News from NEPHO – MAY 2022 Edition

PRACTICE CHANGES/UPDATES

Hugh Taylor, MD of Beth Israel Lahey Health Primary Care, 15 Railroad Avenue, South Hamilton, MA 01982 has announced his retirement effective 6/30/2022. Dr. Taylor will continue to provide coverage only for the group after said retirement. 

Vito Cardone, MD of Cardone Reproductive Medicine and Infertility, LLC, 2 Main Street Suite 150 Stoneham, MA 02180 has termed effective 4/29/2022.

Gary Roark, MD of Beverly Anesthesia Associates, 480 Maple Street Suite C233 Danvers, MA 01923 has termed effective 11/30/2021.

Lloyd Alderson, MD of North Shore Neurology & EMG, 83 Herrick Street Suite 1001 Beverly, MA 01915 has termed effective 4/25/2022.

ANNUAL MEETING

The NECoMG Annual Meeting will be held virtually on June 16, 2022 at 7:00 a.m. Meeting login information and a link to the proxy/voting form has been sent to your email. Please use the form to submit your response by June 14th. Click here to read the bios for this year’s speakers and Board of Directors candidates.

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.

All meetings listed below will be held virtually via Teams meeting. Please check your email for the invite and login information. 

MAY IS MELANOMA AWARENESS MONTH

Thank you to Dr. Katherine Masterpol for this article.

May is Melanoma Awareness Month and it’s our opportunity to raise awareness of the dangers of melanoma, the importance of early detection, and the many ways to practice sun safety. One person in the US dies of melanoma every hour. It is also the #1 most diagnosed cancer in women aged 25 to 29. Melanoma is the most serious skin cancer because it can be fatal, but the majority of melanomas are totally preventable.

We also have to remember some groups of people are at higher risk than others and should be encouraged even more so to have an annual skin check. Fair-skinned people, especially those with red hair, firemen and firewomen, policemen and policewomen, pilots, patients with Parkinson’s disease, and persons who are BRCA positive are some of these groups.

Melanomas come from melanocytes, the skin’s pigment cells that produce skin color. Since these cells can be found anywhere we have skin, melanoma can develop anywhere we have skin, even where the sun doesn’t shine. But it is most common in areas of most sun exposure or sun-damaged skin. When detected early, melanoma can be very treatable.

Melanomas can start as a new spot on the skin, or they can develop in an existing mole. For women, the most common location is the leg, and for men, it is the back. Warning signs include bleeding, scabbing, or not healing without a reason, and we teach the “ABCDEs of melanoma”:

There are many ways to practice sun safety! Seeking shade; wearing a hat; sunglasses; sun protective clothing (makes life so much easier!); moisturizers and makeup with sunscreen in them. We recommend broad-spectrum sunscreen with an SPF over 30 and REAPPLIED every 2-3 hours. There are many effective and safe products, never be afraid to ask for recommendations or to ask about concerns.

We are available to see patients of all ages- from infants to elderly- for skin checks and skin concerns of any kind, as well as skin cancer surgery. We can accommodate urgent visits as well!

DermPhysicians of New England 781-272-7022

www.DermPhysiciansNE.com

Left to right: Shelley Penna NP, Dr. Prasanthi Kandula, Lisa Samson PA-C, Dr. Kasia Masterpol, Dr. May Wang

RIGHT CARE, RIGHT PLACE: SPANISH-LANGUAGE GRAPHICS

MHA launched a Right Care, Right Place campaign last year to assist community members on where to seek care based on a set of common medical scenarios. Recently, Lawrence General Hospital translated the campaign’s social graphics into Spanish to assist it in further broadening its outreach into the community. Click here to view and download the images. 

PAYOR UPDATES

AllWays Health Partners

Please be aware of changes to electronic payment options.  There may be additional fees associated with the new virtual credit card option. Your practice can opt out of this option.

Click here to find out everything you need to know about changes to our electronic payment experience.

Virtual Credit Card (VCC)

Providers who are not currently registered to receive payments electronically will be automatically enrolled in this new payment option.

Starting in January 2022 you will receive Virtual Credit Card (VCC) payments with your Explanation of Payment (EOP). Each EOP will contain a virtual credit card with a number unique to that payment transaction and an instruction page for processing.  

The steps for processing this payment are similar to how you manually key-in patient payments today.

Answer to common questions about virtual credit cards:

How will I receive my virtual credit card?

• If you have a HIPAA certified fax number on file, your office will receive fax notifications.
• If you do not have a fax number on file, we will mail your virtual credit card.

