APM: What is Advanced APM and MIPS APM?
November 30, 2016
Written by Sarah Leake
The Quality Payment Program has two tracks for participation – APMs and MIPS. CMS anticipates the majority of providers will be in the MIPS track in 2017. But, there are alternative payment models which may be available within the Mountain-Pacific region so we’d like to give you a review of APMs.
It’s important to know that being involved in an APM alone will not exempt you from MIPS. There are several important criteria that must be met for a provider to fall completely under the APM umbrella to be exempt from MIPS. However, as CMS wants as many providers as possible to participate in APMs, they view any APM participation favorably and will give you “credit” when reporting in the MIPS track.
Let’s take a look at various types of APMs and the term Qualifying Provider.
Alternate Payment Model – are new approaches to paying for medical care through Medicare that incentivize quality and value. APMs are developed in partnership between the CMS Innovation Center and the clinician community and provide added incentives to clinicians to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.
Advanced APM – a subset of APMs which allows practices to earn more for taking on financial risk while achieving improved quality and health outcomes for patients. Advanced APMs are listed by CMS each year and meet certain criteria, for example, specific uses of EHR, financial risk for participants and use of quality measures comparable to MIPS.
As of the date of publication of this blog, these are the Advanced APMs for 2017:
MIPS APM – is a subset of APMs which include MIPS eligible clinicians as participants and hold their participants accountable for the cost and quality of care provided to Medicare beneficiaries. Participants in MIPS APMs receive special MIPS scoring under the “APM scoring standard.” If an eligible clinician participating in the Advanced APM does not meet the threshold of having sufficient payments or patients through an Advanced APM to become a Qualifying APM Participant (QP), the eligible clinician will be scored under MIPS according to the APM scoring standard.
As of the date of publication of this blog, these are the MIPS APMs for 2017. Note that all Advanced APMs listed above are included as MIPS APMs. Just like the Advanced APM, CMS will indicate each year which APMs are considered MIPS APMs.
Qualifying APM participants (QP) – are clinicians who have a certain % of Part B payments for professional services or patients furnished Part B professional services through an APM Entity. There are several steps involved in determining if an Eligible Clinician (EC) is a QP. CMS will publish a list three times per year identifying which eligible clinicians are considered QPs so you will know in advance if you can report through the APM option.
For more information on the Quality Payment Program and APMs please go to these links.
Leave a reply, ask a question or share information using the “Leave a Reply” section below, or email Sarah Leake directly with your questions or comments.