News from NEPHO – NOVEMBER 2020 Edition

SAVE THE DATE

CODING AND BILLING WEBINARS

Date: Wednesday, December 2, 2020  @10:00 – 11:00 am
Common Coding and Billing Questions from 2020
Location: GoogleMeet Conference Call
RSVP:  margaret.m.doyon@lahey.org

Date: Wednesday, December 30, 2020 @10:00 – 11:00 am
Coding and Billing Review Moving into 2021
Location: GoogleMeet Conference Call
RSVP: margaret.m.doyon@lahey.org

NEW PHYSICIAN ORIENTATION
Date: Tuesday, December 15, 2020 @5:30 pm
Location: GoogleMeet Conference Call
RSVP: alycia.messelaar@lahey.org or 978-236-1784

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.

BETH ISRAEL LAHEY HEALTH AND JOSLIN DIABETES CENTER SIGN LETTER OF INTENT

Please see the recent press release regarding a potential affiliation with the Joslin Diabetes Center.

On November 12, 2020 Boston and Cambridge, Massachusetts, Beth Israel Lahey Health (BILH), and Joslin Diabetes Center (Joslin) signed a non-binding Letter of Intent (LOI) to explore opportunities for Joslin to join BILH.  This represents the first step toward reaching a definitive agreement under which Joslin would become a full member of BILH and bring to the system its expertise as a world-renowned center of excellence in diabetes research, education and clinical care.

An agreement between the two organizations would be part of a natural evolution of the decades-long relationship between Joslin and Beth Israel Deaconess Medical Center (BIDMC), part of Beth Israel Lahey Health. Joslin and BIDMC have for many years maintained a broad clinical affiliation, managed shared education programs, and provided a range of clinical services to each other’s patients. Joslin and BIDMC work closely together to provide outstanding subspecialty care in vascular surgery and foot care, as well as for women with diabetes through pregnancy and childbirth. Joslin joining BILH would further expand that relationship across the spectrum of primary care, preventive care, acute care, and population health management.

An affiliation would also catalyze exciting world-class collaboration among investigators from Joslin and BIDMC, with a focus on bringing discoveries made in the lab to patients and ultimately finding a cure for diabetes.  In addition to Joslin’s expertise in diabetes research and treatment, BIDMC is a leader in metabolism research, and the two institutions already collaborate closely in the training of future clinical and research leaders.  Faculty from Joslin and BIDMC oversee a number of leading clinical trials and research initiatives supported by the National Institutes of Health, foundations and private industry.

“Joslin Diabetes Center is a global leader in diabetes research, education and clinical care,” said Kevin Tabb, MD, president and CEO of Beth Israel Lahey Health. “In coming together, we will be able to further strengthen and extend Joslin’s brand, expertise and innovations to reach many more patients in need of leading-edge diabetes care.”

“Joining BILH will serve to strengthen Joslin’s mission to prevent, treat and ultimately cure diabetes,” said Roberta Herman, MD, president and CEO of Joslin Diabetes Center. “We have worked closely with Beth Israel Deaconess Medical Center for decades, and this agreement presents an opportunity to join a leading health care system and move Joslin’s research, treatment and education protocols to the next level, directly benefiting people with diabetes across a wide geographic and demographic spectrum.”

Because diabetes is a chronic illness, Joslin providers and their patients develop a unique relationship over many years. Joslin’s patients will continue to enjoy those unique relationships at the same time the proposed affiliation fosters the expansion of that level of care for others across the BILH system.

An affiliation would require various state and federal reviews and approvals.

About Beth Israel Lahey Health

Beth Israel Lahey Health is a new health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,800 physicians and 36,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education. For more information, visit www.bilh.org.

About Joslin Diabetes Center

Joslin Diabetes Center is world-renowned for its deep expertise in diabetes treatment and research. Joslin is dedicated to finding a cure for diabetes and ensuring that people with diabetes live long, healthy lives.  We develop and disseminate innovative patient therapies and scientific discoveries throughout the world. Joslin is an independent, non-profit institution affiliated with Harvard Medical School, and one of only 16 NIH-designated Diabetes Research Centers in the U.S. For more information, visit www.joslin.org.

