopathy but it won’t be a CC/MCC
- Many new codes in musculoskeletal chapter for intervertebral annulus fibrosus defects, muscle wasting, slipped femoral epiphysis and fractures associated with chest compression/cardiopulmonary resuscitation (M51-M96) A few M96 are CC.MCC diagnoses.
- Many new endometriosis codes by site and now depth (unsp., superficial, deep) (N80-)
- New OB codes for maternal care for (suspected) various specific nervous malformations or damage, chromosomal abnormalities or other fetal abnormalities by fetal site of fetus (O35-)
- Specific types of sleep apnea codes of newborn (P28-) (CC)
- Several new septal defect codes by type (Q21) (CC)
- Many new codes for various traumatic brain injuries wit LOC status unknown added (S06-) (some CC/MCC)
- Poisoning, adverse effect, et by methamphetamines codes added (T43.6-)
- Significant amount of external cause codes added for electric assisted bicycle accidents (V20-V29)
- New SDOH codes for transportation, financial insecurity or material hardship (Z59-)
- Long term use of several new substances and agents (Z79.6-)
- 9 new personal history codes (Z87.7-)
- 14 new patient or CAREGIVER noncompliance with dietary or medication regimen (Z91-)
Please reach out to Shawn Bromley at firstname.lastname@example.org and/or 978-238-6902 if you have questions related COVID 19 coding updates or would like to schedule a session in August or September to review 2023 ICD-10 Coding updates.
PATIENT EXPERIENCE COMMENTS
Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road Suite 203
- I have the upmost respect for Dr. Deborah Shih. She has always been professional and respectful and above all, Dr. Shih listens and responds thoughtfully, and guides me to a healthier me.
Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center
- Dr. Andrew Lenhardt is the best physician I have ever worked with. He is in a class of his own with his knowledge, attention to detail, and what I would call perfect bedside manner.
Beth Israel Lahey Health Primary Care, Beverly – 30 Tozer Road
- Dr. Tina Waugh is wonderful!
Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street
- I had a very positive experience with Dr. Kristina Jackson and her team. Everyone made me feel very comfortable and were very kind. I feel confident being under her care and will return. I can tell Dr. Jackson is a great person and wonderful doctor.
Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street
- Dr. Margaret Legner is terrific. The medical staff at the practice is wonderful, and the front desk staff is excellent. I always leave there feeling well cared for.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor
- Dr. Victor Carraba Is always professional, trusting and gives me the best of care.
- Dr. Karen Damico is an excellent, caring provider who listens and is well informed about my particular health care needs. I would highly recommend her and, in fact, I have recommended her to a dear friend. I trust and respect this provider.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street, 1st Floor
- I am so very grateful for my wonderful care with Dr. Amy Esdale and her entire staff.
Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue
- Honestly, Dr. Laurence Gordon is one of the best doctors I’ve had. Above all else, every time I have an appointment there, I don’t feel rushed and he genuinely listens. I feel comfortable talking to him about even the littlest things and he is always nice, calm, and patient.
Beth Israel Lahey Health Primary Care, Manchester – 195 School Street
- Dr. Jana Oettinger is very competent, professional, and kind. I would recommend her for guidance, advice, or treatment to anyone in my family.
Blackburn Primary Care, Gloucester – 1 Blackburn Drive
- I am confident in the care and attention I receive from Dr. Jay Isaac, Beth Shanks, and the staff.
Brian Orr Pediatrics, Gloucester – 1 Blackburn Drive
- We love Dr. Brian Orr and all of his staff.
Danvers Family Doctors, Danvers – 140 Commonwealth Avenue
- I have always had great experiences at Dr. Subroto Bhattacharya’s office with him and staff
Essex County Primary Care, Hamilton – 42 Asbury Street
- Excellent care. Very patient and thoughtful. I highly recommend Dr. Nicholas Avgerinos to others.
Garden City Pediatrics, Beverly – 83 Herrick Street
- Dr. John Dean is the best care provider my children have had since they were born. I would recommend him 100 times to anyone. Dr. Dean is caring, understanding & compassionate. He listens to all our concerns and is thorough with the appointments . As long as we live here he will be our favorite doctor.
- We’ve been going to Garden City Pediatrics for over 28 years and feel comfortable and confident in the care we receive from Dr. Elizabeth Humphreys.
Leonard Horowitz, M.D., Danvers – 7 Federal Street
- Dr. Leonard Horowitz is a great provider! Excellent care for the whole family.
North Shore Pediatrics, Danvers – 480 Maple Street
- My children are very comfortable with Dr. Lance Goodman. I feel like he is not only very knowledgeable, but also kind and respectful. All nurses are compassionate and kind as well.
- I have been seeing Dr. Thomas Seman and the doctors at North shore Pediatrics since I was a little girl and now my kids get to experience the practice and I love that the doctors know so much about my family history and kids!
Thomas Pearce, M.D., Gloucester – 279 East Main Street
Dr. Thomas Pearce is kind, caring, compassionate and a most competent physician.
Thompson Medical Associates, Gloucester – 9 F Dr. Osman Babson Road
I am very happy with the quality of care and treatment I get from Dr. Candace Thompson and her nurse practitioner Amy. They always take good care of me and seem genuinely concerned and really take the time to listen and answer questions.
The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local, meet our quality targets and support their colleagues.
Mercy Njuguna, Cape Ann Eye Specialists, was recognized for collaborating with NEPHO Quality team to improve care for patients.
Sue Blake, Thompson Medical Associates, was recognized for her patient experience comment “Dr. Thompson and Amy are an excellent team and are extremely knowledgeable and caring. I especially thought the receptionist/secretary Sue, was wonderful. She is welcoming and friendly and I love her dog, Lulu.”
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 in the newsletter. Please be sure to look for the new winners in next month’s issue!