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Alternative Payment Models (APMs)

Updated: 06/10/2023|Views: 1415

An Alternative Payment Model (APM) is an approach to payment, developed in partnership with clinician communities, providing incentives to clinicians to provide high-quality and cost-effective care. Clinicians must apply or be invited to participate in an APM.

Examples of the approved MIPS-APMs and Advanced APMs for 2023 include:

  • Bundled Payments for Care Improvement Advanced Model (BPCI Advanced)
  • Kidney Care Choices: Comprehensive Kidney Care Contracting (CKCC) Global Option
  • Oncology Care Model (OCM) - Two-Sided Risk, One-Sided Risk

For a full list of Approved APMS visit Quality Payment Program.

Clinicians who participate successfully in an APM may be exempt from MIPS reporting and have the potential to earn a 5% Medicare incentive for performance Years 2019 through 2022, and a 3.5 percent incentive for performance year 2023. Clinicians can use the APM Lookup Tool to check their Qualifying APM Participant(QP) status.

Each APM Type has unique requirements, please contact your APM program coordinator to discuss program and technology requirements.

Important facts to know about APMs:

  • APMs are Medicare Incentive Programs.
  • They are usually managed by local medical entities such as hospitals, medical groups, or Independent Physician Associations (IPAs).
  • Participating providers might also be required to participate in the MIPS track.
  • APM administrators assign quality measures to participating providers.

Types of APM classification:

  • APMs
  • MIPS APMs
  • Advanced MIPS APMs
  • Advanced & MIPS APMs
  • APM Performance Pathway (APP)
  • All-Payer /Other-Payer Option

To learn more about the types of each APM and list of participating programs visit: APMs Overview.

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