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Advanced Alternative Payment Models (APMs)

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Advanced Alternative Payment Models

Advanced Alternative Payment Models (APMs), or Advanced APMs,  are a track of the Quality Payment Program that offer a 5% incentive for achieving threshold levels of payments or patients. Therefore, if you achieve these thresholds, you become a Qualifying APM Participant (QP) and you are excluded from the MIPS reporting requirements and payment adjustment.

Most Advanced APMs are also MIPS APMs. MIPS Eligible clinicians participating in Advanced APMs are included in MIPS if they do not meet the threshold for payments or patients sufficient to become a Qualified Participant (QP).

Advanced APMs are advanced alternative payment models that meet these 3 criteria:

  • Requires participants to use certified EHR technology;
  • Provides payment for covered professional services based on quality measures comparable to those used in the MIPS quality performance category; and
  • Either: (1) is a Medical Home Model expanded under CMS Innovation Center authority OR (2) requires participants to bear a significant financial risk.

Participation in advanced alternative payment models can offer potential benefits for providers, including a 5% bonus. For the reporting year 2020, these are the Advanced APMs: