Volume 1, Spring 2021
IN THIS ISSUE:
New Leadership: Meet CEO Tara Buonocore-Rut
Tara Buonocore-Rut has been appointed President and CEO of CenterLight Health System. Since joining CenterLight as Chief Operating Officer in 2020, Buonocore-Rut has led the company’s efforts to restructure its care delivery, business intelligence, strategy and compliance functions.
Inspired by her close relationship with her grandparents, Tara has devoted her career to the health and well-being of older adults and brings impressive expertise in strategic and operational business planning, financial management, dual eligible populations and long-term care.
She joins CenterLight from Parker Jewish Institute for Health Care and Rehabilitation in New Hyde Park, New York. There, as Executive Vice President, Strategy and Operations, she was responsible for the successful planning and implementation of all corporate, financial, clinical and quality goals. Her previous engagements include roles as Executive Director of AgeWell New York in Lake Success, where under her leadership, AgeWell New York grew to over $750 million in revenue. Prior to AgeWell, she served as Senior Vice President for Business Development at the Parker Jewish Institute.
An active contributor to healthcare industry and governmental workgroups, Tara is President of the PACE/MLTC Cabinet, LeadingAge New York. She’s also a member of the Health Plan Association, the American College of Health Care Executives, the American College of Health Care Administrators and the Health Care Leaders of New York.
A Strengthened Leadership Team
We’re also excited to share several other key organizational appointments. These include: Shaun Ruskin – Executive Vice President and Chief Strategy Officer; Jeannie Doherty-Benckwit – Vice President of Business Development; Gilda St. Fleur – Vice President of Quality; and Alicia Nelson-Jones – Chief Compliance Officer. We will share additional information on these leaders in upcoming issues of this publication.
How to Code for Immunization Refusal
Denise L. Krupp, BBA, CPC, CR
Documenting and coding for patients' immunization refusal may be necessary for quality initiatives and continuity of care. Several HCPCS and ICD-10 codes are relevant and may be used appropriately, depending on the specific payer and practice guidance for coding immunization refusal:
- For influenza vaccine refusal when the reason is documented, HCPCS code G8483, "Influenza immunization was not administered for reasons documented by clinician."
- For pneumococcal vaccine refusal when the reason is documented, HCPCS code G8866, "Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine."
- For immunization refusal due to religious belief or group pressure, ICD-10 code Z28.1, “Immunization not carried out because of patient decision for reasons of belief or group pressure.”
- For immunization refusal due to another reason, such as the discomfort of injections, ICD-10 code Z28.21, “Immunization not carried out because of patient refusal.”
How to Avoid Common Coding Errors
The Importance of Risk Adjustment
Risk adjustment is a predictive model introduced by the Affordable Care Act. It calculates the risk that a healthcare plan member will incur medical expenses above or below an average, over a defined period of time. Risk adjustment assists in financial forecasting of future medical need. The more severe or complex a diagnosis, the higher the risk value assigned.
A risk adjustment value is assigned to each diagnosis code that falls into the payment model. Hospital and physician claims are the main source of data that drives the risk adjustment model. Accuracy and specificity in ICD-10 coding and medical documentation is critical for risk adjustment. ICD-10 coding is used to represent the member’s health status and establish an accurate risk score. ICD-10 diagnoses cannot be inferred from physician orders, nurse notes, or lab or diagnostic tests — they need to come from the medical record documentation.
Accurate Coding: A Must for Peformance-Based Payments
If medical documentation lacks the accuracy and specificity needed to assign the most appropriate diagnosis code, providers face the possibility of reduced payment in a performance-based payment model. There is also missed opportunity for patients to be identified for care management programs or disease intervention programs.
Avoid these common errors:
Coding from a superbill simply does not allow a provider to see all the diagnosis options available to him or her. It is usually a limited, generic list of unspecified codes.
Coding from a problem list. Make sure all problems listed on the assessment and plan are active and appropriate and haven’t been brought forward (copied and pasted) in error.
Coding only the primary diagnosis code. Diagnosis codes are not limited to what brought the patient to the office today. Any condition the provider monitors, evaluates, assesses, or treats should be included in the documentation.
Coding generic or unspecified codes. Code to the highest level of specificity known for that encounter. Example: I49.9 unspecified cardiac arrhythmia vs I48.0 paroxysmal atrial fibrillation
Using rule out diagnosis codes. Code what you know at the time of the encounter. If a definitive diagnosis has not been established, code the signs or symptoms.
Coding “history of” as current. Anything that is listed as “repaired” or “resolved” should not be coded as current. There are Z codes for history of.
Chronic and/or permanent diagnoses should be documented as often as they are assessed or treated. For risk adjustment, the Centers for Medicare & Medicaid Services requires these diagnoses to be submitted at least annually.
Clear, concise and complete documentation accurately reflects the provider’s work and the patient’s condition.
Provider Spotlight
Meet George C. Hall, MD
‘CenterLight Has a Good System to Help You Take Care of Your Patients.’
