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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 a special 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.

Advanced APMs and MIPS APMs in APM Lookup Tool

Clinicians can use the APM Lookup Tool to check their Qualifying APM Participant (QP) status and see whether they'll receive a 5 percent APM incentive payment and be excluded from MIPS. And for the first time, the tool also includes participant data for Advanced APMS and MIPS APMs.

There are approximately 300,000 National Provider Identifiers (NPIs) included in one searchable file. Clinicians simply enter their NPI and receive their QPP APM eligibility and participation requirements.

If conflicts arise between the Performance Year 2017 APM and MIPS Lookup tools, CMS will base APM clinicians status on results from the APM Lookup tool.

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

2018 APM Information

What models are Advanced APMs?

In Performance Year 2018, the following models are Advanced APMs:

Starting this spring the 2018 MIPS Participation Status Tool will include APM information. We are expanding this tool to include both Performance Year 2018 APM participation and predictive Qualifying APM Participant (QP) status.

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.

Advanced APMs and MIPS APMs in APM Lookup Tool

Clinicians can use the APM Lookup Tool to check their Qualifying APM Participant (QP) status and see whether they'll receive a 5 percent APM incentive payment and be excluded from MIPS. And for the first time, the tool also includes participant data for Advanced APMS and MIPS APMs.

There are approximately 300,000 National Provider Identifiers (NPIs) included in one searchable file. Clinicians simply enter their NPI and receive their QPP APM eligibility and participation requirements.

If conflicts arise between the Performance Year 2018 APM and MIPS Lookup tools, CMS will base APM clinicians status on results from the APM Lookup tool.

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


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