February 08, 2018

CMS Defines APM Participation Terms for 2018

The Centers for Medicare and Medicaid Services (CMS) has published a new table specifying key features of six Alternative Payment Models (APMs) for Medicare’s Merit-based Incentive Payment System (MIPS) at the start of calendar 2018.

CMS reported that an APM must meet the following three criteria to qualify as an Advanced APM:

  • Requires participants to use Certified Electronic Health Record Technology (CEHRT)
  • Provides payments based on quality measures comparable to those in the quality category of the MIPS
  • Bears more than nominal financial risk for monetary losses 

If an APM meets these criteria in 2018, their eligible clinicians will be considered qualifying APM Participants (QPs) and will automatically receive a five percent bonus in 2020 for all services they bill to Medicare in 2018.

The table also describes MIPS APM characteristics. These APMs do not meet the above criteria, and physicians who work with them will be considered for MIPS-eligibility under relatively less stringent MIPS APM criteria than other models. If an Advanced APM does not meet the three criteria by the fourth quarter of the 2018 performance year, CMS will not classify its eligible clinicians as QPs. Instead, they will be scored on the measures and improvement activities that these APMs have in place under MIPS.

CMS will modify this list over time to address APM design modifications and the addition of new APMs.

For more information about APMs and MIPS APMs, refer to the CMS Quality Payment Program Fact Sheet or contact American College of Radiology Economics Analysts Dominick Parris (djparris@acr.org) or Pam Kassing (pkassing@acr.org).