With offices in Chinatown, Flushing and Brooklyn, CenterLight Teamcare veteran George G. Hall, MD has 24 years of practice experience in internal medicine, treating patients in both English and Chinese (Cantonese and Mandarin).
Here, Dr. Hall reflects on his experience as a PACE Community-based PCP, including:
His enduring tenure with CenterLight.
I have been with CenterLight Teamcare PACE for 15 years. Currently 20 of my patients are CenterLight participants. Throughout this time, CenterLight has supported my patient care in many ways. It is easy to work with Teamcare, and to refer my patients to a specialist for any needed additional services.
Help in extending his team.
Patients have their regular appointments with us. The CenterLight nurse and home health aide also help to care for my patients. If something happens, they will confer with us. I have not had problems with the additional paperwork.
A new level of care for patients.
Teamcare is helpful to monitor my patients’ condition. They have any additional services they need, like physical therapy, both at home and at the Centers (when they are open). They also have an emotional benefit from PACE, by having a team to talk to in addition to me. Working with the CenterLight Interdisciplinary Team, together, we can give our patients great customer service.
Support for his practice.
Overall, the CenterLight Health System nurses and home health aides reduce a lot of work for physicians. CenterLight has a good system to help you take care of your patients. For these reasons, I would highly recommend Teamcare to other doctors.
Contact Info:
George.hall@eimgny.com
718-938-3188
CenterLight, Mount Sinai Offer CME Credits
In case your missed it – our presentation “Covid-19 and the Geriatric Patient” was on March 31, 2021 at 6:30PM.
Please be on the look out for future announcements regarding future courses.
Any suggestions?
Please share any educational topics that you are interested in to receive CMEs.You can email: providerengagementspecialist@centerlight.org.
Why is the PACE program so unique?
Unlike most Medicare and Medicaid plans, as a PACE plan, CenterLight is able to offer Dental, Vision and Hearing Care. Centerlight is currently partnered with HearUSA, General Vision Services and Healthplex.
Please reach out to the Participant’s assigned site to make the necessary arrangements with General Vison, HealthPlex or Hear USA for appointments.
Credentialing Notes
Did you move?
Do you have new phone, web or other relevant information?
Centerlight’s Credentialing Department would like to remind our providers of the importance of keeping us up-to-date with any changes in your practice.
Click here to complete a demographic change form, or reach out to Provider Engagement at providerengagmentspecialist@centerlight.org for assistance.Did you recently hire a PA or NP? Or perhaps a new MD joined or left your practice?
If so, we’d like to know so that we can update your provider profile with this new information.
Did you know?
State, Federal and PACE regulations require CenterLight to keep our provider network up-to-date.
Quicker, Simpler Payments with EFT
Per CMS Guidelines, CenterLight encourages all its providers to set up Electronic Funds Transfer (EFT) for payments. Beyond streamlining the payment process, EFT offers providers quicker, easier access to their payments vs. snail mail.
Visit this web page to learn more. Required forms, completed documents and a voided check should be e-mailed to Centerlightfax@ppi.com.
QUESTIONS?
Please reach out to the Provider Engagement Department at providerengagmentspecialist@centerlight.org.LCHSA In-Service Drives Quality Care
Christopher D. Hickey, BS, MS
Senior Executive Director
Team Care Learning and Resource Center
We were pleased to connect with many of our LHCSA partners throughout the first week of March at an in-service which focused on:
- Our shared values (Approachability, Accountability and Availability)
- COVID-19 Expectations
- Communication and submission of paraprofessional semi-annual assessment forms
- Referrals and growth
- Education of the aides to PACE and communication with our staff nurses
- Monthly report cards and personnel lists
As transparency and open communication will foster continued success, starting in June, we’ll launch quarterly meetings with the LHCSAs and review the report cards and share our findings.
Please ensure that the aides received the QRcode on the right, which will be the ongoing means by which we will broadcast education-related material to them. We thank you for your support and look forward to working together to provide a quality of care and excellence in service that reflects our shared commitment to those we serve.
Updated Provider Engagement Specialist Contact information
Email: mvdeleon@centerlight.org
Mobile: 347-415-5699
E-Fax: 315-825-4812
Supervises: Provider Engagement Specialists
Email: mbramos@centerlight.org
Mobile: 646-315-5813
E-Fax: 315-825-4812
Provider Engagement Specialists:
IPA: Prominins
Mariela Bodon Ramos
Email: mbramos@centerlight.org
Mobile: 646-315-5813
E-Fax: 315-825-4812
IPA: CAIPA, ECAP, KAPIPA, RAYN
Ann McGarvey AMcGarvey@centerlight.org
Mobile: 646-306-2612
IPA: Hudson
Latarsha Fisher Lsmith@centerlight.org
Mobile: 929-505-3347
How To Make A Referral
1-877-212-8877 (TTY 711)
8AM to 8PM, Monday-Friday
(Click on “Refer a Participant”)
We also accept referrals through out Intake group email, info@centerlight.org.
All of us at CenterLight want to thank you for your continued support, collaboration and commitment to our participants and the communities we serve.
