Dr. Mucciardi named district Community Clinician of the Year; MMS & CMS discuss prior authorization

News and announcements

This past May, the Massachusetts Medical Society passed important and groundbreaking policy when it declared that the opportunity for health, including healthcare, is a basic human right.

We were the first state medical society to make this declaration—a declaration we so strongly believed that state brought this policy resolution to the AMA in June for consideration. And we can be proud to say that this was adopted as AMA policy as well!    

So why is this policy declaration important?    

This policy is a core principle that can serve as our compass as we plan and achieve our work in physician and patient advocacy, education, and support. This principle will inform the envisioned future for health care and be a lens through which decisions are made.    

Thank you for being part of this historic work!    

- Maryanne Bombaugh, MD

Dr. Mucciardi named Bristol South District Medical Society Community Clinician of the Year

Dr. Nicolini Mucciardi was selected as the Bristol South District Medical Society’s 2019 Community Clinician of the Year, an award recognizing his professionalism and contributions as a physician.

Dr. Mucciardi is a pulmonologist in Fall River and is affiliated with Southcoast Charlton Memorial Hospital. He received his medical degree from McGill University in Montreal, Canada, and completed a medical internship and residency at Carney Hospital in Boston.

Dr. Mucciardi is board certified in internal medicine and pulmonary medicine in both Canada and the United States. In 1987, Dr. Mucciardi was the first physician in the Fall River area to be board certified in critical care medicine. He was also awarded the Best Clinical Case of 1987 by the Massachusetts Thoracic Society at their Annual Meeting in 1988. In 2007, Dr. Mucciardi received a citation from the Commonwealth of Massachusetts House of Representatives “in recognition of doing an exceptional job as a lung specialist at the Truesdale Clinic.”

MMS leadership met with CMS in listening session to discuss prior authorization 

MMS President Dr. Maryanne Bombaugh, alongside society leadership and key stakeholders, met with Centers for Medicare & Medicaid Services (CMS) staff to discuss prior authorization on Thursday. The CMS “Patients over Paperwork” team is conducting listening sessions with major parties, including the society, to understand the prior authorization experience and the administrative burdens imposed.

CMS launched the "Patients over Paperwork" initiative in 2017 to find opportunities to modernize—or eliminate—rules and requirements that are outdated, duplicative, or getting in the way of quality patient care. CMS is working to understand the prior authorization experience for Fee-for-Service Medicare, Medicare Advantage, Medicaid Advantage, and Health Insurance Marketplace Plans from the perspective of payers, clinicians, support staff, and industry partners, among others.

(Left-right) Dr. Alain Chaoui, Immediate Past MMS President, Dr. Maryanne Bombaugh, MMS President, and Dr. Jatin Dave, Chief Medical Officer, New England Quality Care Alliance.

(Left-right) Joseph Stone, Special Assistant, Regional Administrator's Office, and Dr. Richard Wild, Chief Medical Officer, CMS Atlanta Region. 

Proposed policy, payment, and quality provisions changes to the 2020 Medicare Physician Fee Schedule 

On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a draft rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020.

The calendar year (CY) 2020 PFS proposed rule is one of several proposed rules that reflect a broader administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.

Public comments on the proposed rules are due by September 27, 2019.

For a fact sheet on the CY 2020 Physician Fee Schedule proposed rule, please click the button below.

Changes to National Government Services local coverage determination process schedule 
In accordance with Section 4009 of H.R. 34-21st Century Cures Act (Public Law No: 114-255), the Centers for Medicare & Medicaid Services (CMS) is updating the “Medicare Program Integrity Manual” with detailed changes to the Local Coverage Determination (LCD) process. These changes were communicated in CMS Transmittal 863, issued on 2/12/2019.

Please ensure that your staff is aware of the LCD revisions and transition of all coding to related articles. There has been no change in coverage associated with this update.

• All coding information will be removed from the LCDs and placed in a related billing and coding article, including national coverage provisions and associated information (documentation requirements, utilization guidelines).
• The article name will begin with “Billing and Coding,” followed by the title of the associated LCD.
• Bill types, revenue codes, CPT/HCPCS codes, ICD-10 codes, as well as any coding guidance or mention of codes in the LCD will now be found in the associated billing and coding article.
• Several LCDs will be revised for 8/1/2019 publication. The remaining LCDs will be revised in the coming months, with all completed by 1/1/2020.
• Billing and coding articles will be listed on the Medical Policy Center page alongside the related LCD.

