APMs

Alternative Payment Models

Certain clinicians have the option to participate more extensively in Medicare’s Value-Based Care system. In the Advanced APM track of the Quality Payment Program, such providers may earn a 5 percent incentive for achieving threshold levels of payments or patients through Advanced APMs. Those that achieve these thresholds are excluded from MIPS.

WHAT are APMs?


According to the CMS,

An Alternative Payment Model (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.

Basically,

MIPS-eligible clinicians, who 1) would like better participation incentives, and 2) fall under one of the categories the CMS has deemed eligible for that year, can choose to contribute to APMs, rather than MIPS.

Options:

There are two main types of APMs for clinicians to participate in, MIPS APMs and Advanced APMs. MIPS APMs are available to MIPS-eligible clinicians who apply to participate. The data submission requirements closely resemble that of MIPS, but with more focus on the goal of the APM. Advanced APMs, on the other hand, have their own set of eligibility requirements and data submission standards.


Participating in Advanced APMs

For 2018, once you’re in an Advanced APM, you’ll earn the 5 percent incentive payment in 2020 for Advanced APM participation if you a) receive 25 percent of your Medicare Part B payments through an Advanced APM, or b) see 20 percent of your Medicare patients through an Advanced APM. Additionally, 50 percent of practices, within the Advanced APM entity, must be using certified EHR Technology.

For 2019, you’ll earn the 5 percent incentive payment in 2021 for Advanced APM participation if you a) receive 50% percent of your Medicare Part B payments through an Advanced APM, or b) see 35 percent of your Medicare patients through an Advanced APM. Additionally, 75 percent of practices, within the Advanced APM entity, must be using certified EHR Technology.

For more information about Advanced APMs, including the full list of participation models, click the button below:


Participating in MIPS APMs

The eligibility requirements for MIPS APMs are the same as those for MIPS. Thus, for 2019, clinicians and groups that apply (and are accepted) for a MIPS APM are eligible if they 1) bill $90,000 or more in Medicare Part B allowed charges, 2) see more than 200 Part B-enrolled Medicare beneficiaries, AND 3) provide 200 or more covered professional services to Part B patients. For 2018, only the first two requirements need to be met.

The data submission requirements are similar to the standard MIPS program, with different weights given to the four performance categories. The distribution is:

  1. Quality – 50%
  2. Improvement Activities – 20%
  3. Promoting Interoperability – 30%
  4. Cost – 0%

The goal is for the data submitted to better reflect the purpose of the respective APM. In other words, the CMS reduces the reporting requirements of categories already accounted for by APMs, so clinicians can more closely focus on the task at hand.

For more information about MIPS APMs, including the full list of participation models, click the button below:

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