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Clinically Integrated Network Newsletter
November 18, 2021
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Cast Your Vote by Friday, November 19
There’s only 1 day left to vote in this year’s Mount Sinai Health Partners Board of Managers Election! Check your inbox for an email from ElectionBuddy <invitations@app.electionbuddy.com> and submit your vote by Friday. If you do not see the e-mail in your inbox, please be sure to check your spam or junk email folder.
The following seats are up for re-election and only providers whose main practice are located in the below areas will receive an email to vote:
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Open Voluntary Seats:
- One Manhattan PCP
- One Non-Manhattan PCP
- One Non-Manhattan Specialist
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Open Employed Seats – Any Specialty
- One West Side, Manhattan
- One Non-Manhattan
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Save the Dates! 2022 Mind Matters Anxiety Module
Mind Matters ECHO will be back in January 2022 with a module on managing anxiety in primary care. Join us once a month for case presentations from your colleagues as well as expert didactic presentations on screening and treating anxiety in the primary care setting. Watch your inbox for an invitation to attend in early December.
January 12, 2022
Barriers to Screening for Anxiety: Effective Solutions for Proactive Anxiety Management
February 9, 2022
Effective Treatments for Anxiety: Psychotherapy
March 9, 2022
Effective Treatments for Anxiety: Pharmacology
April 13, 2022
Understanding and Managing Side Effects of Commonly Prescribed Anxiolytics
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Thank you to all who joined our November Town Hall!
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Review Your Customized Reports
A new suite of customized CI performance and patient opportunity reports were placed in your practice’s OneDrive account on November 3. These reports identify any patient with a care gap and includes all gaps for that patient including chronic condition recapture, quality and patients who have not been seen. Please review these reports.
If you find any discrepancy in reviewing your Patient Opportunity Report and colorectal cancer screening being completed in prior years (before 2021) and within the measurement acceptance period, you can submit historical colorectal cancer screening reports via OneDrive. The documentation will be reviewed by the MSHP Quality Team and if accepted the open care gaps will be closed and reflected in your final calculation for 2021. Documentation is due by November 30. Read this communication for full instructions.
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November is Diabetes Awareness Month
As November is Diabetes Awareness Month, we encourage you to revisit the materials on our Chronic Condition Hub to help you manage diabetes in your practice. Check out our:
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CMS Releases Final 2022 Medicare Physician Fee Schedule
Some highlights include:
- Decrease the Medicare conversion factor to $33.598, from $34.89, which was finalized for 2021, a drop of about 3.7 percent
- Add new chronic care management (CCM) code, 99437, which describes each additional 30 minutes by a physician or other qualified health care professional, per calendar month
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NYC Medicare Advantage Plus Plan Update
The City of New York has awarded their group retiree business to Retiree Health Alliance, an alliance between Empire BlueCross BlueShield and EmblemHealth. Effective January 1, 2022, approximately 240,000 Medicare-eligible City of New York retirees will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan. Mount Sinai Health Partners is working on an agreement with the Alliance and all CIN providers will be participating.
The NYC Medicare Advantage Plus plan is a Medicare Advantage PPO plan that allows retirees to receive services from both in-network and out-of-network providers. Out-of-network providers must be eligible to receive Medicare payment. Under this new plan, City of New York retirees will have no difference in cost-share for both in-network and out-of-network services. NYC Medicare Advantage Plus offers the same hospital and medical benefits Medicare covers, as well as additional benefits Medicare does not provide, such as an annual routine physical exam, hearing exams, health and fitness tracker, LiveHealth Online, and SilverSneakers.
Learn More
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Attend an upcoming webinar to help you and your staff understand the upcoming changes for City of New York retirees transitioning to the NYC Medicare Advantage Plus plan that begins January 1, 2022. The webinars will review key operational processes such as determining eligibility and benefits, prior authorizations requirements and claims submissions to assist you in continuing to provide care for City of New York retirees. Register today! Please select a session you would like to attend by selecting your desired date and time.
- Read the FAQs
- View sample ID cards
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Reimbursement for Counseling Unvaccinated NYC Medicaid and MA Patients
NYC Health Department Program running from September 1 – November 30, 2021
Providers can receive reimbursement for providing COVID-19 vaccine counseling services:
- $50 – clinical outreach by licensed health provider
- $25 – nonclinical outreach by health provider's designee
- Participating Medicaid and MA plans will provide list of patients to provider for outreach
As of October 22, plans participating in the payment program are: Amida Care, Empire BCBC/HealthPlus, HealthFirst, Health Insurance Plan of Greater New York/EmblemHealth, MetroPlus Health and United Healthcare Community Plan. We expect additional plans to join the program.
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Cigna Gastroenterology Update
Cigna shared updates requiring precertification for certain GI procedures. Learn more.
