Provider Resources

Providers are eligible to participate in the ACO who are a MD, DO or Primary Care NP and a member of the medical staff of Franklin Memorial Hospital, LincolnHealth, Maine Medical Center, Memorial Hospital, Mid Coast Hospital, Pen Bay Medical Center, Southern Maine Health Care, Stephens Memorial Hospital, St. Mary’s Regional Medical Center or Waldo County General Hospital. To begin the process of joining the MaineHealth ACO, please email us to request an application packet.

Participants 

• Providers Participating in the MaineHealth ACO (updated monthly) (webpage) 

Annual Compliance Training Documents

• Annual Compliance Training (PDF)
• Annual Compliance Training - Participant 2023 - ACO Specific (PDF)
• Annual Compliance Training Attestation Form (PDF)
• Attestation Fax Cover (PDF)

Compliance and Privacy Manual Policies

• Code of Ethical Conduct (PDF)
• Beneficiary Avoidance and Referrals (PDF)
• Stark and Anti-Kickback Statute (PDF)
• Beneficiary Incentives (PDF)
• Compliance Plan (PDF)
• Conflict of Interest Policy (PDF)
• Privacy and Security Statement (PDF)
• Compliance and Privacy Committee (PDF)

COPD Resources

• COPD Assist: Diagnosis, Treatment and Referral Resources for PCPs 
• Improving the Care of Patients with Lung Health Issues

Colorectal Cancer Resources 

• Colon Cancer Screenings

Diabetes Resources

• Diabetes Education Support
• Diabetes Prevention - Episode 1

End-of-Life Resources

• Code Status Discussions with Patients: Video and Pocket Guide 
• MaineHealth Regional Palliative Care Contacts and Resources

Heart Failure Resources

• ACO Insider: Target Weight at the Center of Heart Failure (video recording) 
• ACO Insider: Advanced Heart Failure: When and How to Refer (video recording) - available upon request. Please contact ContactMHACO@mmc.org
• Heart Failure and Diuretics: Tricks of the Trade
• Heart Failure Fundamentals: Target Weight 

Hypertension Resources

• BP Link: An Initiative to Improve Provider-to-provider Communication in Support of Hypertension Control 
• Peer-to-Peer Hypertension Control 
• St. Mary's "Obtaining Accurate Blood Pressure" Protocol 
• Test Your BP Taking Skills
• Hypertension Control Toolkit

Adolescent & Pediatric Resources

• ACO Insider: Adolescent Well-Care Visit
• Child Health
• Let's Go! 5-2-1-0
• MMC/MMP Pediatric Referral Guidelines

Tobacco Resources

• MaineHealth Center for Tobacco Independence

ACO Insider: Annual Wellness Visits and Clinical Documentation (video recording) 

MaineHealth Annual Wellness Visit Webpage (webpage)

Making Annual Wellness Visits Work (PDF)

Reimbursable Preventative Services (webpage)

Beneficiary Information Notice
Beneficiary Information Notice without Portal
Voluntary Alignment Fact Sheet with Instructions for Beneficiaries (English)
Voluntary Alignment Fact Sheet with Instructions for Beneficiaries (Spanish)
Voluntary Alignment Fact Sheet for Practice Staff
Office Poster 8.5x14 (PDF)
Office Poster 8.5x14 without Portal (PDF)

Coding Documents

• Coding Release Notes
• Prev 5 - Breast Cancer Screening Coding Document
• Prev 6 - Colorectal Cancer Screening Coding Document
• HTN 2 - Controlling High Blood Pressure Coding Document
• MH 1 - Depression Remission at 12 Months Coding Document
• DM 2 - Diabetes Management Coding Document
• Care 2 - Falls Screening Coding Document
• Prev 12 - Preventive Care and Screening Depression Screening and FU Coding Document
• Prev 7 - Preventive Care and Screening Flu Immunization Coding Document
• Prev 10 - Preventive Care and Screening Tobacco Screening Coding Document
• Prev 13 - Statin Therapy CVD Coding Document

