APMs: Last day of the final determination period for 2017 advanced alternative payment models under the CMS Quality Payment Program
Due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare & Medicaid Services (CMS) designed a new Quality Payment Program that has two payment pathway options: the Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models (APMs). The CMS Quality Payment Program began on Jan. 1, 2017, and performance in the pathway you choose this year will affect your Medicare payment in 2019. For physicians and groups who take part in an advanced APM in 2017, CMS will take three snapshots during the performance period: March 31, June 30, and Aug. 31. At the end of each period, CMS will review payment amount and patient count information to determine which eligible clinicians are participating in an advanced APM and whether they meet the required thresholds to become a qualifying APM participant or partial qualifying APM participant under the advanced APM pathway.
Under the CMS Quality Payment Program, to qualify for the 5-percent APM incentive payment (lump-sum bonus in 2019) for participating in an advanced APM in 2017, you must receive a certain percentage of Medicare payments for covered professional services or see a certain percentage of Medicare patients through the advanced APM during the performance year. If you do not meet the required thresholds, you are subject to MIPS participation according to the requirements under the APM scoring standard.
CMS will notify physicians and groups who take part in an advanced APM in 2017 after each determination period is complete: March 31 (notice by July 31), June 30 (notice by Oct. 31), and Aug. 31 (notice by Dec. 31). To find out about your status, check with the administrator managing your APM participation to inquire if you met the required Medicare payment and/or patient thresholds at the end of any of the three determination periods. If you met the full criteria to become a qualifying APM participant, you are eligible for the 5-percent APM incentive payment, in addition to the APM-specific rewards, and excluded from MIPS this year. If you met the lower threshold requirements and are designated as a partial qualifying APM participant, you will not be eligible for the 5-percent APM incentive payment, and participation in MIPS is optional for you this year. If you do not qualify for either status by the end of the year, you are subject to MIPS participation using the APM scoring standard, which includes reweighted MIPS performance categories, modified reporting requirements, and automatic credit for the improvement activities category. For more information, click on the CMS link above or visit the Quality Payment Program website at qpp.cms.gov. For questions, contact the CMS Quality Payment Program Service Center by phone at (866) 288-8292 or by email at QPP@cms.hhs.gov.