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Cigna Fourth Quarter Network News
- 16 new CPT codes and 11 new HCPS codes added to the precertification list
- 18 CPT codes and 4 HCPS codes removed from the precertification list
- Changes in drug formulary effective January 1, 2022 include immune globulins, iron replacement, neutropenia, pulmonary hypertension, transplant therapy, HIV, MS, oncology, asthma/COPD, diabetes, and hypothyroidism drugs
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EmblemHealth October Newsletter
- 2022 preauthorization updates
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More information regarding the January 2022 launch of the NYC Medicare Advantage Plus plan for Medicare-eligible City of New York retirees
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An alert notifying providers of a change at HealthCare Partners (HCP)
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Encouraging providers to use the new Provider Portal, and a linked story on the benefit to providers for moving UM requests from fax/phone to web
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MOC Training for SNP Providers
CMS requires all participating providers participating with Bright Health’s D-SNP and C-SNP plans to complete annual Model of Care (MOC) training.
Action Needed by December 31, 2021:
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Welcome New MSHP Providers!
We'd like to extend a warm welcome to all new provider members who recently joined our clinically integrated network.
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Primary Care
Allison Ostrow, MD
Pediatrics
Bodhi Medical Care, LLC
New York, NY
Lauren M. Perry, DO
Family Medicine
Ryan Frederick Douglass Community Health Center
New York, NY
Gary Tollin, DO
Family Medicine
Primary PartnerCare Physicians, PLLC
Massapequa, NY
Specialty Care
Alex M. Amberg, MD
Obstetrics & Gynecology
William F. Ryan Community Health Center
New York, NY
Teru Hayashi, OD
Optometry
Apple Ophthalmology, PLLC
New York, NY
Diana Y. Ho, MD
Obstetrics & Gynecology
Goncharov Medical PC
New York, NY
Andres Jimenez, MD
Public Health and General Preventive Medicine
Connected Health Medicine P.C.
Rye, NY
Emily Kintzer, MD
Obstetrics & Gynecology
William F. Ryan Community Health Center
New York, NY
Alisha Liggett, MD
Family Medicine
Telemedicine Associates, PC
Brooklyn, NY
Andrea R. Schecter, MD
Obstetrics & Gynecology
William F. Ryan Community Health Center
New York, NY
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Kelly Whelan, AUD
Audiology
ENT and Allergy Associates
Bayside, NY
Advanced Care Practitioners
Sherese R. Fralin, NP
Nurse Practitioner
Connected Health Medicine P.C.
Rye, NY
Amy E. Root, NP
Nurse Practitioner
Telemedicine Associates, PC
Brooklyn, NY
Randa Samaha, NP
Nurse Practitioner
Connected Health Medicine P.C.
Rye, NY
Maria E. Strangie, PA
Physician Assistant
Bobby Buka MD, PC
New York, NY
Caroline Sullivan, NP
Nurse Practitioner
Spring Primary Care
New York, NY
Jaclyn S. Vinagre, NP
Nurse Practitioner
Bobby Buka MD, PC
New York, NY
Behavioral Health
Gregg R. Felice, LCSW
Licensed Clinical Social Worker
Connected Health Medicine P.C.
Rye, NY
Rebecca S. Nerenberg, LCSW
Licensed Clinical Social Worker
Ryan-NENA Community Health Center
New York, NY
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Reduce Claudication, Improve Quality of Life and Functioning in Your Peripheral Artery Disease Patients
Patients with Peripheral Artery Disease may experience claudication and other atypical symptoms that reduce their quality of life and functioning. Patients who have intermittent claudication can benefit from a regular walking program. Studies have shown that regular exercise, particularly walking, can improve your symptoms of leg pain. Click here for a home-based walking program for your patients, developed by Dr. Jeffrey Olin.
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QPM Claims-Based Calculations Guide Available
Provider performance in Mount Sinai Health Partners’ 2021 Quality Performance Metrics (QPM) program accounts for 50% of a primary care provider’s Clinical Integration (CI) Index score. The CI Index score is used to calculate providers’ annual incentive payment under the Clinical Integration Program. Click here for the QPM Claims-Based Calculations Guide to help you navigate the ins and outs of QPM Claims-Based Calculations.
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COVID-19 Diagnosis and Testing Cost-sharing Waivers Remain in Effect Until 12/29/2021
The New York State Department of Financial Services has issued emergency regulations requiring that cost-sharing waivers associated with COVID-19 diagnosis and testing remain in effect until December 29, 2021. New York insurers will continue to be responsible for reimbursing hospitals for any applicable cost sharing. Read the bulletin.
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Frontline Excellence in Ambulatory Chronic Disease Management, Module 3: COPD and Peripheral Artery Disease Recording Now Available on CILC
The recording of the September 21st COPD and Peripheral Artery Disease (PAD) event is now available on CILC behind login. Click here to watch the recording and here to download the slides.
Be sure to use our materials to help you manage COPD and PAD in your practice. Check out our quick guides on COPD and PAD, as well as our COPD and PAD patient materials.
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If you have any questions about any of our announcements, please contact your Population Health Manager, email Mount Sinai Health Partners at mshp@mountsinai.org or call us at 877-234-6667.
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P: 877-234-6667
F: 646-537-1481
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