IPA/POD SUMMARIES

Quality

• Liz Isaac reviewed an updated AQC hybrid scorecard, along with interventions and opportunities for year-end performance improvement.
• HPHC has added accommodations for 2020 performance calculations; HPHC will count 2019 process and outcome rates towards 2020 if 2019 rates are better.
• The system Diabetes Mellitus (DM) composite performance was reviewed.
• NEPHO composite is the same compared to system and other LCPN units.
• NEPHO has good opportunity to improve A1c Adherence as this rate is significantly lower than other LCPN units.

Efficiency

• Case Discussion:
  • Dr. Peppe reviewed a case that with referral re-direction for radiation oncology services that are provided by Lahey and Beth Israel Deaconess.
  • Both referring provider and patient were engaged in the discussion with PHO referral team.
  • Dr. Peppe invited discussion from POD and IPA attendees.
• Pharmacy Efficiency:
  • Carol Freedman reviewed pharmacy efficiency data.
  • Injectables expenses appear in both Medical and Pharmacy “buckets”, with pharmacy accounting for 18% of Commercial Total Medical Expense (TME).
  • Pharmacy expenses increased less than 2% year over year for Q2, a better trend compared to network.
  • Carol reminded providers about the BILHPN Pharmacy newsletter and reviewed drug selections for macular degeneration and osteoporosis (see packet for detail).

Patient Experience

• Liz shared the link to MHQP Telehealth survey site results where providers can look up clinician responses to various telehealth related topics.
• Example of responses related to fatigue was shared.
• Wave 3 survey results to be posted soon.

Informational

• PCP attendance through October was reviewed.
• 2021 PCP meeting schedule for PODS and IPAs was shared.
• Responses from October Rapid Meeting Assessment (RMA) were shared.
• Attendees were asked to complete a RMA for the current meeting.

PAYOR UPDATE

CMS – Medicare

Instructions for Retrieving the 2021 Pricing and Healthcare Common Procedure Coding System (HCPCS) Data Files through CMS’ Mainframe Telecommunications Systems Trans.

This transmittal provides the annual update to the various pricing files used by the Medicare Administrative Contractors (MACs) to adjudicate Part B fee schedule paid claims. The attached recurring update notification applies to chapter 23, section 40. To view the transmittal, click here.

Medicare Wellness Visits  

Learn about the annual wellness visit, the initial preventive physical examination, and the differences between them and a routine physical. To view the education tool, click here.

Fallon Health

New Address for Paper Claims Submissions

When shipping paper claims that are not deliverable to a P.O. Box, (via FedEx, UPS, etc.) send to the following street address: Fallon Health Claims, Smart Data Solutions, 960 Blue Gentian Road, Eagan, MN 55121. For claims that can be delivered to a Post Office box, the address remains the same: Fallon Health, P.O. Box 211308, Eagan, MN 55121-2908. All appeals and corrected claims related to Zelis edits should be directed to Zelis: Zelis Claims Integrity, Inc., 2 Crossroads Drive Bedminster, NJ 07921, Attn: Appeals Department or faxed to: 1-855-787-2677.

Coding Corner: Coding Updates

Fallon Health has posted an updated list of Coding updates. For additional information and to view the notification, click here.  Posted to the Connection October 2020 Newsletter and scroll to related title.

Harvard Pilgrim Health Care

Payment Policy Update: Evaluation and Management

Harvard Pilgrim Health Care has updated the Payment Policy as follows: 1) Removed codes associated with telemedicine and telemedicine E&M services. For additional information and to view the notification, click here.

Flu Vaccine Critical for Upcoming Season

Harvard Pilgrim supports annual influenza immunization efforts by covering flu vaccines at retail pharmacies for a $0 cost share for members age 19 years and older on Commercial formularies (Premium, Value, and Core NH). Flu vaccines are covered as a Preventative Care Benefit for adults under the Affordable Care Act. Because flu vaccines are provided by the state for in-office administration members ages 0 to 18 years, in the past Harvard Pilgrim did not provide coverage for delivery of vaccines in retail pharmacies for children in this age range. However, this flu season to encourage even greater adoption of the flu vaccine, Harvard Pilgrim is covering flu vaccines at pharmacies without cost-sharing for members starting at age 3. Certain age restrictions for specific flu vaccines may apply based on product labeling. For Medicare Advantage members, flu vaccines are covered at $0 cost share (billed under Part B) at retail pharmacies or in doctor’s offices. To view the updates, click here.