Related Content

• More details on this update are available in MLN Matters® Article MM10901.
• For a complete listing of all LCDs, visit our Medical Policy Center.

Join our AMA delegation

The MMS Committee on Nominations is seeking candidates for nomination to the Massachusetts AMA Delegation. Visit www.massmed.org/amanoms to learn more about the qualifications and submit your application. The application deadline is Friday, August 30.

Interviews with the Committee on Nominations will be held at MMS Headquarters, Waltham, on Wednesday, October 2, 4:30 p.m. – 8:00 p.m. Applicants should plan to be available on this date. Questions? Please contact Linda Healy at (781) 434-7008 or lhealy@mms.org, or Karen Harrison at (781) 434-7463 or kharrison@mms.org.

Benefit buzz

Legal Advisory Plan - Why you should enroll

When you receive a Board of Registration in Medicine (Board) investigation or complaint, it is recommended that an attorney delivers a well-crafted response to the Board. If you have to attend an informal Board conference about your situation, it is advised that an attorney represents you in person.

Your malpractice insurance may not cover these legal activities or perhaps only a portion. Your out-of-pocket expenses could cost you thousands of dollars.

Take advantage of the MMS Legal Advisory Plan, a members-only affordable legal service, for a nominal fee of $70/year – a fraction of typical legal fees. Enroll or renew for coverage through July 2020 now. Additional discounts for groups of five or more. Questions? Email lap@massmed.org or call (781) 434-7311.

Member verdicts:

"The Plan is a bargain. Our practice has contacted the attorneys a few times and resolved the Board matters quickly."

"The LAP newsletters were very helpful in helping me be aware of situations to avoid that could impact my medical practice and license."

The PHYSICIAN PRACTICE RESOURCE CENTER (PPRC) serves individual physicians and group practices of all sizes by providing expert knowledge and resources, advocacy, timely and critical information, and ongoing practice support. Our goal is to ensure that you have the information and resources you need to maintain a thriving practice of any size. In today’s challenging environment, practicing medicine is complicated. We make it easier.

We provide physician practices a powerful support and resource network so that you can operate successfully and focus on what matters most.

Feel free to contact us today at PPRC (781) 434-7702 or email us at pprc@mms.org.
 

Payer watch

Blue Cross Blue Shield of Massachusetts

Use Mass Collaborative form for BH level of care requests

As part of its effort to simplify administration for providers, the Massachusetts Collaborative creates standardized authorization forms and updates them as needed. To ensure that providers always use the most up-to-date version of the Behavioral Health - Level of Care Request Form, Blue Cross Blue Shield of Massachusetts has separated the required Supplemental form from the Mass. Collaborative’s form.

How to access the forms

To ensure that providers always use the most current version of the form, Blue Cross Blue Shield of Massachusetts has put a link to the Collaborative’s form and changed the form’s name to Behavioral Health – Level of Care Request Supplemental Form. Please be sure to submit both the Request Form and Supplemental Form.

For all your payer updates, contact us today at PPRC (781) 434-7702 or email us at pprc@mms.org

MMS Individual Claims Consultation Days: Spaces are limited!

The Massachusetts Medical Society is hosting in-person Insurance Claims Consultation Days (ICC). ICC days are designed to allow MMS member physicians and/or their practice staff to schedule 30-minute appointments with health plans to focus on adjudication of troublesome claims.

Available:

• Lakeville ICC Day September 19, 2019

Representatives from health plans will be on-site to review claims with you to facilitate claims processing.  Schedule your appointment at massmed.org/ICC2019 .

The following health plans are participating: Allways Health Partners, Blue Cross Blue Shield of Massachusetts, Fallonhealth, Harvard Pilgrim HealthCare, Health New England, MassHealth, Medicare, Tufts Health Plan, UnitedHealthcare, and Unicare.