Can I opt out of receiving a virtual credit card?

• Yes. After you receive your first VCC payment you can manage your payment preferences and opt out of VCC at any time by visiting echovcards.com. You also contact ECHO directly at 800-895-0713.

What if my practice receives multiple paper checks under one tax identification number?

• If providers in your practice operate under a group tax identification number (TIN) but receive separate checks for various National Provider Identifications (NPI), your VCC payments will be consolidated to one payment at the TIN level.

What if I want to receive paper checks?

• You can continue to receive paper checks and paper EOPs by opting out of the virtual credit card services here.

What about Electronic Funds Transfer (EFT)

• If you are currently receiving EFT payments from AllWays Health Partners, you will continue to receive EFT payments after December 2021.

Medical Payment Exchange (MPX)

If you are not enrolled to receive payments via EFT, you opt out of the virtual credit card, and you have enrolled for MPX with another payer, you will continue to receive your payments in your MPX portal account. Otherwise, you will receive a paper check via mail.

Blue Cross Blue Shield of Massachusetts

Authorization Requirements Previously Relaxed to Resume May 17

Effective for dates of service on and after May 17, 2022, BCBSMA will resume the standard notification, prior authorization, and authorization requirements for coverage for the following services: All inpatient treatment, both COVID-19 and non-COVID-19-related, at acute care and post-acute care facilities; Mental health admissions; Scheduled surgeries. To view the complete notification, click here.

August 2022 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 ebr@bcbsma.com. To view the list, click here.

Authorization Requirements by Products

BCBSMA has posted an updated Authorization Requirements by Products. To view the complete list, click here.

This spring, the Plan is changing from BMC HealthNet Plan in Massachusetts and Well Sense Health Plan in New Hampshire to WellSense Health Plan across both states. To view provider frequently asked questions, click here.

Medicare

COVID-19 FDA Limited the Authorized Use of the Jansen COVID Vaccine

On May 5, 2022, the FDA limited the authorized use of the Janssen COVID-19 vaccine to:

• Patients 18 years and older for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate.
• Patients 18 years and older who elect to receive the Janssen COVID-19 vaccine because they would otherwise not receive a COVID-19 vaccine. To view the notification, click here.

Fallon Health

Prior Authorization Process (ProAuth Tool)

Providers should use ProAuth for submission of any service that requires prior authorization. ProAuth can be used for both standard and expedited requests. Providers not currently set up with ProAuth, it is important to do so by: 1) Filling out the online registration form at fchp.org/providertools/ProAuthRegistration. 2) Or by filling out a paper application here and sending it to askfchp@fallonhealth.org. For additional information and to view the notification, click here and login.

Harvard Pilgrim Health Care

Pilot Digital Cancer Support Program for Select Members

Beginning May 23, 2022, Harvard Pilgrim will offer an innovative new digital telehealth platform for patients with cancer. The platform, known as Iris by OncoHealth, is powered by Harvard Pilgrim’s oncology partner and will initially be available on a pilot basis for a select group of a few hundred members of fully insured, Commercial plans. Iris delivers personalized, 24/7, oncology-specific support to members and their caregivers as they navigate the physical and emotional challenges caused by cancer and cancer treatment. For more information, click here.

GIC Product Updates Effective July 1

The 2022-2023 plan year for Harvard Pilgrim and the Group Insurance Commission’s (GIC’s) Primary Choice HMO and Independence Plan POS begins on July 1, 2022. Harvard Pilgrim issued no changes to the provider tier assignments for the 2022-2023 plan year. Providers received their tier assignment notifications in February 2022. As always, changes initiated by physicians moving to a different provider organization may result in their tier changing to that of the new organization. To view the complete notification, click here.

Tufts Health Plans

60-Days Notifications: Commercial Physician and Outpatient Hospital Fee Schedules to Be Updated (Commercial Products)

Tufts Health Plan reviews its Commercial physician and outpatient hospital fee schedules quarterly to ensure that they are current, comprehensive and consistent with industry standards. In most cases, changes involve adding fees for new or existing codes to supplement the fees already on the fee schedule. Changes will occur on July 1, 2022 and may involve both new and existing CPT and HCPCS codes, as well as the planned quarterly update to physician immune globulin, vaccine and toxoid fees. For additional information and to view the entire notification, click here.

