An 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.
Advanced APMs (AAPMs)
Advanced Alternative Payment Models (APMs) are a track of the Quality Payment Program that offer a 5 percent incentive for achieving threshold levels of payments or patients through Advanced APMs. If you achieve these thresholds, you become a Qualifying APM Participant (QP) and you are excluded from the MIPS reporting requirements and payment adjustment.
Advanced APMs are APMs that meet these 3 criteria:
- Requires participants to use certified EHR technology;
- Provides payment for covered professional services based on quality measures comparable to those used in the MIPS quality performance category; and
- Either: (1) is a Medical Home Model expanded under CMS Innovation Center authority OR (2) requires participants to bear a significant financial risk.
Advanced APM Potential Benefits:
- 5 percent bonus
- APM-specific rewards
- Exclusion from MIPS
The QPP MIPS Participation Lookup includes APM and MIPS participation status.
What models are Advanced APMs?
You can find the most current list of AAPMs here
How do I join an Advanced APM?
- Learn about specific Advanced APMs and how to apply.
- Apply to an Advanced APM that fits your practice and is currently accepting applications.
- This website will be updated as new information is available.
What happens if I am in an Advanced APM?
Once you’re in an Advanced APM, you’ll earn the 5 percent incentive payment in 2021 for Advanced APM participation in Performance Year 2019 if:
- You receive 50 percent of your Medicare Part B payments through an Advanced APM or
- See 35 percent of your Medicare patients through an Advanced APM or
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.
If you leave the Advanced APM during Performance Year 2019, you should make sure you’ve seen enough patients or received enough payments through an Advanced APM to qualify for the 5 percent bonus. If you haven’t met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.
What happens if I or my APM doesn’t meet QP status under the Medicare Option?
Explore the All Payer AAPM option (NEW for 2019) here