Medical Management HELLO, JUST A REMINDER TO ALL THE PRACTICES – February 2023 1. Global and outpatient referrals go through Medical Network One’s POD’s system (www.mednetone.net). If you need assistance uploading a referral, send a fax to 248-475-5777 or a secure email to [email protected]. 2. Office managers can add new members to access PODS. Have the office manager log into the site and select “Request a New Account”. Our referral specialist checks the site daily and will set up new accounts as requested. 3. All MRI’s and CT Scans go through AIM now (1-800-728-8008). 4. All PT/OT/ST (physical/occupational/speech therapy) go through EVICORE (1-877-531-9139). Chiropractor referrals are only good until the end of the year. Initial referral is good for 30 visits and then unlimited after that. 5. Patients with BCN Advantage DO NOT need a global referral to see a specialist. They only need a referral for the procedure that they are having done (e.g. colonoscopy/EEG). 6. Diagnosis codes need to be specific. Please do not submit Z00.00 for any specialist. For example: Knee Pain Unspecified (need specific knee). – If we receive unspecified diagnoses, we will contact you for a different diagnosis. 7. Any practice that cannot get on to PODS and needs a referral completed can print this referral form, fill it out, and fax it to 248-475-5777. 8. As of April 1st Availity Essentials is now Blue Cross Blue Shield of Michigan and Blue Care Network’s provider portal. If you have any questions, please contact us, we are here for you. Stay Safe!!! Christina Pourcho, Referral Specialist Phone: 248-475-4759 Fax: 248-475-5777 Email [email protected] (SECURE EMAIL ONLY) |
Patient-Centered Medical Home Welcome to the Blue Cross Blue Shield of Michigan Patient Centered Medical Home (BCBSM PCMH) monthly newsletter update! Each month we will bring together all relevant PCMH news and updates for our participating provider community. This month we will review the new capability that was added to the BCBSM PCMH program for 2023: Cardiovascular Disease Screening Capability: 9.15: A systematic process is in place to screen adult patients for cardiovascular disease (CVD) risk using evidence-based guidelines PCP Guidelines (applicable to PCPs only): Practice has a written process for screening adult patients for CVD risk using evidence-based guidelines and an evidence-based tool. Resource: Integrating cardiovascular disease risk calculators into primary care (ahrq.gov) (https://www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/heart-health/cvd-risk-calculator.pdf) Practice has a systematic process used at point of care. Systematic process is in place for conducting follow up on high-risk screening results. Process is in place for conducting future screenings. PCMH Validation Notes for Site Visits: Which evidence-based guidelines were used, i.e.: USPSTF, ACC, AHA? Describe the population based on the guidelines used (i.e.: age range) Demo the point of care process using an evidence-based screening tool Provide examples from the patient record of both negative and positive results Provide examples from the patient record of the follow-up process for positive results Provide timeframe for future screenings |
Care Management MedNetOne’s comprehensive Diabetes Education Program is accredited by the American Association of Diabetes Educators and is recognized by the American Diabetes Association. With more than 37 million people living with diabetes in the United States and a total medical cost of $327 billion, diabetes is a major and immediate threat to the health of the country and the productivity of its workforce. If diabetes is poorly controlled and managed, it can lead to additional medical problems and costs. Med Net One believes education is the key to controlling and preventing this disease. MedNetOne offers Diabetes Self-Management Education (DSME) classes in group and individual settings. We have a multi-disciplinary team of clinicians providing education including certified diabetes educators, registered nurses, registered dietitians, behavioral health specialists and exercise specialists. Our staff is dedicated to helping patients increase their self-management skills. Classes include: diabetes disease process, meal planning, monitoring, medications, physical activity, healthy coping and preventing long-term complications. Increased knowledge of diabetes helps those affected by the chronic illness take control of their condition and maintain a healthier lifestyle. To sign up for DSME classes, a patient must obtain a signed referral form from his or her physician. For qualifying patients, please complete the attached referral form and fax to 248-475-5777. Erica Ross, Clinical Services Manager |
Human Resources There is a blood donation crisis in the United States. Every two seconds someone in the U.S. needs blood. According to the Red Cross estimated 6.8 million people in the U.S. donate blood each year. 13.6 million units of whole blood and red blood cells are collected in the U.S. in a year. However, the need for blood, far outpaces the gains. Some patient care is being postponed due to blood shortages. We are seeing upticks in hospitalizations across the country, with RSV and Flu, to other issues, we know Covid is not done, and may be with us for quite some time into the future. It is essential that we plan and build up our blood banks to cover any possible contingency. We know we will need it. Why give blood? Blood donation is essential for surgeries, cancer treatment, chronic illnesses, and traumatic injuries. Whether a patient receives whole blood, red cells, platelets or plasma, this lifesaving care starts with one person making a generous donation. What causes such