Complete the HIPAA Privacy Training Module by September 30

The Health Insurance Portability and Accountability Act (HIPAA) privacy training module is a requirement of the 2023 Clinical Integration Program for all providers and must be completed by September 30. The course can be accessed online in the Mount Sinai Clinical Integration Learning Center via the MSHP Provider Portal (log in required).

Timeframes for completing all of the mandatory elements of the 2023 Clinical Integration are available on the 2023 Timeline Checklists for PCPs and specialists.

Our next condition management CME course is September 12

Attendees will participate in an interactive, expert-led discussion of management considerations and best practices for patients with comorbid diabetes and CKD.

At the conclusion of the event, physician participants will earn a maximum of 1.5 AMA PRA Category 1 Credits™.

MSHP Board of Managers Spotlight

Meet Mount Sinai Health Partners’ Board Member, Alfred Burger, MD. Dr. Burger is an internal medicine and hospital medicine physician at Mount Sinai Beth Israel and Downtown Union Square. We recently caught up with Dr. Burger to learn more about him as a MSHP Board member! 

How long have you served on the Board?

I have served on the Board for three years. 

What do you like most about serving on MSHP’s Board of Managers?

The greatest part of being a member of the MSHP Board of Managers is the opportunity to represent and advocate for the all of the amazing providers working in our health system.

On the board we address many healthcare delivery issues, one of which is provider reimbursement rates and what quality measures we use to reward providers for the all the hard work they do. As a board member I am able to merge my passion for delivering the best patient care with my background in healthcare systems delivery to work with MSHP leadership in a meaningful way on all the topics we have to consider. I have also used this position to clarify several policies or processes for providers when they had questions.

The joy I get from serving in this role comes from working on behalf of all the providers in the downtown area to make sure we have a voice in the decisions before the board.

What do you hope to accomplish while serving on MSHP's Board of Managers?

As a board member my goal is to work with MSHP leadership to reward our medical practices and providers for the great work they do in keeping New York City as healthy as possible. I am proud of the work we did to adjust our metrics and measurements during the various waves of the COVID-19 pandemic and will strive to continue this work to fit the evolving world of healthcare in which we live and the external societal factors that impact us. I hope to continue to make our health system a great place to work and the best health system in NYC. 



What are your interests/hobbies outside of work?

Spending time with my family and our soon to arrive puppy, reading a good novel, running/walking in the various parks around NYC, and playing in a few adult sports leagues. 

We look forward to Dr. Berger continuing to

serve on MSHP’s Board of Managers! 

Interested in becoming part of MSHP's governance? Join a committee today! Reach out to Lauren Hertan to learn more about how you can participate.

Try GLP-1 RAs before insulin in patients with type 2 diabetes

The American Diabetes Association (ADA) now recommends that most patients with type 2 diabetes try glucagon-like peptide-1 receptor agonists (GLP-1 RAs) before insulin.

GLP-1 RAs have a low risk of hypoglycemia, can help promote weight loss, and may be more cost-effective than insulin. If you do prescribe insulin, consider combination therapy alongside a GLP-1 RA for greater efficacy and benefit.

Prior to beginning GLP-1 RAs, counsel patients on potential adverse effects and suggested dietary modifications.

• Side effects are typically temporary and often occur during initiation and titration

• Most common GI side effects include nausea, vomiting, and diarrhea
• May result in acute kidney injury (AKI) due to volume loss

• Recommend reducing meal size and limiting higher-fat and liquid carbohydrate foods including alcohol

To learn more, review this month's Condition Management Tip of the Month.

Policy Updates from UnitedHealthcare

UnitedHealthcare (UHC) shared some policy changes for the Commercial Line of Business effective July 1st including:

• Clinical and pharmacy policy and protocol updates
• Specialty medical injectable drug benefit update
• Prior authorization notification and medical necessity

Please note as well that effective August 4, 2023 UHC will no longer mail claim letters to most medical network health care professionals and facilities for UHC commercial plans. Claim letters can be found in the Document Library Claim Letters folder of the UnitedHealthcare Provider Portal.

UHC is also working to reduce the administrative burden for providers when it comes to prior authorizations with the following changes:

• Starting September 1, UHC will begin a two-phased approach to eliminate the prior authorization requirement for many procedure codes. Together, these code removals account for nearly 20% of UHC's overall prior authorization volume.

• In 2024, UHC will implement a national Gold Card program for provider groups that meet eligibility requirements. Qualifying provider groups will follow a simple administrative notification process for most procedure codes, rather than the prior authorization process. More information will be available later this year.

Lastly, UHC has revised their After Hours Weekend Policy for Physician Assistants when for CPT codes 99050 and 99051.

Learn more about the latest UHC updates

Updated Medicaid Reimbursement Policy for COVID-19 Vaccines

The New York Department of Health shared updated reimbursement policies for the administration of COVID-19 vaccines for New York State Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC).

EmblemHealth July 2023 Provider Newsletter

EmblemHealth released their July provider newsletter. Highlights include

• Updated medical policy reimbursement
• Updated preauthorization list
• Correct Claims Submission Reimbursement Policy
• Telehealth & Virtual Care Services Policy for Commercial, Medicare and Medicaid
• Bundling Services for Commercial & Medicare (Effective October 1, 2023)

Welcome to MSHP!

We'd like to extend a warm welcome to the newest members of our Clinically Integrated Network:

Specialty Care

Farnoush Bentley, DO

Family Medicine

Parsley Health PLLC

New York, NY

Elliot Nadelson, MD

Urology

Adam Nadelson MD PC

New York, NY

Andrea Persaud, MD

Dermatology

Bobby Buka MD, PC

New York, NY

Advanced Care Practitioners

Olesya Razhba, NP

Nurse Practitioner

Gynecology & Integrative Women's Care, PC

Brooklyn, NY