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MIPS Alternative Payment Models (APMs)

Certain Alternative Payment Models (APMs) are considered MIPS APMs and their participants are eligible for certain scoring benefits under MIPS.

MIPS APMs are APMs that meet these criteria:

  • APM entities that participate in the APM under an agreement with CMS;
  • APM bases payment incentives on performance (either at the APM entity or eligible clinician level), on cost/utilization, and quality measures.

Performance Year

Select your performance year.

2021 MIPS APMs

As of December 31, 2020, we are sunsetting the APM Scoring Standard.

Beginning January 1, 2021 MIPS APM participants may report to APM Performance Pathway (APP).

The APM Performance Pathway (APP) is a MIPS reporting and scoring pathway for 

MIPS eligible clinicians
 who are also participants in MIPS APMs. The APP is designed to reduce reporting burden, create new scoring opportunities for participants in MIPS APMs, and encourage participation in APMs. Performance is measured across three areas - Quality, Improvement Activities, Promoting Interoperability.

Any APM Entity in a MIPS APM may report via the APP on behalf of their constituent MIPS eligible clinicians. However, the 

final score
 earned by the group through the APP would be applied only to those MIPS eligible clinicians who appear on a MIPS APM’s Participation List or Affiliated Practitioner List on one or more snapshot dates. The final score applied to each individual MIPS eligible clinician would be the highest available final score for that clinician (
TIN
/
NPI
), or a 
virtual group
 score, if applicable.

MIPS reporting and scoring requirements are applicable to all MIPS eligible clinicians, including those reporting through the proposed APP. Individuals, groups, APM Entities, and ACOs may report via the APP.

MIPS APM participation is determined through 4 snapshots between January 1 through December 31.

If you join a MIPS APM during that period, you:

  • Will be considered a participant in the MIPS APM, and
  • Will be eligible to voluntarily report through the APP

Note: ACOs participating in the Medicare Shared Savings Program would be required to report through the APP for purposes of assessing their quality performance for that program, but MIPS eligible clinicians participating in these ACOs also would have the option of reporting outside the APP, or within it at an individual or group level, for purposes of being scored under MIPS, like all other MIPS APM participants.

Extreme and Uncontrollable Circumstances

APM Entities (those with MIPS eligible clinicians who aren’t

Qualifying APM Participants
, or QPs) in the following models are eligible to submit an extreme and uncontrollable circumstances exception application for all MIPS performance categories:

  • Medicare Shared Saving Program
  • Next Generation ACO Model
  • Vermont Medicare ACO Model
  • Comprehensive Primary Care Plus (CPC+)
  • Comprehensive ESRD Care (CEC)
  • Bundled Payments for Care Improvement (BPCI)
  • Oncology Care Model (OCM)
  • Maryland Primary Care Program
  • Independence at Home Demonstration

When you submit an application on behalf of an APM Entity, you are attesting that at least 75% of the MIPS eligible clinicians in the Entity qualify for reweighting in the Promoting Interoperability performance category.

2020 MIPS Exceptions APP Fact Sheet (pdf)

Participation

To prepare to participate, you can receive further support with our technical assistance resources.

Join

  1. Learn about specific MIPS APMs and how to apply.
  2. Apply to a MIPS APM that fits your practice and is currently accepting applications.

Current Participants

If you are an eligible clinician currently participating in a MIPS APM (see MIPS APM List), please contact your APM entity for participation specifics.

Clinicians can see a list of Alternative Payment Models in the 2020 and 2021 Comprehensive List of APMs.

Additional Resources