Key Measures

• Measure Release Notes
• CMS Web Interface Measures List
• Prev 5 - Breast Cancer Screening Measure
• Prev 6 - Colorectal Cancer Screening Measure
• HTN 2 - Controlling High Blood Pressure Measure
• MH 1 - Depression Remission at 12 Months Measure
• DM 2 - Diabetes Management Measure
• Care 2 - Falls Screening Falls Screening Measure
• Prev 12 - Preventive Care and Screening Depression Screening Measure
• Prev 7 - Preventive Care and Screening Flu Immunization Measure
• Prev 10 - Preventive Care and Screening Tobacco Screening Measure
• Prev 13 - Statin Therapy CVD Measure

Practices that participate in the ACO's MSSP contract are automatically enrolled in a special MIPS payment model created for ACO participants called the MIPS APM. Because the ACO reports some categories of data on behalf of its participants, this model places a reduced reporting burden on practices, compared to those enrolled in the standard MIPS model. Specifically, the ACO reports Quality data for MIPS and MSSP, Cost is not scored, and MIPS APM participants receive full credit for Improvement Activities.

Promoting Interoperability (PI) - Each ACO participant TIN (tax ID number) is required to report for the Promoting Interoperability (PI) category, or apply for and receive a hardship exception from CMS. Beginning in 2022 the Small Practice exception became an automatic exception (no application required). Definition of small practice is practice or clinician with 15 or fewer clinicians billing under the practice’s TIN. NEW EHR requirements for 2023: MIPS reporters must attest to CEHRT certified to the 2015 Edition Cures Update: 2015 Edition Cures Update CEHRT functionality must be in place by the first day of your MIPS Promoting Interoperability performance period and your EHR must be certified by ONC to the 2015 Edition Cures Update CEHRT criteria by the last day of your performance period. You will need to provide your EHR’s CMS identification code from the Certified Health IT Product List (CHPL), available onHealthIT.gov, when you submit your data. We suggest working directly with your HIT / EHR vendor to ensure their compliance plans.

For more information:

• 21st Century Cures Act Final Rule

MIPS Promoting Interoperability Requirements

Participants must submit collected data for specific measures from each of the 4 objectives (unless an exclusion is claimed) for 90 continuous days or more during 2020:

1. e-Prescribing
2. Health Information Exchange
3. Provider to Patient Exchange
4. Public Health and Clinical Data Exchange 

Measure Specifications

e-Prescribing

• E-Prescribing (required)
• Query of Prescription Drug Monitoring Program (PDMP) (optional bonus measure- will be required for 2023 reporting))

Health Information Exchange

• Support Electronic Referral Loops by Sending Health Information (Option 1)
• Support Electronic Referral Loops by Receiving and Incorporating Health Information (Option 1)
• Bi-Directional Exchange (Option 2)

Provider to Patient Exchange

• Provider to Patient Exchange (required)
• Enabling Exchange Under TEFCA

Public Health and Clinical Data Exchange

• Immunization Registry Reporting (required)
• Electronic Case Reporting (required)
• Public Health Registry Reporting (bonus for 2023)
• Clinical Data Registry Reporting (bonus for 2023)
• Syndromic Surveillance Reporting (bonus for 2023)

Attestations Required but Not Scored

Security Risk Analysis: must conduct on 2015 CEHRT on an annual basis - SUBMIT YES

• Risk Analysis Guidance

Actions to Limit or Restrict Interoperability of CEHRT: acted in good faith and took necessary steps to prevent limiting or restricting the compatibility or interoperability of CEHRT - SUBMIT YESONC (Office of the National Coordinator for Health Information Technology)

Direct Review Attestation: assent to federal government audit - SUBMIT YES

Safety Assurance Factors for EHR Resilience (SAFER) Guides measure

• SAFER Guides | HealthIT.gov

HARP (HCQIS access roles and profile system) Account Information

The Quality Payment Program (QPP) portal requires you to have a login and password. If you already have a HARP account / QPP login you may continue to use it. If you do not have an account, please follow the process outlined in the documents below.

1. Register for a HARP Account
2. Connect to an Organization
3. Connect as a Clinician
4. Security Officials Manage Access
5. QPP Access at a Glance

If you have any questions, please contact Emily Levi, ELevi@mainehealth.org

2023 Payer Resources Information (PDF)  

MaineHealth ACO Contract List 2022 (PDF)

Payer e-updates (PDF)

Clinical Documentation Improvement (webpage)

• FY2023 Heat Map Quality Metrics Guide