APMs

APMs

What are APMs?

An APM, or Alternative Payment Model, 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 are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes.  If you have sufficient participation in an Advanced APM, you may earn a 5% Medicare incentive payment during 2019 through 2024 and be exempt from MIPS reporting requirements and payment adjustments.  
How do I join an Advanced APM?
First learn about specific Advanced APMs and how to apply on CMS's website. Then apply to an Advanced APM that fits your practice and is currently accepting applications.

What happens once I'm in an Advanced APM?
Once you're successfully in an Advanced APM, you'll earn the 5% incentive payment in 2019 for Advanced APM participation in 2017 IF:
  • You receive 25% of your Medicare Part B payments through an Advanced APM OR 
  • You see 20% 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.

What if I leave an Advanced APM?
If you choose to leave the Advanced APM during 2017, make sure you've seen enough patients or received enough payments through an Advanced APM to qualify for the 5% bonus.  If you haven't met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.
Visit CMS's website for more educational resources and tools.
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