shortages? People and availability. People may not even think of blood donation importance. Through our busy daily lives, we may just not have the time to donate. Doctors are having to make difficult choices and delays in patient care due to the shortage. There are accidents and disease treatments, that bring on the need for blood transfusions, people who seriously need blood to survive. Medical institutions across the country are doing everything they can to increase blood donation. According to the Red Cross, there has been a 10% decline in blood donation since the start of the pandemic. January is Blood Donation Month, but the cause is important every month Every January is Blood Donation Month. It is a point of regular awareness for the public, about doing your part and donating blood. We need blood every day in America, for any number of reasons. Our bodies can replace blood over time, with the average adult having around 10 pints of blood. A blood donation is about 1 pint (500 mL). Our bodies make about 2 million red cells every second, so no need to worry, our bodies can make more rather quickly! After you donate, you should wait 12 weeks before you do it again. Getting the word out Encourage your patients to think about blood donation through flyers, brochures, emails, and phone calls. When they are in your care, have signs in the exam room about blood donation. Share the word to the public about date and location of Blood Drives, and Bloodmobile distributions. Saving lives It is more essential than ever before to get the word out about increasing blood donation. It’s just one pint at a time, to save more lives. Source : Aleph Group Inc. Robert Pejas, Director of Human Resources |


ABOUT THESE COURSES
This training will create a foundation for introducing palliative care into the primary care setting earlier in the course of a serious illness. Multiple training sessions have been created and are available to any physician or care team member who would like to attend. The training opportunities are:
- Palliative Care – Cultural Aspects of Care
- This two-hour course will discuss the definitions and importance of inclusion of cultural aspects of the care of patients with serious illness. This course will also include the opportunity to review cultural assessment tools that can be utilized in future clinical practice.
- Palliative Care – Spiritual, Religious and Existential Aspects of Care
- This two-hour course will discuss the definitions and importance of spirituality, religion, and existentialism in the care of patients with serious illness and at the end of life. This course will provide information on assessment tools and conceptual models of practice.
Additionally, several on-demand learning opportunities are available via the link below. These can be viewed at any time.
Learner Materials:Palliative Care Training Overview (PDF) – for the full-day course
On-Demand Learning Social Aspects of Care AND
Ethical and Legal Aspects of Care
3- hours course will:
- Explain the importance of medical ethics in palliative care
- Identify six values of medical ethics
- Discuss the integration of medical ethics into serious illness care
- Identify common legal issues patients face in serious illness care
- Describe the three components of the Advance Care Planning (ACP) process
- Explain types of Advance Directives (AD)
- Explain the social aspects of care domain
- Describe the importance of the social assessment
- Discuss one clinical tool for completing a comprehensive assessment
- Identify resources that support the needs of the patient, family members and caregivers
Please note that a separate account will be necessary to view these on-demand materials. You will get an email from Udemy Platform to access the videos.
Cost: Complimentary
Successful Course Completion includes:
- Attendance at the entire course. If attending live virtual, you must have audio and see the live slides
- Completion of the course post-test: need to have a score of 80% or greater
- Completion of the course evaluation
If you have any questions, contact Yang Yang at [email protected]
CONTINUING EDUCATION:
Cultural Aspects of Care
Physician/Nurse:
Statement of Accreditation
Practice Transformation Institute is accredited by the MSMS to provide continuing medical education for physicians.
AMA Credit Designation Statement
Practice Transformation Institute designates this live activity for a maximum of 2 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Social Work:
This course is approved by the NASW-Michigan Social Work Continuing Education Collaborative
This approval statement is for Practice Transformation Institute Approval Number: 011323-07 #CE Hours approved: 2 Type of course: Live Webinar
Spiritual, Religious and Existential Aspects of Care
Physician/Nurse:
Statement of Accreditation
Practice Transformation Institute is accredited by the MSMS to provide continuing medical education for physicians.
AMA Credit Designation Statement
Practice Transformation Institute designates this live activity for a maximum of 2 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Social Work:
This course is approved by the NASW-Michigan Social Work Continuing Education Collaborative
This approval statement is for Practice Transformation Institute Approval Number: 011323-07 #CE Hours approved: 2 Type of course: Live Webinar
Social Aspects of Care AND
Ethical and Legal Aspects of Care
Physician/Nurse:
Statement of Accreditation
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Michigan State Medical Society (MSMS) through the joint providership of Practice Transformation Institute and MI-CCSI. Practice Transformation Institute is accredited by the MSMS to provide continuing medical education for physicians.
AMA Credit Designation Statement
Practice Transformation Institute designates this live activity for a maximum of 3 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Social Work:
This course is approved by the NASW-Michigan Social Work Continuing Education Collaborative
This approval statement is for Practice Transformation Institute Approval Number: 011323-07 #CE Hours approved: 3 (One CE in Ethical) Type of course: On-demand
Course Date and Time: (Live Virtual) Cultural Aspects of Care April 12, 2023 9:00am-11:00am June 21, 2023 9:00am-11:00am November 8, 2023 1:00pm-3:00pm Register here Spiritual, Religious and Existential Aspects of Care February 8, 2023 9:00am-11:00amMay 17, 2023 1:00pm-3:00pmSeptember 13, 2023 9:00am-11:00amRegister here |
On-demand/Enduring Materials Set your own time and day! Social Aspects of Care Ethical and Legal Aspects of Care Register here |

About the Course:
The Introduction to Team-Based Care course helps the learner better understand how to work in a multidisciplinary care team and in collaboration with the patient. Open to all members of the practice to gain foundational knowledge in Team-Based Care. Introduction to Team-Based Care will include:
- Why, What, Who and How: Team-Based Care
- Care Management Process
- Outcomes and Triple AIM
- Billing Applications
*This course is required for all care team members new to their role in order to bill PDCM codes.
Cost: Complimentary to MNO Practices
Successful Course Completion includes:
- Attendance at the entire course. If attending live virtual, you must have audio and see the live slides
- Completion of the course post-test: need to have a score of 80% or greater
- Completion of the course evaluation
Please visit the MICMT website or www.transformcoach.org for additional information.
If you have any questions, contact Yang Yang at [email protected]
OPPORTUNITY TO EARN CONTINUING EDUCATION CONTACT HOURS
Nursing:
- Upon successful completion of the Introduction to Team Based Care Course, the participant will earn 5.5 Nursing CE contact hours
- Michigan Institute for Care Management and Transformation is approved as a provider of nursing continuing professional development by the Wisconsin Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. WNA Activity# 2020-0000001417
Social Work:
- Upon successful completion of the Introduction to Team Based Care course, the participant will earn 5.5 Social Work CE contact hours
- Michigan Institute for Care Management and Transformation is an approved provider with the Michigan Social Work Continuing Education Collaborative. Approved provider Number: MICEC 110216
Registered Dietitians
- Registered Dietitians can use the MICMT Nursing CE certificate for their CPEUs. See CDRnet core criteria for details https://www.cdrnet.org/core-criteria
Course Date and Time: (Live Virtual)
March 1, 2023 8:00am – 4:00pm
(Must attend all day to receive credits)
May 24, 2023 8:00am – 12:30pm
May 25, 2023 9:00am – 11:30am
(Must attend both days to receive credits)
July 19, 2023 8:00am – 12:30pm
July 20, 2023 9:00am – 11:30am
(Must attend both days to receive credits)

About the Course:
The goal of this course is for all Care Team Members to learn engagement tools/skills in order to have productive conversations with patients about their health including basic motivational interviewing skills.
The Care Team Member will build upon this foundation, to utilize patient engagement skills in different situations such as Medication Assisted Treatment, (MAT) and Palliative Care.
It is strongly recommended to take Introduction to Team Based Care before taking this course.
For additional details, please visit https://micmt-cares.org/training/patient-engagement
Successful Course Completion includes:
- Attendance at the entire course. If attending live virtual, you must have audio and see the live slides
- Completion of the course post-test: need to have a score of 80% or greater
- Completion of the course evaluation
Please visit the MICMT website or www.transformcoach.org for additional information.
If you have any questions, contact Yang Yang at [email protected]
OPPORTUNITY TO EARN CONTINUING EDUCATION CONTACT HOURS
Nursing:
- Upon successful completion of the Patient Engagement course, the participant will earn 5.5 Nursing CE contact hours
- Michigan Institute for Care Management and Transformation is approved as a provider of nursing continuing professional development by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91)
Social Work:
- Michigan Institute for Care Management and Transformation is an approved provider with the Michigan Social Work Continuing Education Collaborative. Approved provider Number: MICEC 110216
Registered Dietitians
- Registered Dietitians can use the MICMT Nursing CE certificate for their CPEUs. (See CDRnet core criteria for details https://www.cdrnet.org/core-criteria)
Course Date and Time: (Live Virtual)
April 18, 2023 9:00am – 4:00pm
(Must attend all day to receive credits)
June 13, 2023 9:00am – 4:00pm
(Must attend both days to receive credits)
November 1, 2023 9:00am – 4:00pm
(Must attend both days to receive credits)

About the Course:
This course builds upon the Introduction to Team-Based Care course, focusing on reimbursement for care management services. The course is designed to support and train physician organizations and practice staff on care management billing.
The course includes:
- Care Team Coding and Billing is a Team Sport
- Billing Optimization
- Billing Applications
- Billing Resources
Intended Audience
Open to all members of the care team; Nurses, Social Workers, Pharmacists, Medical Assistants, Community Health Workers, Registered Dietitians, Billers, Coders, and others
*This course is open for identified Physician Organization billing subject matter experts.
Learning Objectives:
Members of the health care team – Nurses, Social Workers, Pharmacists, Registered Dietitians, Medical Assistants, Community Health Workers, and others will be able to:
- Identify members of a care team
- Define health care coding and health care billing
- Describe the two common health care coding classification systems
- Explain the importance of documenting the encounter
- Illustrate how a care team member may impact risk adjustment and the financial model of a practice
Please visit the MICMT website or www.transformcoach.org for additional information.
If you have any questions, contact Yang Yang at [email protected]
OPPORTUNITY TO EARN CONTINUING EDUCATION CONTACT HOURS
Continuing Education Requirements:
- Attendance at the entire course. If attending live virtual, you must have audio and see the live slides
- Completion of the course post-test: need to have a score of 80% or greater
- Completion of the course evaluation
Nursing
- Upon successful completion of the Foundational Care Management Codes and Billing Opportunities course, the participant will earn 3.5 Nursing CE contact hours
- Michigan Institute for Care Management and Transformation is approved as a provider of nursing continuing professional development by the Wisconsin Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Social Work
- Upon successful completion of the Foundational Care Management Codes and Billing Opportunities course, the participant will earn 3.5 Social Work CE contact hours
- Michigan Institute for Care Management and Transformation is an approved provider with the Michigan Social Work Continuing Education Collaborative. Approved provider Number: MICEC 110216
Billers & Coders
- AAPC has approved 3.5 CEUs for successful completion of the Foundational Care Management Codes & Billing Opportunities course
Registered Dietitians
- Registered Dietitians can use the MICMT Nursing CE certificate for their CPEUs. See CDRnet core criteria for details https://www.cdrnet.org/core-criteria
Course Date and Time: (Live Virtual)
March 8, 2023 8:00am – 12:00pm
(Must attend all day to receive credits)
July 25, 2023 8:00am – 12:00pm
(Must attend both days to receive credits)
October 4, 2023 8:00am – 12:00pm
(Must attend both days to receive credits)

About the Course:
This program will inform attendees of important strategies that can be used to identify, minimize or eliminate implicit and explicit bias and the many facets of each. It will describe and discuss how bias, whether conscious or unconscious, can be subtle or overt and how either can negatively affect communication with patients and colleagues. How one looks outside their own journey to see the uniqueness of other journeys is an important question that all health care professionals should ask themselves. Lack of awareness of the beliefs and feelings of others can impact care which may create unequal treatment and discrimination in health care. The need to understand others and their social determinants of health and social injustices is critical to understanding and caring for others effectively.
Learning Objectives:
- Discuss the link amongst implicit and explicit bias; stereotyping, prejudice and discrimination
- Describe what unconscious bias is and how it operates in both individuals and organizations
- Illustrate how implicit bias may impact the health care setting or learning environment
- Discuss strategies that can be used to minimize impact of implicit bias
Successful Course Completion includes:
- Attendance at the entire course
- Use of webcam during training is strongly encouraged
- Completion of the course post-test: need to have a score of 70% or greater on the post-test
- Completion of the course evaluation
Cost: Complimentary Training
If you have any questions, contact Yang Yang at [email protected]
CONTINUING EDUCATION:
Statement of Accreditation
The Practice Transformation Institute is accredited by Michigan State Medical Society to provide continuing medical education for physicians.
AMA Credit Designation Statement
Practice Transformation Institute designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Course Date and Time: (Live Virtual)
February 22, 2023 8:00am-9:30am
May 5, 2023 8:00am-9:30am
August 9, 2023 5:00pm-6:30pm
November 15, 2023 8:00am-9:30am

