What is an Alternative Payment Model (APM)?
APMs are new approaches to paying for medical care through Medicare that incentivize quality and value. There are generally three buckets that APMs can apply to:
- Specific clinical condition
- Care episodes
What is an Advanced APM?
Advanced APMs are a subset of APMs that reward eligible clinicians and practices to earn greater rewards for taking on some risk related to their patient’s outcomes.
Advanced APMs must meet three criteria:
- Quality reporting requirements
- Certified electronic health record technology (CEHRT) use requirements
- Nominal risk requirements
What are the eligible models for participation in an Advanced APM?
For 2017, there are seven eligible models:
Why Participate in an Advanced APM?
There are three primary advantages to participation in this pathway:
- Excluded from MIPS reporting
- A 5 percent lump sum bonus is paid through CY 2024
- Following the phase out of the lump sum bonus, will receive a 0.75 percent payment update from 2026 and beyond
What are the Eligibility Criteria?
If you see patients in an Advanced APM, you are eligible (i.e., a Qualified Participant) for the payment bonus if you meet at least one of the following:
- You receive 25 percent of your Medicare Part B payments through an Advanced APM, or
- See 20 percent of your Medicare patients through an Advanced APM
Are you Interested in Reporting in an APM?
Review the MACRA Readiness Checklist to determine if you’re ready and/or eligible to participate in an APM.