NEW PROVIDERS
- Andrew Orenberg, MD of Marblehead Ophthalmology 1 Widger Road Suite 108 Marblehead, MA 01945 Phone: 781-631-8300 Fax: 781-639-9017
PRACTICE CHANGES/UPDATES
- Kristina Jackson, MD of Beth Israel Lahey Health Primary Care, Danvers 480 Maple Street Suite 204 Danvers, MA 01923 has closed her panel, except to existing patients
- Stephen Defossez, MD of Beverly Radiological Associates 85 Herrick Street Beverly, MA 01915 has termed effective 6/30/2023
NEWS FROM NEPHO
SEPTEMBER 2023 EDITION
IN THIS ISSUE:
NECoMG/NEPHO Merger Approval into LCPN
New Beverly/Addison Gilbert Hospitals Website Launched
BILHPN Acuity Training for Epic Users
NECoMG/NEPHO MERGER APPROVAL INTO LCPN
A majority of the Class P and Class S Shareholders approved the merger of NECoMG into LCPN. The Northeast PHO Shareholders approved the merger of NEPHO into LCPN. Thank you for your responses to this request and for your participation in the information sessions.
We will provide more details about the organizational changes in the upcoming months.
Sincerely,
Pierre A. Ezzi, MD
President
SAVE THE DATE
NP/PA Meeting
Date: October 25, 2023 @ Noon
Speaker: Sara Tortorici
Topic: Medical Weight Loss
Location: Teams Meeting
RSVP: Alison.Wiklund@Lahey.org
New Physician Orientation
Date: Thursday, November 9, 2023 @ 7:30 am
Location: Teams Meeting
RSVP: Alycia.Messelaar@Lahey.org
Date: November 29, 2023 @ Noon
Location: Teams Meeting
RSVP: Alison.Wiklund@Lahey.org
Office Manager Meeting
Date: December 13, 2023 @ Noon
Speaker: TBD
Location: Teams Meeting
RSVP: Alycia.Messelaar@Lahey.org
NEW BEVERLY/AGH WEBSITE LAUNCHED
Beverly Hospital and Addison Gilbert Hospital are thrilled to announce that their new website launched. This site represents the culmination of months of work by teams across their locations and system.
This new website is part of a larger effort to build a cohesive, modern web presence for all BILH entities. With added functionality and a refreshed design, it is capable of expanding and evolving to meet the needs of our communities, including patients, donors, job seekers and more.
BILHPN TEXTING CAMPAIGN
The following texting campaigns are scheduled for October.
Breast Cancer:
[Practice Name] @ Beth Israel Lahey Health: October is Breast Cancer Awareness Month. A mammogram, the screening test for breast cancer, can help find breast cancer early when it’s easier to treat. To schedule a screening mammogram, call Radiology Scheduling at [SCHEDULING #]. To update our records, please contact your PCP office at [PRACTICE PHONE]. To stop receiving messages, reply with ‘STOP’.
Hypertension:
[Practice Name] @ Beth Israel Lahey Health: Elevated blood pressure, known as hypertension, is a leading risk factor for heart attacks and strokes. To decrease this risk, people with high blood pressure should work with their PCP team to bring it into a normal range. If you have hypertension and have not been seen by your PCP recently, please contact your PCP office at [PRACTICE PHONE]. To stop receiving messages, reply with ‘STOP’.
If you have any questions regarding the BILHPN texting campaigns please contact Laureen Viel at laureen.viel@lahey.org.
PAYOR UPDATES
Blue Cross Blue Shield
Reminder: Providers Need to Submit Requests Via Authorization Manager
As a reminder, all providers are required to submit initial authorization requests and inquiries electronically through Authorization Manager rather than by phone or fax as of June 1, 2023 for the commercial (HMO, PPO) and Federal Employee Program (FEP) members. Despite the required use of the portal, BCBSMA has still been receiving some requests via phone and fax. This is a reminder that providers must submit using Authorization Manager in order for BCBSMA to process the request. BCBSMA does not accept any other methods of submission. To view the complete notification, click here.
Policy 034 Medical Benefit Prior Authorization Medication
BCBSMA has posted an updated Policy 034 Medical Benefit Prior Authorization Medication List. To view the complete list, click here.
Reducing Cost Barriers to Improve Access to Mental Health Care
Effective immediately, BCBSMA is waiving member cost share for services billed with the attached codes. To view the complete notification, click here.
