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.


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.

Participating in APMs

Once you’re in an Advanced APM, you’ll earn the 5 percent incentive payment in 2020 for Advanced APM participation in Performance Year 2018 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

For more information about eligible APM categories for 2018, click the button below and check out the ‘Models’ section:

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