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APM Entity Participation

Performance Year

Select your performance year.

Participate as an APM Entity

MIPS eligible clinicians
 can participate in MIPS in several ways. The following information is specific to participation in MIPS as an Alternative Payment Model (APM) Entity.

An APM Entity is an entity that participates in an Alternative Payment Model or other payer arrangement through a direct agreement with CMS, other payer, or through federal or state law or regulation. The clinicians identified on an APM Participant List (or Affiliated Practitioner List) on 1 of the 4 APM snapshot dates are eligible to participate in MIPS as an APM Entity. 

Data Collection

An APM Entity's performance is assessed and scored at the APM Entity level across 3 MIPS performance categories. APM Entities must aggregate performance data for all clinicians (sometimes across multiple

Taxpayer Identification Numbers (TINs)
) within the APM Entity for the quality and improvement activities performance categories. Beginning with the 2023 performance year: 

  • APM Entities have the option to report Promoting Interoperability data at the Entity level. 
  • Alternatively, Promoting Interoperability data can be submitted at the group and individual level and it will be aggregated to create an APM Entity score. 
  • Learn more about Promoting Interoperability

APM Entities aren't scored in the cost performance category, whether reporting via traditional MIPS, the APM Performance Pathway (APP), or MIPS Value Pathways (MVP).

Submission Methods

There are multiple ways to report data to CMS as an APM Entity. How you choose to report and which methods are available to you depend on:

  • The type of information technology used
  • The performance category reported

APM Entities should consider which submission method(s) best fits their practice(s).

Most methods are available to APM Entities; however, Medicare Part B claims quality measures can only be submitted by APM Entities with the small practice designation.

Final Score and Payment Adjustments

Each

MIPS eligible clinician
in the APM Entity receives a
MIPS payment adjustment
based on the APM Entity's final score unless they have another higher score from individual or group participation. MIPS eligible clinicians that participate in MIPS through multiple APM Entities under the same
TIN/NPI combination
will receive the highest of these final scores.