NEW PROVIDERS
- Yonwook Justin Kim, MD of Microsurgical Eye Consultants, 31 Centennial Drive Peabody, MA 01960. Phone: 978-531-4400 Fax: 866-531-7106. Start date: 9/1/2022
PRACTICE CHANGES/UPDATES
- REMINDER: Coastal Orthopedic Associates will be relocating the Danvers practice location from 480 Maple Street Danvers, MA 01923 to 99 Conifer Hill Drive Danvers, MA 01923. Anticipated Move: End of December 2022
- Stephen Johnson, DO of North Shore Neurology & EMG 83 Herrick Street Suite 1001 Beverly, MA 01915 has termed effective 7/1/2022
- Michael Waisberg, MD of Beverly Pathology 85 Herrick Street Beverly, MA 01915 has termed effective 11/21/2022
NEWS FROM NEPHO
NOVEMBER 2022 EDITION
IN THIS ISSUE:
Beverly Hospital Receives 10 Years of Straight ‘A’ Hospital Safety Grades
BILHPN Acuity Training for Epic Users
Beverly Hospital Receives 10 Years of Straight ‘A” Hospital Safety Grade from The Leapfrog Group
The Leapfrog Group has awarded Beverly Hospital with an “A” Hospital Safety Grade for the 22nd consecutive time, recognizing it as one of the only 22 hospitals in the country to be awarded an “A” in every Hospital Safety Grade cycle since 2012.
Click here to view the Press Release.
SAVE THE DATE
BILHPN Sponsored Webinar with Allways Health Partners
Presenter: Meghan Morrissey, Senior Provider Network Account Executive
Date: Thursday, December 1st, 11:00 a.m. – 12:00 p.m.
Click here to join the Zoom Meeting
Meeting ID: 222 892 8629 Passcode: 301020
Join by Telephone
Dial: US: +1 312 626 6799 or +1 267 831 0333 or +1 346 248 7799
Meeting ID: 222 892 8629 Passcode: 301020
NP/PA Meeting
Date: Wednesday, January 25th, Noon
Speaker: Smita Patel, MD, Psychiatrist
Topic: Bipolar Disorder
Location: Teams Meeting
RSVP: Alison.Wiklund@lahey.org
BILHPN ACUITY TRAINING FOR EPIC PROVIDERS
The December date for BILHPN Acuity Training for Epic users is December 6th from Noon-1:00pm. This session will provide a demonstration and walkthrough of acuity functionality that can be leveraged in Arcadia.
Training Contents1. Overview on training and agenda2. Acuity outreach and documentation workflow outline and demonstration3. Overview and use cases for the patient browser report4. Overview and use cases for the risk gaps report5. Overview and use cases for additional reports/functions inside Arcadia for risk6. Q&A
To register for the December 6th training session, click here.
PAYOR UPDATES
AllWays Health Partners
AllWays Health Partners implemented a new fee schedule for Northeast PHO Providers. The new fees will represent a 4% increase effective 7/1/2022. AllWays implemented the new rates as of 9/1/2022 and prorated the fees to account for the 2 month delay. AllWays modified the base fee schedule therefore the increase may vary by CPT code. Please click here to check our website for the new fee schedule. If you need help with accessing the fee schedules, please contact Nick Catino at nicholas.catino@lahey.org or 978-236-1773.
You may have received the below notification from Allways Health Partners regarding return to pre-pandemic rates for telehealth services effective January 1, 2022. Please be advised that the implementation of this change is on-hold as it is under review. We will update you as more details become available from Allways Health Partners.
Click here to view the notification.
All other contracted health Plans telemedicine policies are still in effect with no changes.
As always, please contact the Northeast PHO at Alycia.Messelaar@lahey.org if you have any questions.
Blue Cross Blue Shield of Massachusetts
BCBSMA will Follow 2023 AMA Evaluation and Management Guidelines
Effective January 1, 2023, there will be significant updates to the American Medical Association’s (AMA) Evaluation and Management Code and Guidelines for hospital inpatient, observation, and outpatient services. To view the complete notification, click here.
BCBS modifies the physician base fee schedule each September. The BCBS HMO Risk and BCBS PPO rates effective 9/1/2022 are on our website.