Tufts Health Plans

Payment Policy Update: Evaluation and Management

Added edit for critical care E&M services and telehealth edits for online digital E&M services, modifier G0, interprofessional telephone/internet consultations and remote physiologic monitoring, effective for dates of service on or after January 1, 2021. To view the complete policy, click here.

PROVIDER RELATIONS

Interested in being Featured?

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

Click here  to access a list of practices who are scheduling in office visits and/or Telehealth visits at this time.

Please take a moment to review your practice information and reach out to Alycia Messelaar, Alycia.Messelaar@lahey.org with update requests.

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 by clicking here.

Click here to find the most recent links to COVID-19 specific health plan materials and updates. Please note, we have included health plans that NEPHO does not contract with in an effort to help keep you well informed of current COVID-19 updates we have been made aware of.  If you have questions or concerns, please reach out to Alycia Messelaar, Alycia.Messelaar@lahey.org.

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 by clicking here .

REFERRAL MANAGEMENT

Benefits and Eligibility Verification

When members arrive at your office it is important to ask to see their current health plan member identification cards at each visit. Doing so will help you:

• Identify the member’s product
• Obtain health plan contact information
• Speed claims processing

Patient eligibility and benefits should be verified prior to each scheduled appointment. Coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts may be available based upon plan product design.

It’s strongly recommended that providers ask to see the member’s ID card for current information and photo ID to guard against medical identity theft.

If you have questions please contact Ann Cabral, Manager, Referral Services at  978-236-1758  (fax) 978-236-1611.

PHARMACY

November 2020 Pharmacy Update 

BILHPN Pharmacy Newsletter

The monthly BILHPN Pharmacy Newsletter provides valuable information about medications, including cost savings tips, new medication updates and resources for patients regarding their medications.  This newsletter is available to NEPHO providers in the following ways:

• Emailed to all providers “from the desk of Carol Freedman”
• Available on NEPHO website at nepho.org under News & Resources, BILHPN Pharmacy Newsletter

Click on the link for the current November BILHPN Pharmacy Newsletter, which focuses on “deprescribing”.  In addition there is an update of the Practical Diabetes Pearls for Primary Care presentation by BILHPN Pharmacy Team, which includes key updates in evidenced-based diabetes prescribing, including recommendations for SGLT-2 inhibitors and GLP-1 agonists for patients regardless of glycemic control.

See below for topics addressed in past issues of the BILHPN Pharmacy Newsletter that can be accessed via links at the END of the current issue.

For more information or questions, please contact Carol Freedman, NEPHO Pharmacy Manager at carol.freedman@lahey.org

POPULATION HEALTH

November is COPD Awareness Month

According to the Pulmonary Education and Research Foundation (PERF) 16 million Americans are diagnosed with COPD, and another 16 million people are thought to be undiagnosed.  52% of patients with COPD reported that SOB affected their quality of life.  Pulmonary rehabilitation is one of the most effective treatments for COPD but only 2% of Medicare-eligible patients actually undertake a program (PERF, 2020).

At Lahey Outpatient Center Danvers (LOCD) and Addison Gilbert Hospital the Pulmonary Rehabilitation Program’s main goal is to improve the quality of life. The program is available to anyone who has chronic lung disease, asthma, emphysema or undergone lung surgery. Depending on the patient’s particular diagnosis, they may enter the program through a referral from Pulmonologist or PCP. In 2019 the Pulmonary Program at LOCD achieved certification by the AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation).

Lahey Clinic also offers a comprehensive disease management program with a multidisciplinary team whose goal is to improve and maintain quality of life in patients living with COPD.

Lahey Outpatient Center Danvers
480 Maple Street
Danvers, MA 01923
978 304-8444

Addison Gilbert Hospital
(currently suspended due to COVID)
298 Washington Street
Gloucester, MA 01930
978 283-4000, ext. 443

Lahey Clinic
Lahey’s Center for Chronic Obstructive Pulmonary Disease (COPD)  To make an appointment or for more information, please call 781-744-COPD (2673).

If you have questions please contact Lucia Kmiec, NEPHO Health Coach at 978-880-2318.

QUALITY

2020 Cancer Screenings – Progress YTD

2020 has been a year unlike any other.  The pandemic has resulted in fewer patients seeking   in-person care and preventive screenings.  Unfortunately there is no virtual substitute for pap smears, mammograms and colorectal screenings.  Not surprisingly, the NEPHO has seen a decrease in routine pap smears, mammograms and colorectal cancer screenings in 2020:

• Cervical Cancer Screenings down 34% over 2019
• Breast Cancer Screenings down 35% over 2019
• Colorectal Cancer Screenings down 54% over 2019

Yet the news is not all bad.  There was a significant dip in the number of cancer screenings performed during the 2^nd quarter of 2020 during the height of the battle against the Covid-19 virus. However the 3^rd quarter of 2020 has seen a rebound in the number of cancer screenings performed across the board:

YTD NEPHO AQC patients have had the following cancer screenings:

• 232 Cervical Cancer Screenings
• 338 Mammograms
• 144 Colorectal Cancer Screenings (104 colonoscopies, the remainder stool-based screenings)

The NEPHO Quality Team has reached out to over 550 AQC patients during August, September and October to remind them about cancer screenings due and offer assistance in scheduling their screenings.  Quality Team members have mailed over 360 letters and sent more than 60 messages through the Epic patient portal.  Health Coach Lucia Kmiec has called 125+ patients to assist them in scheduling their mammograms.  Hopefully the positive trends will continue in the 4^th quarter of 2020.

CODING TIP OF THE MONTH

OPTUM Newsletter – November focus – Diabetes

NEPHO 2020 Coding and Billing Highlights

NEPHO practices during 2020 were focused on managing COVID 19 and building a Telehealth program to better support patient access to care during the pandemic. NEPHO focused efforts in supporting practices during this unique time frame. Areas of focus included the following:

• Telehealth Program Build
• Practice Coding Support
  • Coding and Billing Webinars
  • Practice Coding Audits
  • Provider Education
• COVID 19 Updates
• Payer Updates
• Practice Workflow Development

The rapid expansion of Telehealth services due to the pandemic came with a number of coding and reimbursement challenges for practices and providers. NEPHO practices and providers responded effectively to the pandemic and kept patient care as a priority. Many practices were delivering Telehealth services by April 2020. There were many challenges due to COVID 19 that impacted NEPHO practices at a business level. These challenges included the following:

• Inconsistent payer rules
• Implementing a HIPAA compliant Telehealth program
• Reduction in practice resources due to decrease in practice revenue
• Patient access to care during the state emergency directive
• Limited knowledge of new coding and billing requirements due to COVID 19
• Video/Audio vs. Audio only Telehealth services

NEPHO helped to support practices and providers overcome these challenges and focused on obtaining the most up to date information to better manage coding and billing. As 2020 progressed so did the development of a “new normal” for practices and providers. Patients have started to come back to the office but the implementation of Telehealth services has now brought an additional patient access source that is here to stay. As COVID-19 continues, payers at a state and national level are loosening restrictions around Telehealth and licensing requirements to make it easier for providers to deliver care. As we move towards 2021 NEPHO will keep Telehealth as an area of focused support to providers and practices. Having a solid understanding of the guidelines related to Telehealth services will be necessary to maximize reimbursement opportunity. The Telehealth service restrictions that payers lifted due to the pandemic have started to be put back in place and the Office of Inspector General (OIG) have listed Telehealth services on the 2021 work plan. There are best practices that can be put in place to better manage Telehealth services and stay compliant during this changing time frame.

HIPAA guidelines on Telehealth is contained within the HIPAA Security Rule and stipulates:

• Only authorized users should have access to ePHI.
• A system of secure communication should be implemented to protect the integrity of ePHI.
• A system of monitoring communications containing ePHI should be implemented to prevent accidental or malicious breaches.

