Alternative Payment Models
Alternative Payment Models (APMs) are a form of payment reform that incorporate quality and total cost of care into reimbursement rather than a traditional fee-for-service structure. APMs can apply to a specific clinical condition, a care episode, or a population.
In the Advanced APM track of the Quality Payment Program (QPP), you may earn a 5 percent incentive for achieving threshold levels of payments or patients through Advanced APMs. If you achieve these thresholds, you are excluded from the MIPS reporting requirements and payment adjustment.
Most Advanced APMs are also MIPS APMs so that if an eligible clinician (EC) participating in the Advanced APM does not meet the threshold for sufficient payments or patients through an Advanced APM in order to become a Qualifying APM Participant (QP), thereby being excluded from MIPS, the MIPS EC will be scored under MIPS according to the APM scoring standard.
Information for Advanced APMs and MIPS APMs may change each Performance Year (PY).
To learn more about how to join an Advanced APM, check your APM participation, or to access the Qualifying APM Participant Methodology Fact Sheet, visit https://qpp.cms.gov/apms/overview.