If you need help with accessing the fee schedules, please contact Nick Catino at nicholas.catino@lahey.org or 978-236-1773.
Cigna
Cigna continues to leverage the power of technology and data to accelerate its transition to fully adopt digital-only ID cards* by 2024. This approach to digital ID cards is the next step in our journey to offer more digital-first solutions for our customers and providers.
What this means to you
Digital ID cards are not new for Cigna or the industry overall. Over the past several years, you may have noticed patients starting to present their ID cards to you in a digital format – typically on their phone from the myCigna® app or from the myCigna.com® website. This experience for you and your front-office staff should not change.
However, you may start to see more patients who have a digital-only ID card beginning in 2023. As they do today, your patients will have the option to:
- Share their digital ID card image on a phone screen in your office
- Relay the information verbally over the phone to preregister for their appointment
- Upload a digital ID card image to your health portal (as technology allows)
- Email the digital ID card image directly to your office from the myCigna app
- Print a copy of their digital ID card and share it with your office
Importantly, please note the digital ID card will look the same as the physical ID card does today and will contain the same benefit information. For more information, please click here.
Medicare/Medicaid
Update on the COVID-19 Public Health Emergency
On Thursday, Oct. 13, 2022, the Department of Health and Human Services announced an extension (renewal) of the COVID-19 public health emergency (PHE) for an additional 90 days. The latest extension of the COVID-19 PHE will end on January 11, 2023. Posted to the website 11/2/2022. To view the notification, click here.
COVID-19 Updated Booster Vaccines Covered Without Cost-Sharing for Eligible Children Ages 5–11
The CDC recently expanded the use of updated (bivalent) COVID-19 vaccines to children ages 5 through 11 years. This followed the FDA’s authorization of updated COVID-19 vaccines from Pfizer-BioNTech for children ages 5 through 11 years and from Moderna for children and adolescents ages 6 through 17 years. People with Medicare, Medicaid, Children’s Health Insurance Program coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna and Pfizer-BioNTech COVID-19 vaccines, at no cost, for as long as the federal government continues purchasing and distributing these COVID-19 vaccines. CMS issued 4 new CPT codes effective October 12, 2022: 91314, 91315, 0144A, 0154A. For additional information, click here.
Fallon
Coding Corner: New 2023 CPT/HCPCS Codes
All new codes will require prior authorization until a final review is performed by Fallon Health. Fallon will review and assign the appropriate coverage and determine prior authorization requirements for all new codes by January 1, 2023. Fallon will notify all contracted providers of this determination via the April issue of the Connection newsletter and on the Fallon Health website. For additional information and to view the article, click here.
Discharge Planning to Support Members Experiencing-or at Risk of- Homelessness
In accordance with MCE Bulletin 64, Fallon Health has established a dedicated email address— HomelessHelpline@fallonhealth.org—for hospital staff to notify the plan of Medicaid ACO, NaviCare, and Summit ElderCare members who are inpatient and homeless/housing insecure. The email inbox will be monitored 8 a.m. to 6 p.m., seven days a week at designated times—including weekends, holiday closures and early release days. For additional information and to view the article, click here.
COVID-19 Updates
When the federal public health emergency (PHE) ends, Fallon Health will resume the need for a PCP referral submission into ProAuth for Fallon Medicare Plus, Fallon Medicare Plus Central, NaviCare, Fallon 365 Care, and Berkshire Fallon Health Collaborative. In preparation, ensure the ProAuth log-in is still active and you are familiar with the process. For additional information and to view the article, click here.
Harvard Pilgrim Health Care
Payment Policy Update: Evaluation and Management
Harvard Pilgrim Health Care has updated the policy as follows: Removed CPT 99421-99423. For additional information and to view the notification, click here.
Tufts Health Plan
2023 Benefit Changes Tufts Medicare Preferred HMO
The following benefit changes apply to Tufts Medicare Preferred HMO members and are effective for dates of service on or after Jan. 1, 2023, upon the plan’s effective or renewal date.
