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APM Performance Pathway

What

The Alternative Payment Model (APM) Performance Pathway (APP) is an optional MIPS reporting and scoring pathway for who are also participants in MIPS APMs.

The APP is designed to reduce reporting burden, create new scoring opportunities for participants in MIPS APMs, and encourage participation in APMs. This reporting option is available to MIPS eligible clinicians identified on an APM Participation List or Affiliated Practitioner List of an APM Entity participating in any MIPS APM on any of the 4 snapshot dates (March 31, June 30, August 31, and December 31) during a performance year. 

Performance is measured across 3 areas - quality, improvement activities, and Promoting Interoperability.

There are also 2 other reporting options available to MIPS eligible clinicians in MIPS APMs for meeting MIPS reporting requirements:


How it Works

The APP is a single, predetermined measure set that MIPS APM participants may report on. There are 3 performance categories that make up your final score. Your final score determines what your payment adjustment will be. These categories are:

Quality

Quality Illustration Traditional MIPS

This category assesses the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional groups, specialty societies, and interested parties. MIPS eligible clinicians reporting the APP will report and be scored on a fixed set of quality measures.

Learn more about quality requirements for the APP

Promoting Interoperability

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This performance category promotes patient engagement and electronic exchange of information using (CEHRT). You report a defined set of Promoting Interoperability objectives and measures. 

Learn more about Promoting Interoperability requirements.

Improvement Activities

IA Illustration MIPS Traditional

This performance category assesses how you improve your care processes, enhance patient engagement in care, and increase access to care. Currently, MIPS APM participants reporting the APP automatically receive full credit in this performance category.


Why

The APP creates a more stable and uniform set of MIPS reporting requirements for MIPS eligible clinicians in MIPS APMs to increase confidence to move into more risk-bearing arrangements without concern about reporting to MIPS if they don't attain status.


When

The MIPS performance year begins on January 1 and ends on December 31 each year. If you're eligible for MIPS, you must report data collected during the calendar year by March 31 of the following calendar year. Payment adjustments, based on the data you submit for services provided, are applied to Medicare Part B claims during January 1 to December 31 of the year following data submission. For example, if you collect data between January 1 and December 31, 2024 (i.e., the performance year), you must report your data by March 31, 2025, and you'll receive a MIPS payment adjustment between January 1 and December 31, 2026 (the payment year). 

Learn more about Timelines and Important Deadlines.

Choose How You Will Participate

APM Entity (Non-Medicare Shared Savings Program Accountable Care Organizations)

Any APM Entity in a MIPS APM may report the APP on behalf of their MIPS eligible clinicians. (Promoting Interoperability data can still be reported at the individual or group level when reporting quality at the Entity level). The clinicians in the Entity who are on a MIPS APM's Participation List of Affiliated Practitioner List on one or more APM snapshot dates and who are MIPS eligible at the individual or group level will receive a payment adjustment based on the APM Entity's final score unless they have a higher final score from individual or group participation. (Note that clinicians in a virtual group always receive the virtual group's final score). 

Learn more about APM Entity participation.

Medicare Shared Savings Program Accountable Care Organizations

Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program are required to report the APP for the purposes of assessing their quality performance for that program. participating in these ACOs also have the option of reporting for MIPS outside the APP (traditional MIPS or an MVP), or within it at an individual or group level like other MIPS APM participants. 

Group

Groups may also report the APP on behalf of their MIPS eligible clinicians, but the final score earned by the group from the APP would be applied only to those MIPS eligible clinicians who appear on a MIPS APM’s Participation List or Affiliated Practitioner List on one or more snapshot dates. MIPS eligible clinicians will receive a payment adjustment based on the group's final score unless they have a higher final score from individual or APM Entity participation. (Note that clinicians in a virtual group always receive the virtual group's final score).  

Learn more about group participation.

Individual

Individual MIPS eligible clinicians who are participants in MIPS APMs may report the APP at the individual level. These clinicians will receive a payment adjustment based on their individual final score unless they have a higher final score from group or APM Entity participation. (Note that clinicians in a virtual group always receive the virtual group's final score). 

Learn more about individual participation