Coverage Change for COVID-19 Testing Codes (All Products)

Effective for dates of service beginning July 1, 2022, Tufts Health Plan will no longer cover the following CPT codes for COVID-19 testing:

• 0202U – Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
• 0223U – Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
• 0225U – Proprietary laboratory analyses to detect SARS-CoV-2. For additional information and to view the entire notification, click here.

Temporary COVID-19 Telehealth Payment Policy Update

Tufts Health Plan reinstated member cost share effective for dates of service beginning May 1, 2022. To view the complete policy, click here.

Coding Advisor Program Offers Guidance for E&M Services (Commercial Products)

Beginning in June, Tufts Health Plan will partner with Change Healthcare to implement the Coding Advisor Program for Commercial plans. The Coding Advisor Program is intended to provide practices with information about how their billing of various E&M services compares with that of their peers, based on specialty and geographic area. For additional information and to view the entire notification, click here.

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. 

Click here for the PDF version of the updated PHO Directory as of May 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!

• 2022 MIPS Payment Reporting
• 2022 Annual Meeting: SCP Vote & Proxy Response Requested by June 14th
• 2022 Annual Meeting: PCP Vote & Proxy Response Requested by June 14th
• Ordering and scheduling tips for Imaging and Labs

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

PHARMACY UPDATE

Paxlovid Drug Interactions:

As you may know, there are some drug interactions with Paxlovid (nirmaterelvir/ ritonavir), currently being used to treat Covid 19. Some providers have reached out for support regarding potential drug-drug interactions. The following resources may support your decisions regarding use of Paxlovid along with a patient’s current med regimen. Please feel free to reach out to Carol Freedman if you require additional information.

Updated BILH COVID-19 Treatment Guidelines

Liverpool Interaction Checker https://www.covid19-druginteractions.org/

Liverpool Drug Interactions pdf

Paxlovid Fact Sheet

Managing Paxlovid and Anticoag Interactions

UP-TO-DATE

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.

CODING TIP OF THE MONTH

OPTUM NEWSLETTER – May – Focusing on Chronic Kidney Disease

Social Determinants of Health (SDOH) Coding Update

Social determinants have an impact on health outcomes. Factors such as a patient’s education, income level, upbringing and environment must be considered when creating a patient plan of care. Social Determinants of Health (SDOH) will support patient acuity and are impacting, and will continue to impact our patients. NEPHO has been educating and working with providers on this important area of coding capture. The following examples are from a recent NEPHO coding review on documentation and ICD-10 CM coding capture.

SDOH Documentation and Coding Examples:

• A patient requiring dialysis treatments has no transportation and no access to public transportation. Therefore, her circumstances require discussions with home health for home treatments and/or researching community service options for help with transportation for those in need.
  • Z59.7 Insufficient social insurance and welfare support
• A patient requiring a specific drug that is very expensive, was recently laid off and has no income or prescription benefits. The decision might be made to try a different drug to ease the cost burden for the patient.
  • Z56.0 Unemployment, unspecified
  • Z59.7 Insufficient social insurance and welfare support
• A patient with a complicated medical history that includes multiple medications reports having trouble reading the prescription labels and remembering the medication schedule. He lives alone and currently has no support for these types of situations. This might require initiation of home health or some type of elderly assistance service.
  • Z55.0 Illiteracy and low-level literacy
  • Z60.2 Problems related to living alone

NEPHO Top 10 SDOH Examples:

• Z56.0: Unemployment unspecified: Example: Patient was laid off from job
• Z56.6: Physical and mental strain related to work: Example: Patient works 3 jobs to manage home
• Z56.89: Other problems related to employment: Example: Patient is on disability due to recent injury
• Z63.0: Problems in relationship with spouse or partner: Example: Patient is separated from spouse
• Z63.3: Absence of family member: Example: Patient has recently gone through a divorce
• Z63.4: Disappearance and/or death of family member: Example: Husband/Wife passed away a year ago
• Z62.810: Personal history of physical and sexual abuse in childhood: Example: Patient experienced sexual abuse from 6-12 years by family member
• Z62.898: Other specified problems related to upbringing: Example: Patient does not speak to biological father
• Z63.7: Stressful events affecting family household: Example: Patient is having issues with teenage children
• Z72.3: Lack of physical exercise: Example: Patient does not exercise

Please reach out to Shawn Bromley at shawn.m.bromley@lahey.org or 978-238-6902 if you would like to review SDOH and/or would like to have an education session on SDOH coding capture.

