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Advanced Alternative Payment Models

 

What are Advanced Alternative Payment Models (APMs)?

Advanced Alternative Payment Models (APMs) are a track of the Quality Payment Program that offer an 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.

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.

Advanced APMs offer potential benefits for providers, including a 5% bonus. For the reporting year, 2019, these are the Advanced APMs:

 

Comprehensive Primary Care Plus (CPC+)

Comprehensive Primary Care Plus (CPC+)

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Medicare Accountable Care Organization (ACO)

Medicare Accountable Care Organization (ACO)

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Next Generation ACO Model

Next Generation ACO Model

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Vermont Medicare ACO Initiative

Vermont Medicare ACO Initiative

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Maryland All-Payer Model

Maryland All-Payer Model

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Maryland Total Cost of Care Model

Maryland Total Cost of Care Model

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Oncology Care Model (OCM)

Oncology Care Model (OCM)

Accountable Care Organization

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Comprehensive Care for Joint Replacement (CJR)

Comprehensive Care for Joint Replacement (CJR)

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