September 2022 eNews

September 2022

MONTHLY NEWS

Top Story

MHACO Participants Earn Significant Medicare Reimbursement Increase While Contributing to Overall Medicare Savings

The Centers for Medicare and Medicaid Services (CMS) recently released performance results for MHACO providers who participated in the Merit-based Incentive Payment System (MIPS) and Medicare Shared Savings Program (MSSP) in 2021.

In MIPS, MHACO participants collectively achieved a score of 100 out of 100, earning a 2.33% rate increase in professional services payments made under the Medicare Physician Fee Schedule. We estimate that this will result in a $280,000 increase in revenue to the MaineHealth system in 2023 and will also favorably impact our private practices and St. Mary’s participants. The rate increase will be applied directly to eligible claims beginning in January.

ACO in Action

Shared Savings Transformation Projects 2022

We’re pleased to announce this year’s ACO-supported Shared Savings Transformation Projects. Projects were selected from a call for proposals open to all ACO participants and are being funded through a reinvestment of $200,000 in shared savings earned by the ACO based on contract performance in 2020. These funds are made available in addition to the regular shared savings distribution as a way to seed innovation in value-based care among ACO participants.

“We’re fortunate that savings can be distributed back to our care teams to help fund these innovative projects that align with the mission and vision of the ACO. These initiatives positively impact our patient care and pave the way for better health outcomes year after year.” Said Rob Chamberlin, MD, MHACO’s chief medical officer.

Please join us in congratulating project teams. See the full list of funded projects.

In Practice: Commentary by Rob Chamberlin

Continuity

Last week, a patient of mine canceled his appointment, and the spot was quickly filled with a colleague’s patient. This patient, L, was coming in for knee pain. I had just a couple of minutes to review L’s chart. She’s 67, has depression, PTSD, some vague abdominal pain for which significant testing has been unrevealing, a variety of orthopedic problems, and has been reticent to get her COVID-19 vaccine. Recognizing the complexity of care for this patient, I had some guilty relief that I was not her PCP, and was only asked to evaluate her knee pain. But that subtle relief was clouded by the larger realization that I would be giving her worse care than she’d otherwise get from her own PCP, given I don’t know her full story, and care outside of narrative is almost always worse care.

Need to Know: Important Updates

September BACON Podcast: Community Health Workers & a Fond Farewell

Marin Johnson, Katie Sharp, MD, and Renee Wolf, MD, join us to discuss the role community health workers are playing in preventive medicine. Also, co-host Julie Grosvenor, MD, reflects on the role of the ACO and the podcast as she prepares to leave the show.

BACON is the MaineHealth ACO’s short monthly news and information podcast, hosted by Mike Clark, MD and Julie Grosvenor, MD. Find it on your podcast app by searching for “mainehealth.” Not a podcast listener? Transcripts, audio and bonus content can be found on our website.

Monkeypox Guidance for MaineHealth

In order to offer a centralized resource for monkeypox information, MaineHealth has created a monkeypox intranet site that offers general information in addition to MaineHealth-specific guidance. Resources include a downloadable fact sheet for providers including information on transmission, symptoms, precautions, and testing, as well as a one-pager with patient instructions. Access the site here.

MaineHealth Post-COVID Clinic Winding Down

As knowledge about Long COVID has advanced, it has become clear that Long COVID patients are best served by managing their health through their primary care team, who has the full picture of each patient’s medical history. As a result, MaineHealth will be discontinuing services at the Portland-based Post-COVID clinic on Jan. 1, 2023.

MaineHealth’s RECOVER study continues to collect information to help guide future understanding and treatment options. Those interested in participating in the study can learn more by visiting www.recoverCOVIDstudies.org.

Anyone with questions or concerns as the clinic transitions can call (207) 662-7305, option 7.

Resources

Upcoming Project ECHO® Sessions Link PCPs and Specialists

Project ECHO® is an interactive learning opportunity that uses video conferencing to connect a community of providers with common interests. Connect with other primary care providers and specialists on a monthly basis to discuss cases and share best practices for delivering care. CME/CEs are awarded for participation and it is FREE. MaineHealth-sponsored Project ECHO sessions currently cover more than two dozen topics.

Registration & Info for all sessions. Questions? Contact Kelly Barnes.

Upcoming Care Management Trainings

MaineHealth offers MA Foundational Training, MA Advanced Training for Medical Assistants, and Care Management Training. MAs, RNs, LPNs, Social Workers, and other clinical support staff are an integral part of the healthcare team and essential to the success of our primary care system. MaineHealth is committed to providing clinical staff with training to help prepare them for success in the practice setting.

Rooms are booked at 110 Free Street in the event that we can be in person; for the time being, the training is via zoom.

CM Training dates, next session offered November 1, 8, 15, 29, 2022.

Questions? Contact Beth Wilcox at MHMG_Care_Management_Training@mainehealth.org

Payer News

MaineHealth Employee Health Insurer

Effective January 1, 2023, MaineHealth employees will be insured by Aetna. We are alerting you so you can start planning for claim filing, prior authorizations, and obtaining copies of new ID cards for the new year. More information will be forthcoming from Aetna as it becomes available.

COVID-19 Payer Policies and Information

View our website under Provider Resources for payer information including coding, waivers for member cost shares on diagnostic testing and telemedicine visits, opening crisis response lines, and expanding 24/7 access to nurse medical lines. Payers are taking action and issuing information at a rapid pace.

Anthem, now Elevance Health, Updates

Notice of material changes/amendments, learn more.
Add supporting documents to your claims, learn more.

Cigna

Virtual care services should now be billed with POS code 02

Effective July 1, 2022, we recommend that providers bill all virtual care services using Place of Service (POS) code 02. We recently updated our systems to ensure providers receive 100 percent of the face-to-face reimbursement rate using this code. When you bill POS code 02, your patients may also pay a lower cost share for the virtual services they receive due to a recent change in some plan benefits. View more information.
View Clinical, Reimbursement and Administrative Policy Updates.

Harvard Pilgrim Health Care Updates

Harvard Pilgrim's Access to Care Standards

Harvard Pilgrim maintains commercial and Stride (HMO) Medicare Advantage policies that outline network practitioner standards regarding clinician availability, timeliness of appointments, and telephone accessibility, among other things. Read more.

Humana

Claims Policies now available online, view the published policies.
Claims processing edits are posted on the first Friday of each month. View the claims edits.

United Healthcare

Codes added to the prior authorization list are delayed until 10/01/2022, view the list.

Payer Newsletters

Subscribe to payer newsletters to receive notice of preauthorization changes, policy updates, tool roll-outs and other information that may impact your practice.

Find payer website resources.

Aetna

Frequency: Quarterly (March, June, September, December)

View online and subscribe

Anthem Network Update

Frequency: Monthly

View online OR Subscribe for Network eUPDATE

Beacon Health - Northern Light Health System

No longer provides a newsletter

Centers for Medicare and Medicaid Services (CMS)

Frequency: Weekly

View online OR Subscribe for Medicare Learning Network