downloadchevron-downchevron-rightchevron-with-circle-downchevron-with-circle-upcheckcircle-with-minuscircle-with-plusexporthelp-with-circleinboxlinkmailold-phonestar-outlinedstaruserv-cardcloseBack to top
Top

APMs Overview

How it Works

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Advanced APMs

In the Advanced APM track of the Quality Payment Program, you may earn a 5 percent incentive for achieving threshold levels of payments or patients through Advanced APMs. If you achieve these thresholds, you are excluded from the MIPS reporting requirements and payment adjustment.

MIPS APMs

If you’re in a specific type of APM called a “MIPS APM” and you are not excluded from MIPS, you may be scored using the APM scoring standard. The APM scoring standard is designed to account for activities already required by the APM. For example, the APM scoring standard eliminates the need for MIPS clinicians to duplicate submission of Quality and Improvement Activity performance category data and allows them to focus instead on the goals of the APM.

Most Advanced APMs are also MIPS APMs so that if an eligible clinician participating in the Advanced APM does not meet the threshold for sufficient payments or patients through an Advanced APM in order to become a Qualifying APM Participant (QP), thereby being excluded from MIPS, the MIPS eligible clinician will be scored under MIPS according to the APM scoring standard.

Information for Advanced APMs and MIPS APMs may change each Performance Year (PY).

2017 APM Information

What Models Are Advanced APMs?

In Performance Year 2017, the following models are Advanced APMs:

How Do I Join an Advanced APM?

  1. Learn about specific Advanced APMs and how to apply.
  2. Apply to an Advanced APM that fits your practice and is currently accepting applications.
  3. This website will be updated as new information is available.

What Happens if I Am in an Advanced APM?

Once you're in an Advanced APM, you'll earn the 5 percent incentive payment in 2019 for Advanced APM participation in Performance Year 2017 if:

  • You receive 25 percent of your Medicare Part B payments through an Advanced APM or
  • See 20 percent of your Medicare patients through an Advanced APM

You'll need to send in the quality data required by your Advanced APM. Your model's website will tell you how to send in your Advanced APM's quality data.

If you leave the Advanced APM during Performance Year 2017, you should make sure you've seen enough patients or received enough payments through an Advanced APM to qualify for the 5 percent bonus. If you haven't met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.

Check your APM participation using the QPP Participation Status tool

You can use the QPP Participation Status tool to check your APM participation, which includes your Qualifying APM Participant (QP) status.

The Methodology Fact Sheet can help you understand how we determined the QP Status based on eligible clinician performance.

How Do I Join an Advanced APM?

  1. Learn about specific Advanced APMs and how to apply.
  2. Apply to an Advanced APM that fits your practice and is currently accepting applications.
  3. This website will be updated as new information is available.

What Happens if I Am in an Advanced APM?

Once you're in an Advanced APM, you'll earn the 5 percent incentive payment in 2020 for Advanced APM participation in Performance Year 2018 if:

  • You receive 25 percent of your Medicare Part B payments through an Advanced APM or
  • See 20 percent of your Medicare patients through an Advanced APM

You'll need to send in the quality data required by your Advanced APM. Your model's website will tell you how to send in your Advanced APM's quality data.

If you leave the Advanced APM during Performance Year 2018, you should make sure you've seen enough patients or received enough payments through an Advanced APM to qualify for the 5 percent bonus. If you haven't met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.

Check Your APM Participation Using the QPP Participation Status Tool

You can use the QPP Participation Status tool to check your APM participation, which includes your Qualifying APM Participant (QP) status.

For PY 2018, APM participation will be updated for each snapshot as described in the QP Methodology Fact Sheet. The QP Methodology Fact Sheet can help you understand how we determined the QP Status based on eligible clinician performance.

2019 APM Information

Advanced APMs

What models are Advanced APMs?

In Performance Year 2019, the following models are Advanced APMs:

How do I join an Advanced APM?

  1. Learn about specific Advanced APMs and how to apply.
  2. Apply to an Advanced APM that fits your practice and is currently accepting applications.
  3. This website will be updated as new information is available.

What happens if I am in an Advanced APM?

Once you're in an Advanced APM, you'll earn the 5 percent incentive payment in 2021 for Advanced APM participation in Performance Year 2019 if:

  • You receive 50% of your Medicare Part B payments through an Advanced APM or
  • See 35% of your Medicare patients through an Advanced APM

You'll need to send in the quality data required by your Advanced APM. Your model's website will tell you how to send in your Advanced APM's quality data.

If you leave the Advanced APM during Performance Year 2019, you should make sure you've seen enough patients or received enough payments through an Advanced APM to qualify for the 5% bonus. If you haven't met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.

All-Payer Combination Option

Qualifying APM Participant (QP) of Other Payer Advanced APMs

Starting in the 2019 QP Performance Period, Eligible Clinicians will be able to become QPs through the All-Payer Combination Option. This Option is attainable through participation in a combination of Advanced APMs with Medicare and Other Payer Advanced APMs.

Medicaid Other Payer Advanced APMs in the Quality Payment Program for Performance Year 2019

Under the Quality Payment Program’s All-Payer Combination Option, State Medicaid Agencies, Medicare Advantage and other Medicare Health Plans, as well as commercial and private payers participating in CMS-sponsored Multi-Payer payment arrangements (CMS Multi-Payer Models), may submit information to CMS about their payment arrangements with eligible clinicians.

CMS will determine whether each submitted payment arrangement constitutes an Other Payer Advanced Alternative Payment Model (APM) for a given Performance Year. If a payer chooses not to (or is not eligible to) submit its arrangements to CMS, eligible clinicians or APM Entities participating in the payment arrangement may do so. The list of determined Medicaid Other Payer Advanced APMs is available for your review, before electing to complete the Eligible Clinician Initiated Submission Form.

The Eligible Clinician Initiated Submission Form

The Eligible Clinician Initiated Submission Form is now available. The form may be used to request that CMS determine whether such payment arrangements are Other Payer Advanced APMs under the Quality Payment Program as set forth in 42 CFR § 414.1420. The process is called the APM Entity or Eligible Clinician Initiated Other Payer Advanced APM Determination Process (Eligible Clinician Initiation Process).

CMS will review the payment arrangement information in this form to determine whether the payment arrangement meets the Other Payer Advanced Alternative Payment Model (APM) criteria. Additional details and explanation about the submission process are available by selecting the Eligible Clinician Initiated Submission Form.


Get Help From CMS

Phone1-866-288-8292
TTY PhoneTTY: 1-877-715-6222

Subscribe to Updates