NP/PA MEETING REDESIGN
NP/PA meetings will be held monthly on the 4th Wednesday from 12pm-1pm (via Teams)
The 2023 dates are: January 25, 2023, February 22, 2023, March 22, 2023, April 26, 2023, May 24, 2023, June 28, 2023, July 26, 2023, August 23, 2023, September 27, 2023, October 25, 2023 and November 29, 2023** .
** Moved due to Thanksgiving
- Odd months: 1h CME
- Even Months: APP Meeting
- Open forum conversations
- PHO Updates
- Wellness Conversations
- APP introductions
Invites will be sent out and the reminders will be posted in the Save The Date section of our newsletter.
PROVIDER RELATIONS
Virtual Networking videos from NEPHO providers can be found at https://www.nepho.org/virtual-networking/.
Please reach out to Alycia Messelaar at alycia.messelaar@lahey.org if you are interested in being featured in a Virtual Networking video.
A PDF version of the NEPHO provider directory is available for download and printing. Download pdf version. For your convenience, click here to download a separate Specialists Only directory. If printing, please print double sided to save paper.
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.
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
- Monthly BILHPN BMC WellSense MassHealth ACO Newsletter
- COVID 19 Treatment Update – Variants Drive Changes in Therapeutics
- Updates to COVID-19 Testing Locations
- SSRIs and Beyond Survey for CME credit
- BILHPN Participation in MassHealth ACO sessions (PCP specific)
- BILHPN Participation in MassHealth ACO appendix K (PCP specific) due December 7, 2022
- Atrius Fallon MassHealth contract participation for Specialists (opt in) due December 2, 2022
- Change in Access to BCH Dermatology
Please reach out to Alycia.messelaar@lahey.org for a specific communication that you are unable to find.
On behalf of BILH Physician Outreach, Beverly Hospital/Addison Gilbert Hospital and the Northeast PHO, we’d like to thank you for taking the time to attend the Provider Networking event at Tupper Manor on November 9, 2022. We hope you found this event enjoyable, and a great opportunity to meet and re-connect with others.
Click here to find contact information for the new physicians who were introduced at the event. Please feel free to share with your practice colleagues.
If you have not already provided feedback, we would love to hear from you! Please click here to complete the brief event survey when you have a moment. Your input will help us enhance future events.
Please reach out to us if you have any questions.
Thank you.
Kathy McCormack
Manager, Physician Outreach
Beth Israel Lahey Health
Cell: 781-901-3978
and
Alycia Messelaar
Director, Contracting & Operations
Northeast PHO
P: 978-236-1784
Beverly Hospital Hernia Center offers a personalized approach to care. Click here to access a copy of the Beth Israel Lahey Health Beverly Hospital Hernia Clinic flyer to provide patients information about the robotic hernia repair option that is offered locally.
REFERRAL MANAGEMENT UPDATE
The Northeast PHO Referral Department has developed an EPIC user referral pad .dot “smart phrases” in order to help streamline the referral process as well as retain care within the Northeast PHO. These referral pad smart phrases when inserted into patient notes or discharge instructions will print out NEPHO Specialist Names/Addresses/Phone Numbers on the patient AVS (After Visit Summary).
Many practitioners have found these smart phrases to be very useful in conjunction with the paper referral pads. For further education on how to use these smart phrases within EPIC, please reach out to Ann Cabral at Ann.Cabral@lahey.org.
CODING TIP OF THE MONTH
OPTUM NEWSLETTER – November- Focusing Alcohol and Substance Related Disorders
The Clinovations SmartForm in Epic is the tool we use to assist in addressing patients’ chronic conditions. The SmartForm is currently turned on for our Medicare Shared Savings, MassHealth, and Tufts Medicare Preferred patients. Effective November 14th, the SmartForm was turned on for our BCBS, HPHC and Tufts commercial insurance patients as well.
- Click here for helpful tips regarding this SmartTool
- Email Alycia.Messelaar@lahey.org to view the recording of the webinar hosted on Nov. 16, 2022
- Click here to take a survey to better help practice who are on EPIC implement this SmartTool use into your workflow
Let us help you work smarter not harder!
The Northeast PHO Coding Team
PATIENT EXPERIENCE COMMENTS
Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road Suite 203
- I have been a patient of Dr. Driscoll for many years and wouldn’t consider placing my care with anyone else!
