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APMs Overview

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.

Types of APMs

APMs

Meet the statutory definition of an APM. MIPS eligible clinicians participating in an APM are also subject to MIPS.

MIPS APMs

MIPS APMs have MIPS eligible clinicians participating in the APM on their CMS-approved participation list.

Learn more about MIPS APMs.

Advanced APMs

An Advanced APM is a type of APM that includes specific features and allows participating eligible clinicians to seek

Qualifying APM Participant
(QP) status by achieving threshold levels of payment amounts or patient counts through the Advanced APM. If an eligible clinician meets or exceeds either of these thresholds, the eligible clinician becomes eligible for an APM Incentive Payment and, beginning with the calendar year 2024 performance period/2026 payment year, a differentially higher conversion factor for QPs applied to Medicare payments for covered professional services. QPs are also excluded from MIPS reporting requirements and
payment adjustments
.

Learn more about Advanced APMs.

Advanced & MIPS APMs

Most Advanced APMs are also MIPS APMs. Eligible clinicians participating in Advanced APMs are MIPS eligible clinicians if they do not meet either the payment amount or patient count threshold to become a QP. 

All-Payer/Other-Payer Option

Eligible clinicians may become QPs through the All-Payer Option. To achieve QP status through this option, eligible clinicians must participate in a combination of Advanced APMs with Medicare and Other-Payer Advanced APMs. Other-Payer Advanced APMs are non-Medicare payment arrangements that meet criteria that are similar to Advanced APMs under Medicare.

Learn more about All-Payer Advanced APMs.

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

  1. Learn about specific Alternative Payment Models and how to apply.
  2. Apply to an Alternative Payment Model that fits your practice and is currently accepting applications.