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Alternative Payment Model


Alternative Payment Model

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Alternative Payment Model


Alternative Payment Model

alternative Payment Model incEntive

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Advanced Alternative Payment Models (APMs) are a track of the Quality Payment Program that offer a 5 percent incentive for achieving threshold levels of payments or patients through Advanced APMs. If you achieve these thresholds, you become a Qualifying APM Participant (QP) and you are excluded from the MIPS reporting requirements and payment adjustment.

There are four performance categories that make up your final score. Your final score determines what your payment adjustment will be. These categories are:


Alternative payment model

APMs

Meet the statutory definition of an APM. MIPS eligible clinicians participating in an APM are also subject to MIPS.


MIPs APM's

MIPs APMs

Certain Alternative Payment Models (APMs) include Merit-Based Incentive Payment System (MIPS) eligible clinicians as participants and hold their participants accountable for the cost and quality of care provided to Medicare beneficiaries. These types of APMs are called MIPS APMs, and participants receive special MIPS scoring under the APM scoring standard. All eligible clinicians should check their participation status to understand their MIPS participation.

MIPS APMs are APMs that meet these 3 criteria:

  • APM entities that participate in the APM under an agreement with CMS;

  • APM entities that include 1 or more MIPS eligible clinicians on a Participation List

  • APM bases payment incentives on performance (either at the APM entity or eligible clinician level), on cost/utilization, and quality measures.


Advanced APM

Advanced APMs

Advanced Alternative Payment Models (APMs) are a track of the Quality Payment Program that offer a 5 percent incentive for achieving threshold levels of payments or patients through Advanced APMs. 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 APMs 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 APM Potential Benefits:

  • 5 percent bonus

  • APM-specific rewards

  • Exclusion from MIPS


Advanced APM and MIP

Advanced MIPs APMs

These models have both types of participants under one model name. Each participant’s eligibility is based on the level of participation within the model.


Payer Options Quality Care

All-Payer/Other-Payer Option

Starting in Performance Year 2019, eligible clinicians will be able to become Qualifying Alternative Payment Model Participant (QPs) through the All-Payer Option. To attain this Option, eligible clinicians must participate in a combination of Advanced APMs with Medicare and Other-Payer Advanced APMs. Other-Payer Advanced APMs are non-Medicare payment arrangements that meet criteria that are similar to Advanced APMs under Medicare.


 
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Connect with an edgeMED expert to discuss how you can participate and thrive in the Quality Payment Program.

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APM Get Started


Ready to Participate

APM Get Started


Ready to Participate

getting started

You can now submit your data for Performance Year 2018. You can submit and update your data any time until April 2, 2019 at 8pm EDT when the submission window closes. Please note that the CMS Web Interface opened on January 22, 2019 for data submission.


Collect the CMS Data

STEP 1

Collect Data

Record quality data and how you used technology to support your practice. If an Advanced APM fits your practice, then you can join and provide care during the year through that model.

Report CMS Data

STEP 2

Report Data

To potentially earn a positive payment adjustment, send in data about the care you provided and how your practice used technology.

Feedback from CMS

STEP 3

Feedback Available

CMS will provide feedback to you on your level of performance and how you compare to historical benchmarks, if applicable.

CMS Payment Adjustment

STEP 4

Payment Adjustment

You may earn a positive pay adjustment if you submit data by the submission deadline. If you participate in an Advanced APM, then you may earn a 5% incentive payment.


MIPS tools

BEST IN CLASS TOOLS TO SUCCEED WITH MIPS

Our best-in-class tools will help you avoid penalty and succeed with the Quality Payment Program (QPP). Whether you want to avoid a penalty or continuously monitor your performance, QPP Solutions Products and Services will help you succeed with Medicare quality reporting.

In conjunction with Mingle Health, an industry leader in Medicare quality reporting, edgeMED provides you with knowledgeable consultants and access to best-in-class tools including:

MIPS tools for success

Measure Advisor™

Use our Quality Measure, Advancing Care Information, and Improvement Activities Advisors™ to make informed decisions about the measures most applicable to your organization. Our Advisor tools will allow you to review specifications and recommendations by specialty and type of practice.

MIPS tools for success

Measure Analyzer™ and Incentive Analyzer™

Our Measure Analyzer™ will give you confidence in your submission by showing you which measures you have eligibility for based on your data. You’ll be able to make fully informed decisions about which measures are most applicable to you and your practice. Our Incentive Analyzer™ will predict your potential penalty or incentive ahead of time based on your Medicare Part B claims.

MIPS tools for success

Quality Performance Analyzer™

Know how your providers’ and practices’ perform on their selected measures continuously, quarterly or annually, depending on the MIPS Edition you purchase. Having this information at your fingertips allows you to identify low-performing measures so you can make improvements throughout the year.

MIPS tools for success

Solutions™ Dashboard and Scorecard

When you sign-up for our Quality Payment Program services, you’ll have access to your QPP Solutions Dashboard in the Mingle Analytics Portal. You’ll be able to review your performance in each quality performance category and manage your submission to Medicare. You’ll also have access to our customer knowledge base for QPP specific information, a tool for the secure exchange of data files, and step-by-step project management to guide and track your submission progress.