Educational programs and events

CME education programs & events  

Featured NEW online CME course

• Talking to Patients About Gun Safety
• Firearm Violence: Policy, Prevention & Public Health (6 Modules)
• Initiating a Conversation with Patients on Gun Safety

Upcoming events and trainings

September 7-8: Enhanced Recovery After Surgery: Providing Evidence-Based Care in the Multidisciplinary Setting Course and Workshops (MMS Headquarters)   Dedicated to addressing topics related to understanding all components of ERAS, including preoperative, intraoperative, and postoperative Phases, the course and workshops consider evidence-based best practices for each component according to the various levels of care across different medical specialties. Participants will learn the value and implications of ERAS as a relatively new holistic approach to patient care.

September 8-10: Schwartz Center’s Compassion in Action Healthcare Conference (Westin Boston Waterfront)
This unique conference brings together clinicians, health system leaders, and others who are committed to making compassion a priority in their organizations and communities. Through interactive experiential sessions with experts from diverse care settings and communities, this conference will provide cutting-edge programs, strategies, and tools to help health care professionals across all roles and disciplines create and sustain cultures of compassion.

Quote of the week

"The only thing worse than a death is a death that can be prevented. And to go and talk to the mom of a child who was normal at breakfast and now is not here, is the worst possible thing."

—  Dr. Ronnie Stewart on the prevalence of gun violence from a physician’s perspective (CBS)

Tweet of the week

@FoodisMedMa
A coalition dedicated to building a health care system that recognizes the critical relationship between food & health. Co-led by @HarvardCHLPI & @communityserv

What’s new in health care

Check out the most clicked-on stories from this week's MMS Media Watch. Sign up for daily Massachusetts media roundups by email. Some publications are fully accessible only to their subscribers.

Safe injection sites are another tool on the path to recovery (Boston Globe)
Researchers from the Massachusetts Medical Society assisted with an AMA study and issued an April 2017 report recommending that the state pursue a pilot program for safe injection facilities, create an advisory board to design an evaluation protocol for the pilot, and build on programs with expertise in providing high-quality harm-reduction services to populations that would be served by the facilities. They also urged us to consider harm-reduction strategies as a component of the pilot beyond the facilities, to ensure that comprehensive health care is available to marginalized individuals who inject drugs and need treatment."

Three hospitals team up on $3m plan to help low-income families pay rent (Boston Globe)

Three big Boston teaching hospitals are launching an initiative to help families facing eviction, collectively acknowledging the strong connection between stable housing and good health. Together, Boston Medical Center, Boston Children's Hospital, and Brigham and Women's Hospital plan to spend about $3 million over three years to fund housing programs through grants to community organizations. The first $1.5 million is slated for families struggling with unstable housing, including those behind on rent payments and at risk of eviction. The initiative reflects the growing recognition in the health care industry that such issues as housing, education, and food play a critical role in a person's health — and in health care costs.

Coworkers, Life Star flight helped save worker after saw cut jugular vein (MassLive)

Trauma surgeon, Dr. Reginald Alouidor, who performed surgery on Bull, said that from the moment the helicopter touched down at Baystate Medical Center, Bull was in the Trauma bay within a minute and a half, and on the operating table within two. "Because of the severity of Mr. Bull's injury we went straight into surgery," said Alouidor. "This was one of the worse cases that I've seen." "I have two more operations to undergo," says Bull. " One on my voice box and the other to repair the nerve damage in my neck and shoulder." Unable to lift his arm due to the nerve damage, Bull has a variety of medication that he now needs to take to help with the pain but is very happy to be alive.

Local 'red flag' law sponsor questions Trump's motives (WGBH)

The national "red flag laws" President Donald Trump called for in the wake of last week's mass shootings would be similar to laws already on the books here in Massachusetts. But the author of the state's protection order law doesn't agree with Trump's priorities when it comes to preventing gun violence. "We must make sure that those judged to pose a grave risk to public safety do not have access to firearms, and that if they do, those firearms can be taken through rapid due process. That is why I have called for red flag laws, also known as extreme risk protection orders," Trump said Monday, addressing the nation after attacks in Dayton, Ohio and El Paso, Texas. Even though Rep. Marjorie Decker (D-Cambridge) pushed through the state's one-year-old red flag law last year, she doesn't think Trump's endorsement of weapon removal or his conflation of gun background checks with immigration reform gets to the root of gun violence.