Get Details About Your 5% Medicare Bonus
By David Doolittle

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If you participated in the advanced alternative payment model (APM) track during the 2017 Quality Payment Program (QPP) performance year, full details of your 5% APM incentive payment are finally available.

The Centers for Medicare & Medicaid Services (CMS) recently updated the QPP website with APM details after delaying the incentive payment, which was initially expected to be paid during the first half of 2019. Over the past month, APM entities finally began receiving their payments after the Texas Medical Association and organized medicine called on the agency to make the payments as soon as possible.

Calendar year 2019 is the first year for the 5% incentive payment, which is paid in one lump sum to the APM entity rather than directly to physicians or through payment adjustments for individual claims – the method used for the Merit-Based Incentive Payment System (MIPS) track.

CMS says it took so much time to ensure correct payments would be made and now has published APM incentive payment details on its website via the QPP portal. If you expect to receive a bonus, contact your APM administrator to ensure your details are accurate, and to discuss the entity’s physician compensation model and the amount you are owed.

If you don’t already know, APMs in general are models that focus on a specific clinical condition, care episode, or patient population. To be eligible for the 5% incentive payment, physicians must become qualifying APM participants (QPs). That means they must see a minimum number of Medicare patients or receive a minimum amount in Medicare payments. As outlined by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), 5% APM incentive payments will be made in 2019 through 2024 to physicians who achieve QP status two years prior. The APM bonus is in addition to APM-specific rewards and is intended to create a margin for physicians to invest in changing the way they deliver care. Of note, physicians who are QPs are exempt from MIPS.

Advanced APMs include financial risk and use certified electronic health record technology and quality measures comparable to those used in MIPS.

While CMS encourages participation in APMs and is working to transition physicians to a value-based payment system, TMA continues to advocate that the agency do more to increase its offering of advanced APMs for all physician practices and specialties who wish to participate in the APM track, including models with lower financial risk requirements. TMA also is pushing CMS to extend the 5% APM incentive payment beyond 2024 to provide physicians with an onramp to move to APMs once additional models become available.

For complete details, refer to the APM 2019 Incentive Payment Fact Sheet. For answers to your APM questions, contact the QPP Service Center at (866) 288-8292 or by email at QPP@cms.hhs.gov. For QPP help, visit the TMA MACRA Resource Center.

 

Last Updated On

November 05, 2019

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David Doolittle

Editor

(512) 370-1385

Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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