Advanced Alternative Payment Models (APMs) are one track of the Quality Payment Program that offer incentives for meeting participation thresholds based on your levels of payments or patients through Advanced APMs. If you achieve these thresholds, you become a Qualifying APM Participant (QP). The comprehensive list of Advanced APMs is available here.
QPs receive the following benefits, which include burden reduction and financial incentives:
- Exclusion from MIPS reporting
- Exclusion from MIPS payment adjustments
- For performance years 2017 – 2022, a 5 percent APM Incentive Payment
- For performance year 2023, a 3.5 percent APM Incentive Payment
- For performance year 2024, a 1.88 percent APM Incentive Payment and an increased physician fee schedule update based on the QP conversion factor
- For performance years 2025 and beyond, an increased physician fee schedule update based on the QP conversion factor
Performance Year
Select your performance year.
2023 Advanced APMs
Qualifying APM Participant (QP)
Advanced APMs allow eligible clinicians to become QPs.
To become a QP, clinicians must receive at least 50 percent of Medicare Part B payments or see at least 35 percent of Medicare patients through an Advanced APM Entity during the QP Performance Period (January 1 - August 31). Learn more in the Learning Resources for QP Status and APM Incentive Payment.
An eligible clinician in an Advanced APM can also become a QP through the "All-Payer and Other Payer Option," which is a combination of Medicare and non-Medicare payer arrangements, such as private payers and Medicaid.
Partial Qualifying APM Participant (Partial QP)
Not all clinicians who participate in Advanced APMs may achieve QP status. Some clinicians may be eligible to become Partial QPs.
To become a Partial QP, a clinician must receive at least 40 percent of Medicare Part B payments or see at least 25 percent of Medicare patients through an Advanced APM Entity during the QP Performance Period (January 1 - August 31). Learn more in the Learning Resources for QP Status and APM Incentive Payment.
The benefit of achieving Partial QP status includes the option to choose whether to participate in MIPS.
1. If a Partial QP chooses not to report to MIPS:
a. The clinician will not receive a MIPS payment adjustment.
2. If a Partial QP chooses to report to MIPS:
a. The clinician must fulfill all MIPS reporting requirements.
b. The clinician must complete a submission to MIPS by reporting either:
i. APM Performance Pathway (APP)
ii. Traditional MIPS
iii. MIPS Value Pathways (MVP)
c. The clinician will receive a MIPS payment adjustment.
Snapshots
CMS reviews APM participation 4 times each performance year, during what is referred to as a snapshot.
These data are used to:
1. Determine QP status (Snapshots 1-3)
2. Update APM participation (Snapshots 1-4)
Financial Incentives for Qualifying APM Participants (QPs)
APM Incentive Payment
Once an eligible clinician achieves QP status for a year, the clinician is excluded from MIPS for that year. In addition, for performance year 2024/payment year 2026, QPs will receive a 1.88 percent APM Incentive Payment.
- For payment year 2026 [1], the APM Incentive Payment is equal to 1.88 percent of the eligible clinician’s estimated aggregate payments for covered professional services during the incentive payment base period (the calendar year immediately preceding the payment year).
- CMS uses claims submitted for covered professional services with dates of service from January 1 through December 31 of the incentive payment base period.
Qualifying APM Conversion Factor
After the 2024 performance year/2026 payment year, the APM Incentive Payment will end. Instead, beginning with the 2024 performance year/2026 payment year, QPs will receive a higher Medicare Physician Fee Schedule (PFS) update (“qualifying APM conversion factor”) than non-QPs. Eligible clinicians will continue to be excluded from MIPS reporting and payment adjustments for each applicable year.
- The QP will continue to be excluded from MIPS and associated payment adjustments.
- For payment years 2026 and beyond, payment rates under the Medicare PFS for covered professional services furnished by eligible clinicians will be updated by the 0.75 percent qualifying APM conversion factor. [2]
[1] APM Incentive Payments are paid 2 years after the QP Performance Period. The 2022 QP Performance Period/2024 payment year was the last year for which QPs could receive a 5 percent APM Incentive Payment. For the 2023 QP Performance Period/2025 payment year, QPs can receive a 3.5 percent APM Incentive Payment and for the 2024 QP Performance Period/2026 payment year, QPs can receive a 1.88 percent APM Incentive Payment.
[2] Social Security Acts sections 1848(d)(1)(A) and (d)(20)
Advanced APM Participation
Prepare to Participate
If you are interested in preparing to participate in an APM, you can receive further support with our technical assistance resources.
Join
- Learn about specific Advanced APMs and how to apply.
- Apply to an Advanced APM that fits your practice and is currently accepting applications.
Current Participants
If you are an eligible clinician currently participating in an Advanced APM (see Advanced APM List), please contact your APM entity for participation specifics.