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Clinically Integrated Network Newsletter
October 26, 2021
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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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Join us for the November 16th Town Hall. We want to hear from you!
Mount Sinai Health Partners is hosting its final virtual Town Hall Gathering for this year on Tuesday, November 16 from 6:00 - 7:30PM. We will be providing COVID-19, payor, and health system updates during this event.
We also want to hear from you!
We have a tremendous amount of expertise and know-how within our CIN, and would like to use this Town Hall to help share your knowledge.
Some topic suggestions include:
- How to increase patient engagement with their medical issues and medications
- Success stories in quality or operational excellence
- How physicians manage and process medication prior authorization on a daily basis
- Recent successes and challenges with telemedicine
As a reminder, attendance for this program will also meet a portion of the Program Engagement CI requirement for 2021.
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Thank you to all who joined our September Town Hall!
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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 event is now available on CILC behind login. Click here to access CILC and then scroll down to find the course titled MSHP September 2021 Virtual Event: Frontline Excellence in Ambulatory Chronic Disease Management - Module Three: COPD and Peripheral Artery Disease. Click 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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Your Vote Counts! Vote in the Upcoming MSHP Board of Managers Election
The Mount Sinai Health Partners Board of Managers Election begins on Friday, October 29 and will run through Friday, November 19. MSHP will be using an online election system to tabulate the votes. Please look out for an email from ElectionBuddy <invitations@app.electionbuddy.com> and cast your vote! 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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Provider Relief Fund Updates
HHS will be distributing an additional $17 billion in Provider Relief Funds to providers intended to cover losses from July 1, 2020 to March 31, 2021. The application period remains open through October 26, 2021. Changes to note this round are that smaller providers will be reimbursed at a higher rate than larger providers, and bonus payments will be awarded based on the amount of services provided to Medicaid, CHIP, and Medicare patients. Click here to learn more.
Please also note that providers who received more than $10,000 during Payment Received Period 1 (April 10, 2020 to June 30, 2020) needed to report by September 30, 2021. HHS is providing a 60-day grace period allowing providers to come into compliance by November 30, 2021. Click here to learn more.
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MSHP Podcast: Episode 37: Suicide Prevention Programs in the Healthcare Workforce
Healthcare workers bear a tremendous burden in their day-to-day work. Dr. Jonathan DePierro and Dr. Rob Fields discuss how the culture of not seeking help increases the risk of suicide among these workers, the immense fear and stress of the COVID-19 pandemic, and more. Listen now.
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MSHP Podcast: Episode 36: Remote Patient Monitoring and Connected Devices
A number of MSHP staff join Dr. Rob Fields for a discussion of connected devices and remote patient monitoring at Mount Sinai. They talk about lessons learned, strategy, optimizing clinical decision making, and more. Listen now.
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Pharmacogenomics CME Event at Mount Sinai
This CME course will equip physicians, nurse practitioners and physician assistants with the relevant knowledge necessary for understanding the background and key concepts in clinical pharmacogenomics. Participants will receive information to guide them on testing, return of results, applications in patient care, and other emerging clinician roles in pharmacogenomics. Clinicians will also learn to apply these principles in their own practices. Register here.
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MSHP's Anitha Iyer, PhD on Leveraging Collaborative Partnerships to Increase Access to Behavioral Health
Join our very own Anitha Iyer, PhD, and the Primary Care Development Corporation for a webinar on Wednesday October 27, 2021 from 1:00pm-2:00pm EST on leveraging collaborative partnerships to increase access to behavioral health care. Register here.
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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
Rui Jiang, MD
Internal Medicine
Ryan-NENA Community Health Center
New York, NY
Raman Singhal, MD
Internal Medicine
Ryan-NENA Community Health Center
New York, NY
Specialty Care
Jarrett Masson, MD
Obstetrics & Gynecology
Goncharov Medical PC
New York, NY
Norman Coleburn, MD
Urology
Ryan/Chelsea-Clinton Community Health Center
New York, NY
Peter Hashim, MD
Dermatology
Bobby Buka MD, PC
New York, NY
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Gerald Hoke, MD
Urology
Ryan/Chelsea-Clinton Community Health Center
New York, NY
Jeanie Tse, MD
Psychiatry
Ryan/Chelsea-Clinton Community Health Center
New York, NY
Advanced Care Practitioners
Devin Bonura, PA
Physician Assistant
Primary Partner Care
Nassau, NY
Theresa Crafa, NP
Nurse Practitioner
Primary Partner Care
Nassau, NY
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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.
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
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! Webinar sessions begin in November. Please select a session you would like to attend by selecting your desired date and time.
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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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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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COVID-19 Vaccine Booster Shot Medicare Coverage
On September 22, 2021, the FDA amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to allow for use of a single booster dose for certain populations.
- Medicare covers Pfizer COVID-19 booster shots for populations specified in EUA
- Medicare FFS covers vaccine administration for Medicare FFS and Medicare Advantage patients
- For Medicare Advantage patients, vaccine claim should be submitted to Part B Medicare Administrative Contractor (not the MA plan)
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For more information on billing Medicare for vaccines, visit: https://www.cms.gov/covidvax-provider
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Medicare Coverage of Monoclonal Antibody Treatment
During the COVID-19 public health emergency (PHE), Medicare will cover and pay for these infusions when furnished consistent with their respective EUAs.
Can be administered by:
- Freestanding and hospital-based infusion centers
- Home health agencies
- Nursing homes
- Entities with whom nursing homes contract to administer treatment
Health care providers administering the infusions of monoclonal antibody products to treat COVID-19 will follow the same enrollment process as those administering the COVID-19 vaccines.
As with COVID-19 vaccines, claims for these services delivered to Medicare Advantage patients should be submitted to original Medicare.
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MOC Training for SNP Providers
EmblemHealth
CMS mandates all providers participating in the VIP Bold and Reserve Networks to complete the Special Needs Plan Model of Care (SNP MOC) training annually.
Action Needed by October 31, 2021:
Bright Health
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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EmblemHealth September Newsletter
- Provider Portal information
- Special Needs Training
- COVID-19 Policy Updates
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October 7th was National Depression Screening Day
But it’s important to screen your patients for depression every day! Learn more about screening for depression in your practice.
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Payments Issued
Community-based primary care physicians received Q2 2021 care coordination payments the first week of October.
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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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