Merit Based Incentive Payment Systems (MIPS) APMs
What is an alternative payment model (APM)?
What is a MIPS APM?
What is the APM scoring standard?
What is the APM Scoring Standard Criteria?
What are Participation Determinations and Snapshot Dates?
What is the 2019 Scoring Standard for MIPS APMs?
How will the scoring standard be applied to ECs in a MIPS APM?
How will the MIPS APM payment adjustment be applied for an EC in a MIPS APM?
The MIPS APM payment adjustment will be applied at the TIN/NPI level for each EC in the MIPS APM.
Medicare Advanced APMs
What is an Advanced APM?
What are the criteria to be considered a Medicare Advanced APM Model?
How may an EC earn an incentive bonus payment by participating in a Medicare Advanced APM?
How does an EC meet the payment or patient threshold levels for full QP status?
CMS sets the annual Medicare payment and patient threshold levels for each performance year. For example, in 2019 an EC must meet 50% of Medicare payment or 35% of Medicare patients to qualify as a full QP. If the EC meets the full QP status based on the CMS determined eligibility thresholds, the EC receives the incentive bonus in the payment year that is two years after the performance year (e.g. performance year 2019, payment year 2021.) If an EC does not meet the annual payment or patient threshold levels set for full QP status based on the Medicare thresholds, the EC may be able to still earn partial QP status.
What are the benefits of Partial QP status?
When are QP status determinations made?
Can QP status be determined at the individual level?
Generally, QP status is determined at the APM Entity level. CMS will determine QP status at the individual level in the following situations: (1) the CRNA participates in multiple Advanced APMs, none of which collectively meet the QP threshold, or (2) when the Advanced APM includes ECs only on an Affiliated Practitioner List. This only occurs after the Final QP determinations for a calendar year.
All Payer Combination Advanced APMs
What other ways can an eligible clinician in a Medicare Advanced APM become a Qualified Participant if they don’t meet the Medicare payment or patient thresholds?
What is the All-Payer Combination Advanced APM option?
What is the purpose of the All-Payer Combination Option?
How does an Advanced APM become an Other Payer Advanced APM under the All-Payer Combination Option?
What criteria must the APM entity fulfill in order for it to be considered in an Other Payer Advanced APM?
What if a payer, such as Medicaid Advanced APM, does not submit payer information to CMS for approval to be an Other Payer Advanced APM?
How will I know if the APM entity that I am participating in is approved to be an Other Payer Advanced APM under the All-Payer Combination Option?
Can ECs who are QPs in the All-Payer Combination Advanced APM option qualify for the APM five percent incentive bonus?
How does an EC attain QP status in the All-Payer Combination Option?
Do ECs trying to achieve QP status have to participate in Medicare Advanced APMs to utilize the All-Payer Combination Option?
What are the advantages of attaining partial QP status under the All-Payer Combination Option?
ECs who achieve Partial QP status can decide whether to participate in MIPS via the Special Scoring Standard. Absent an express election to participate in MIPS, a Partial QP will automatically be excluded from MIPS and will not be subject to the upward or downward payment adjustment.