Why You Should Not Use SMS, Skype or Email for Telemedicine:

When ePHI created by a medical professional or a healthcare organization (covered entity) is stored by a third party, the covered entity is required to have a Business Associate Agreement (BAA) with the party storing the data. This BAA must include methods used by the third party to ensure the protection of the data and provisions for regular auditing of the data’s security.

Telehealth services are billed as a face-to-face visit E/M service when supported by audio/video technology. There are additional services that can be billed when audio/video is not available. The following services have been updated to help support patient access to healthcare:

Online Digital E&M Services

• 99421 – Online digital E/M service, for an established patient for up to 7 days, cumulative time during the 7 days; 5-10 minutes
• 99422 – 11-20 minutes
• 99423 – 21 or more minutes
• (99421-99423 replaces 99444)

These codes are for use when E/M services are performed, of a type that would be done face-to-face, through a HIPAA compliant secure platform. These are for patient-initiated communications, and may be billed by clinicians who may independently bill an E/M service. They may not be used for work done by clinical staff or for clinicians who do not have E/M services in their scope of practice.

Report these services once during a 7-day period, for the cumulative time.

Non-Face-to-Face Services Audio Only

• 99441 – Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
• 99442 – Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
• 99443 – Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.

Please reach out to Shawn Bromley if you would like to review your current Telehealth program or to discuss implementation of a HIPAA compliant Telehealth program moving into 2021.
Contact: shawn.m.bromley@lahey.org or 978-236-1704.

PATIENT EXPERIENCE COMMENTS

Garden City Pediatrics – 83 Herrick Street, Beverly

• We absolutely love Dr. John Dean! He is knowledgeable, kind, down-to-earth, and really listens!
• My family has been going to Dr. Eric Sleeper and GCP for almost 11 years. I can’t say enough great things about Dr. Sleeper and the entire staff…the nurses, the receptionists…we love this office!

Lahey Health Primary Care, Beverly – 900 Cummings Center

• I have been a patient of Dr. Andrew Lenhardt for many years. He is a very caring and compassionate doctor. He is very professional and is also a wonderful person.

Lahey Health Primary Care, Beverly – 100 Cummings Center

• I have never had such a good a doctor as Dr. Pierre Ezzi!

Lahey Health Primary Care, Beverly – 30 Tozer Road

• Dr. Tina Waugh is a smart, caring and compassionate person – she always listens and is very helpful – I am so happy that Dr. Waugh is my physician.
• Dr. Gail Ellis is a caring, knowledgeable provider and I feel very lucky to be in her care.

Lahey Health Primary Care, Danvers – 5 Federal Street

• Dr. Steven Keenholtz is a dedicated caring physician. Every physician should have his qualities.

Lahey Health Primary Care, Danvers – 480 Maple Street

• Dr. Galina Feldman and Staff are always kind and helpful. Especially Meghan who recently helped me get information to me in a professional and efficient manner.

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

• It has always been a positive experience with meeting with Dr. Yuliya Mandel. The explanations are clear, the staff cooperative…and there is a concern for my wellbeing.

Lahey Health Primary Care, Gloucester – 298 Washington Street 1st Floor

• I have always appreciated Dr. Amy Esdale and her genuine concern for my health. She’s the best!

Lahey Health Primary Care, Hamilton – 15 Railroad Avenue

• Dr. Laurence Gordon is by far the best physician I have ever had – He is an excellent doctor and an excellent man.
• I have been a patient of Dr. Hugh Taylor for 35-40 years. Great person, listens, and cares. Office personnel and other care givers are great.

Lahey Health Primary Care, Manchester – 192 School Street

• Dr. Jana Oettinger is EXCELLENT!

North Shore Pediatrics – 480 Maple Street, Danvers

• We love Dr. Lance Goodman! He is so caring and thorough!

Thomas Pearce MD – 279 E Main Street, Gloucester

• I always have a great experience at the office of Dr. Thomas Pearce! He is a real MD! I feel fortunate to be in his care!

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!