PATIENT EXPERIENCE COMMENTS

Beth Israel Lahey Heath Primary Care, Beverly – 30 Tozer Road

• I have confidence in Dr. Neeraj Mahajan. I feel that he cares for my health. He is very knowledgeable and a wonderful doctor.
• I have a great deal of confidence in Dr. Tina Waugh. She is thorough and well-informed.

Beth Israel Lahey Heath Primary Care, Beverly – 900 Cummings Center, Suite 111W

• Dr. Andrew Lenhardt is a great doctor. He always listens and gives eye contact when speaking. He provides the highest quality of care. He is always there when I need him. He’s been my doctor over 15 years and I am totally satisfied.
• Dr. Daniel McCullough is respectful and thorough during annual visits and actively listens.

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

• Dr. Brent Fryling is a thoughtful, brilliant primary care physician. I could not be more pleased. Incredibly thorough.

Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street, Suite 204

• Dr. Kristina Jackson and her entire staff are phenomenal. I would highly recommend them to my family and friends.

Beth Israel Lahey Heath Primary Care, Gloucester – 298 Washington Street, 1st Floor

• This office is awesome!! I have been with Dr. Amy Esdale for 15 years, if not more. They are always kind and understanding. 

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

• Excellent experience-excellent care. Physician is warm, kind, understanding, very caring, knowledgeable and trustworthy. I believe I am in exceptionally good hands with Dr. Victor Carabba.

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

• Dr. Laurence Gordon was respectful and kind. He listened and advised thoughtfully. Both Dr. Gordon and the staff were courteous throughout.
• Dr. William Medwid Is The Best Doctor I HAVE EVER HAD. Kind and Caring, always follows through, just an Amazing doctor! Feel so lucky to be one of his patients for the last 13 years!!!

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

• Dr. Matthew Plosker and his team are top notch. Professional and caring. I’m lucky to have them looking after me.

Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road, Suite 203

• Dr. Alyssa Handler is a dedicated professional whom I trust to take excellent care of her patients, as she has consistently taken great care of me. She is warm, caring and very knowledgeable. I appreciate the time she takes to listen to my concerns and to reassure me when needed.
• Dr. Deborah Shih and her entire staff are the very best. I always tell her how thankful I am to have her as my primary doctor.
• I am so grateful that I found Nicole Leaver, NP and that she has helped me feel so much better overall in just a short time! She is so attentive and I truly felt heard and cared about by Nicole.

Blackburn Primary Care, Gloucester – 1 Blackburn Drive

• The staff and Dr. Jay Isaac are always prompt, courteous and helpful

Brian Orr Pediatrics, Gloucester – 1 Blackburn Drive

• We always have a good experience when we visit Dr. Brian Orr’s office. He and his whole staff care very much for their patients and it shows. Thank you all!

Danvers Family Doctors, PC, Danvers – 140 Commonwealth Avenue, Suite 202

• Dr. Subroto Bhattacharya is by far the best doctor around. He is so knowledgeable and very caring and kind. He makes you feel as if you are his only patient.

EMTAR Health Care, Inc., Hamilton – 205 Willow Street, Suite C-1-C

• Dr. Michael Edwards is a compassionate doctor who cares for his patient’s well-being and makes every effort to listen and to help.

Garden City Pediatrics, Beverly – 83 Herrick Street, Suite 1003

• Dr. Suzanne Graves and her staff are attentive, supportive and caring. Dr. Graves provides care for both my children, I strongly recommend her to anyone. She is a doctor who cares about her patients and takes time each visit with my children to know them and understand who they are.
• Dr. Sheryl Silva is wonderful! So approachable and friendly and puts my child at ease even when they are nervous!
• Dr. Eric Sleeper is amazing, patient and understanding. My children are thankful to have him!

North Shore Pediatrics, Danvers – 480 Maple Street, Suite 3 A

• Everyone associated with Dr. David Danis’ office is wonderful, caring and professional.
• Excellent! Cannot say enough wonderful things about the care & especially the way Dr. Thomas Seman is with my daughter makes her feel at ease always.

Thomas Pearce, MD, Gloucester – 279 East Main Street

• Extremely thoughtful, efficient and professional staff. Dr. Thomas Pearce listens carefully to my questions and concerns, and explains health and treatment issues thoroughly

Thompson Medical Associates, Gloucester – 9 E Dr. Osman Babson Road

• I always feel very comfortable at Dr. Candace Thompson’s office. I feel like I can call for any concerns I may have. They are very friendly yet professional. I would highly recommend this provider and her staff.

PRACTICE RECOGNITION

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!