Medical Policy Announcements
This document announces new medical policy changes that take effect Dec. 1, 2023. To view the list, click here.
Pharmacy Medical Policy Update: Drugs for Weight Loss
The policy has been updated as follows: Updated to add new age update for Wegovy and to require additional documentation and updated significant weight loss for Wegovy and the length of approvals were also updated and updated IC to align with 118E MGL § 51A. To view the complete policy, click here.
Medicare
Seasonal Flu Vaccine Pricing for 2023–2024 Season
Part B payment allowance limits for seasonal influenza (flu) vaccines (that is, the vaccine product) are 95% of the Average Wholesale Price (AWP). In hospital outpatient departments, payment is based on reasonable cost. Part B deductible and coinsurance amounts don’t apply for flu vaccine products or their administration. With respect to the vaccine product, all providers and suppliers must accept assignment on the claim. The annual flu vaccine season is August 1–July 31 of the following year. To view the notification, click here.
2023-09-14-OCE: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older
On September 11, the FDA approved and authorized for emergency use updated Moderna and Pfizer-BioNTech COVID-19 vaccines formulated to more closely target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death. These vaccines have been updated to include a monovalent (single) component that corresponds to the Omicron variant XBB.1.5. The CDC recommends everyone 6 months and older get an updated COVID-19 vaccine. Six New CPT Codes Effective September 11, 2023: 90480 – COVID-19 Vaccine Administration, 91318 – COVID-19 Vaccine, 3 mcg/0.2 mL, 91319 – COVID-19 Vaccine, 10 mcg, 91320 – COVID-19 Vaccine, 30 mcg, 91321 – COVID-19 Vaccine, 25 mcg. and 91322 – COVID-19 Vaccine, 50 mcg. For additional information, click here.
MLN Booklet: Evaluation and Management Services Guide
CMS has made significant updates to the language, order and formatting of this product to better meet provider needs and improve understanding. For additional information, click here.
Vaccine Pricing
Get payment allowances and effective dates for the 2023-2024 season. For additional information, click here.
Tufts Health Plan
Payment Policy Update: Preventive Services
The policy has been updated as follows: Added codes 90678, 90611, 90622, 90380, and 90381 to the “Adult or Pediatric Immunizations section, effective September 15, 2023. To view the complete policy, click here.
Payment Policy Update: Behavioral Health and Substance Use Disorder
The policy has been updated as follows: Added Harvard Pilgrim Health Care inclusion, effective for DOS on or after November 1, 2023. To view the complete policy, click here.
Autism Spectrum Disorder Services Prior Authorization Form
Tufts Health Plans has posted the most current Autism Spectrum Disorder Services Prior Authorization Form. To view the complete form, click here.
Tufts Health Public Plan
MassHealth Billing Reminders (Tufts Health Plan Senior Care Options, Tufts Health Together, Tufts Health Unify)
While MassHealth is working to renew member eligibility, there may be several eligibility updates occurring at this time. In MassHealth All Provider Bulletin 372, MassHealth shared important reminders of billing responsibilities and billing for retroactively reinstated members. For additional information, click here.
Harvard Pilgrim Health Care and Tufts Health Plan (Point32Health)
Reminders and Update: Billing for PrEP and HIV Services (Harvard Pilgrim Health Care Commercial, Tufts Health Direct, Tufts Health Plan Commercial)
Prescribing of HIV PrEP medication, as well as ongoing follow-up and monitoring and other related services, are considered preventive services and are required under the Patient Protection and Affordable Care Act to be covered with no cost sharing responsibility for the member when rendered by an in-network provider. When submitting claims for these services, it’s important to bill in accordance with the Harvard Pilgrim Patient Protection and Affordable Care Act (Federal Health Care Reform) policy and Tufts Health Plan Preventive Services Payment Policy to ensure that no member cost sharing is inappropriately applied. To view the complete notification, click here.
Medical Necessity Guidelines: Cardiovascular Disease Risk Tests
Harvard Pilgrim Health Care has updated the Medical Necessity Guidelines as follows: Coverage guideline created to outline medical necessity for cardiovascular disease risk tests, effective July 7, 2023. For additional information and to view the notification, click here.
POPULATION HEALTH UPDATE
- According to the National Cancer Institute, in 2023:
- More than 106,000 women in the US are expected to be diagnosed with a gynecological cancer
- Gynecological cancers make up 10-15% of all women’s cancers
Prevention:
- GARDISIL 9 protects against: cervical, vulvar, vaginal, anal, oropharyngeal, neck/head cancers and lesions.