- Dr. Shih is a fabulous doctor, smart and caring. I always recommend her.
- Dr. Shih – A staff member at the sign-up desk helped me set up the app for my Lahey chart. It took about 5 minutes and she did it with a smile.
Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center
- It is always a pleasure meeting with Dr. Pierre Ezzi and his staff. They are always on time and have very outgoing personalities.
Beth Israel Lahey Health Primary Care, Beverly – 30 Tozer Road
- Very confident in care provided by Dr. Tina Waugh. Great doctor relationship…trust her recommendations.
Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center
- Dr. Daniel McCullough – I have always found this office, both its providers, as well as staff to be outstanding.
Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street
- Dr. Kristina Jackson and her medical assistants and front desk staff are very professional and helpful.
Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street
- All went well! Very pleased with my appointment with Dr. Brent Fryling!
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor
- Dr. Carabba and staff are wonderful.
- I feel Dr. Damico really cares because she asks questions and answers questions honestly, I never feel as though I’m being rushed.
Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue
- Dr. Laurence Gordon was excellent in every way helping make medical decisions and discussing my health.
- Dr. William Medwid – I always feel comfortable during my visit, the doctors and staff are friendly and helpful. I’ve never had a bad experience. Great, professional people!
Beth Israel Lahey Health Primary Care, Manchester – 195 School Street
- I have been a patient of Dr. Jana Oettinger for a very long time. The overall experience with the staff, people who answer the phone, everyone, has been excellent! Very kind and understanding people.
- Dr. Matthew Plosker is very personable and shows great care for my health. I feel that I’m in very competent hands.
Blackburn Primary Care, Gloucester – 1 Blackburn Drive
- Dr. Jay Isaac – Everyone is very courteous and competent!
Danvers Family Doctors, Danvers – 140 Commonwealth Avenue
- Dr. Subroto Bhattacharya – Always have good experiences with Danvers Family Doctors!
EMTAR, South Hamilton – 205 Willow Street
- Dr. Michael Edwards – Everything was perfect as always!
Essex County Primary Care, South Hamilton – 42 Asbury Street
- We love Dr. Nicholas Avgerinos and staff. Appointments are easily available, the doctor is not only brilliant, but easy to talk to and he listens!
- Dr. Nicholas Avgerinos – Clinical assistant taught me how to use my own BP cuff. Very helpful, including taking about 10 minutes to let me ‘relax’ before activating my cuff.
Garden City Pediatrics, Beverly – 83 Herrick Street
- Dr. Sheryl Silva – I would never bring my child anywhere other than Garden City Pediatrics, they’re a wonderful team!
- Dr. Ian Sklaver and his staff have been outstanding. Very understanding and extremely helpful staff!
- Dr. Meghan Weir has always been very professional and nice and explained everything in detail.
Leonard Horowitz, M.D., Danvers – 7 Federal Street
- Dr. Leonard Horowitz and the staff at his office are absolutely the best!
North Shore Pediatrics, Danvers – 480 Maple Street
- We love it here! My son is super comfortable with Dr. Shannon Dufresne.
- Dr. Lance Goodman is excellent! He is invested in my child’s overall health, wellness and success. Thank you.
Thomas Pearce, M.D., Gloucester – 279 East Main Street
- Dr. Thomas Pearce – Fabulous!!! Extremely experienced doctor and always very caring and genuine! Hard to find!!
Thompson Medical Associates, Gloucester – 9 F Dr. Osman Babson Road
- The care from Dr. Candace Thompson’s office is always exceptional in every way. Always above and beyond. Truly exceptional from Amy and Dr. Thompson and the front desk staff. Thank you!
PRACTICE RECOGNITION
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.
This month’s winners are:
Kathleen “Kat” Wear, BILH Primary Care, Beverly, for a patient comment which read: “The staff person that took my vitals and got me situated in the exam room was polite, friendly, knowledgeable and caring. A very pleasant experience I was completely relaxed.”
Michaela Friesth-Peters, Blackburn Primary Care, for proactive collaboration with local ophthalmologist to schedule eye exams for diabetes patients.
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!