If you join a qualifying Alternative Payment Model, you'll be eligible for a 5% bonus from 2019 to 2024.
Alternative payment models are payment systems that shift away from traditional volume-based fee-for-service payments to those that are value- or quality-based. If you participate in a qualifying advanced Alternative Payment Model (APM), you’ll be exempt from MIPS payment adjustments, and you’ll be rewarded with a 5% lump-sum bonus for each year you participate from 2019 to 2024. In 2026 and beyond, there will be a 0.75% bonus for physicians who participate in qualifying advanced APMs. However, even if you participate in an APM, you will still need to report for MIPS starting in 2018.
MACRA currently recognizes six advanced APM models:
- Comprehensive ESRD Care LDO Arrangement (CEC)
- Comprehensive Primary Care Plus (CPC+)
- Medicare Shared Savings Track 2 (MSSP2)
- Medicare Shared Savings Track 3 (MSSP3)
- Next Generation ACO Model (NextGen)
- Oncology Care Model two-sided risk arrangement (OCM)
Revenue and risk
APMs require two-sided financial risk, which means that while your practice could potentially lose money, you also stand to gain revenue. Advanced APMs also require you to use certified EHR technology, demonstrate value and keep a certain amount of revenue in the APM:
- 2019-2020: 25% of all your Medicare revenue must be in advanced APMs.
- 2021-2022: 50% of all your Medicare revenue must be in APMs, or 25% of all your Medicare revenue and 50% of your revenue from all payers must be in advanced APMs.
- 2023 and on: 75% of all your Medicare revenue must be in advanced APMs, or 25% of all your Medicare revenue and 75% of your revenue from all payers must be in APMs.
Partial qualification for APMs
It’s possible to partially qualify in an advanced APM. If you partially qualify for an APM, you won’t get the 5% APM annual bonus. Instead, you can choose to participate in MIPS and receive a MIPS payment adjustment. If you choose not to participate in MIPS, you will have no payment adjustment for that year.
To view more videos on the Quality Payment Program from CMS, visit the CMS YouTube channel.