Alternative Payment Models (APMs)

New developments in APMs

★ Congress passed a minibus healthcare package on March 3, 2024, that provides a 1.88% incentive payment for Qualifying Participants (QPs) for performance year 2024 (payment year 2026).

★ Advanced Alternative Payment Model (APM) Incentive Payments for 2023 are now available. See what your organization received and verify your information, if necessary. 

★ CMS extended the BPCI Advanced Model for two years until December 31, 2025. The deadline for Applications is May 31, 2023. 

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Payment in Advanced APMs Illustrated

Your participation in an APM determines what incentive you may receive illustrated by the U.S. Centers for Medicare & Medicaid Services.

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APM Entity

An APM Entity is composed of Eligible clinicians and their associated TINs, who are listed on a participant list, or an affiliated practitioner list associated with an APM.

2024 Qualifying APM Participant

To become a QP, you must receive at least 75% of your Medicare Part B Covered Professional Service payments or see at least 50% of Medicare patients through an Advanced APM entity on the determination periods (snapshots).

2024 Partial Qualifying APM Participant (Partial QP)

Not all clinicians who participate in Advanced APMs may achieve QP status. Some may be eligible to become Partial QPs. To be a Partial QP, you must receive at least 50% of Medicare Part B payments or see at least 35% of Medicare patients through an Advanced APM Entity during the QP performance period.

To be considered an Advanced APM, the APM must meet three specific criteria:

1. Require participants to use certified electronic health record technology (CEHRT).
2. Provide payment for covered professional services based on quality measures comparable to those used in the quality performance category of MIPS.
3. Either be a Medical Home Model expanded under the CMS Innovation Center authority; or require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses.

Access the details of 2024 Advanced APMs at Advanced APMs Intro (cms.gov)

Four primary advantages to participating in the Advanced APM pathway:

1. Participants are excluded from MIPS reporting.
2. For performance years 2017-2022, participants receive a 5% lump sum bonus through 2024.
3. For performance year 2023, participants received a 3.5% APM incentive payment.
4. For performance years 2024 and beyond, eligible clinicians will receive a 0.75% payment update if they are Qualified Participants (QPs) and 0.25% if they are partial QPs. An increased physician fee schedule update based on the QP conversion factor will determine future bonus payments.