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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.

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


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