- “Long-Term Follow-up Data on Sustained Immunogenicity and Safety for GARDASIL®9” Published in Pediatrics
- Phase 3 trial and 10 year long-term follow up on the immunogenicity in GARDASIL 9 in male and female patients 9-15 years
- Findings:
- At 7 months 99.6-100% patients were seropositive (HPV-9 competitive Luminex® immunoassay cLIA)
- At 126 months 81.3-97.7% patients were seropositive (HPV-9 competitive Luminex® immunoassay cLIA)
- At 126 months 94.9% to 100% of patients were seropositive (HPV-9 immunoglobulin G Luminex immunoassay IgG-LIA)
- There were no cases of high-grade disease in females
- There were no serious adverse events or deaths
For full articles, see links below:
Screening:
- Continue on-time cervical cancer screening per guidelines below:
https://www.npwomenshealthcare.com/position-statement-cervical-cancer-screening-2/
NEPHO Performance:
- We have seen an incredible improvement in our HPV vaccination rates. This is significant and will reduce HPV related cancers in our pediatric patients. Great job to our pediatricians and our family medicine providers!
- Continue to provide confident recommendations for the 2 doses of GARDSIL before the patient’s 13th birthday
- The chart below shows NEPHOs BCBS performance in 2022 vs. 2023
- NEPHO holds >50% of the pediatric population for BILHPN.
PROVIDER RELATIONS
Please take a moment to share this newsletter with staff members to ensure they are being kept up-to-date with important information.
Please click here to take a moment to read the Provider Spotlights!
- Kevin Grafmiller, MD – North Shore Ear Nose and Throat
- William Rubenstein, MD – Sports Medicine North
- Tanner Brown, MD – Gurley Eye Care Associates
- Karra Cheever, FNP – BILHPC-FMA
Virtual Networking videos from NEPHO providers can be found here.
If you would like to be featured on the PHO website, please reach out to Alycia Messelaar at Alycia.Messlaar@Lahey.org or 978-236-1784.
Please click here to listen to Healthcare 360, a podcast from Dr. Rob Fields, Chief Clinical Officer at BILH.
Click here for the PDF version of the updated PHO Directory as of September 2023. 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 at 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 are the key memos that have been sent out over the last month –
JUST in case you missed it!
- Monthly BILH Pharmacy Newsletters
- BILHPC’s Core CME Series Offer
- Boston Children’s Hospital
- BCH’s Satellite Expansion Update/ BCH’s September CME newsletter
- “The Environment and Children’s Cancers” Continuing Education Opportunity
Please reach out to Alycia.Messelaar@lahey.org for a specific communication that you are unable to find.
BILHPN ACUITY TRAINING FOR EPIC PROVIDERS
There is one training session still scheduled for 2023. Click on the link below to register.
Arcadia Acuity Training
CLINICAL DOCUMENTATION IMPROVEMENT
OPTUM NEWSLETTER – September – Focus on Vascular Disease
Please click here to view the 2023 Optum webinar schedule.
On June 16, 2023, CMS announced the addition of 395 new diagnoses codes, 25 deletions to the ICD-10 CM code set, and 13 revisions. These changes will take effect October 1, 2023, for fiscal year 2024. These 2024 ICD-10-CM codes are to be used for discharges occurring from October 1, 2023 through September 30, 2024 and for patient encounters occurring from October 1, 2023 through September 30, 2024.
Please click here for more information.
Please reach out to Jessica Bryan at Jessica.M.Bryan@Lahey.org with questions or concerns regarding this clinical documentation tip or any other coding guidance.
PATIENT EXPERIENCE COMMENTS
Beth Israel Lahey Health Primary Care, Beverly – 30 Tozer Road
- I’m very happy with my medical office and Dr. Spencer Amesbury. Thank you for great service, professionalism, timeliness, follow through, etc. Kuddos to all! Keep up the great work!
- It was my first time having an appointment with Dr. Karenjeet Chahal and I found her very professional, kind and she answered all my questions.
- This was the first time I met Dr. Neeraj Mahajan and he was excellent- attentive, very knowledgeable, thorough, and a warm person and clinician! I will definitely look forward to seeing him more often.
Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road Suite 203
- I have been Dr. David Driscoll’s patient for more years than I want to count. He is probably one of the best doctors I have ever seen. He is kind, patient, and professional. His staff represents him very well.
- Dr. Deborah Shih and her staff always treat me with respect while providing excellent patient care.
Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center
- Dr. Pierre Ezzi listens to what I have to say and respects what I have to say.
- Dr. Pierre Ezzi is kind, thorough, knowledgeable and professional. He has a very inclusive and personalized manner.
Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center
- Dr. Andrew Lenhardt is the best! He is professional, caring and exceptional, I value being part of his practice
- Dr. Daniel McCullough – Truly outstanding care and service!!!
Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street
- Dr. Brent Fryling is a very professional, caring doctor. He listens to your concerns and takes appropriate action. I highly recommend him.
- My visits with Dr. Margaret Legner are always productive & thorough.
Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street Suite 204
- Dr. Timothy Loughran is exactly what I want in a PCP.
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 1st Floor
- Dr. Amy Esdale is very pleasant, respectful and competent provider and group!
Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor
- I really like Dr. Victor Carabba. He really explains everything and has always been a wonderful doctor to my family. I feel like I can talk to him anytime I need him. Everyone at the office is always so nice.
- As always, I left completely knowledgeable and satisfied with my visit with Dr. Karen Damico.
Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue
- Had a great experience. Appreciate how Dr. William Medwid takes time to listen to my concerns and answer my questions.
Beth Israel Lahey Health Primary Care, Manchester – 195 School Street
- I never feel rushed with Dr. Jana Oettinger. She always listens to any concerns that I may have and answers my questions clearly and completely. The staff is always courteous.
- Dr. Matthew Plosker was wonderful! Patient, down to earth, non-judgmental, informative, and offered helpful insight and suggestions.
Cape Ann Medical Center, Gloucester – 1 Blackburn Drive
- Sara Defilippo, NP saw me and she is AMAZING! She consulted with Dr. Janet Doran when necessary. Together they are my perfect caregiving team. Love them!
Cape Ann Pediatricians, Gloucester – 298 Washington Street
- Dr. Jeffrey Stockman – Always helpful and always a pleasure!
Danvers Family Doctors, Danvers – 140 Commonwealth Avenue
- I always have great visits with Dr. Subroto Bhattacharya. They are all so kind caring and professional. I’m always very comfortable being there.
EMTAR Healthcare, Inc., South Hamilton – 205 Willow Street
- Dr. Michael Edwards is the best PCP I have ever had!
Essex County Primary Care, South Hamilton – 42 Asbury Street
- Always quick and friendly visits. Dr. Nicholas Avgerinos exceeds my expectations as a PCP, and a human. So very friendly. Very knowledgeable and empathetic. Great personality and happy disposition. I cannot say enough about him!
Garden City Pediatrics, Beverly – 83 Herrick Street
- We love Dr. John Dean! He is so great with my children and he always includes me in his conversation/ decisions as well.
- Dr. Suzanne Graves – As always, 100% positive experience! Wouldn’t go anywhere else!
- We are thankful for Dr. Elizabeth Humphreys & the staff at Garden City. Dr. Humphreys has always been thorough and caring while talking with us about any concerns she has had regarding our son’s health.
- Dr. Meghan Weir and her nurse were amazing and made my children and myself feel at ease when visiting a new practice. Transition from old practice to Garden City was seamless.
North Shore Pediatrics, Danvers – 480 Maple Street
- We remain incredibly satisfied with Dr. David Danis and North Shore Pediatrics. He is the best!
- Dr. Lance Goodman was very patient and kind. He made our son feel safe and happy. We’re so fortunate to have a wonderful doctor who listens and never felt rushed. We 100% recommend him and his staff.
Brian Orr Pediatrics, Gloucester – 1 Blackburn Drive
- We’ve been with Dr. Brian Orr for over 15 years and can’t imagine having to go elsewhere. I recommend often.
Thomas Pearce, MD, Gloucester – 279 East Main Street
- Dr. Thomas Pearce – The staff is efficient, knowledgeable, kind and personable.
Thompson Medical Associates, Gloucester – 9 F Dr. Osman Babson Road
- Dr. Candace Thompson and Amy are the best. I trust them with my life and they always are kind.
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:
Melanie Ring, pictured below with Dr. Jana Oettinger. Melanie had a patient comment which read: “She (Melanie) is the best front office staff I’ve experienced in a while at this practice. Very friendly & very helpful!”
The September Referral Incentive Certificate was awarded to Anne Innis of North Shore Pediatrics. Anne is shown below with Dave Smith, Office Manager (Left) and Dr. Lance Goodman (Right).
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!