MIPS APM

MIPS APM

Some eligible clinicians may be participating in an Alternative Payment Model (APM) that does not qualify as an Advanced APM, according to the Centers for Medicare & Medicaid Services (CMS) standards. CMS created a separate category of APMs called Merit-based Incentive Payment System (MIPS) APMs. These models include MIPS-eligible clinicians and, like Advanced APMs, hold eligible participants accountable for the cost and quality of care provided.

Why participate in a MIPS APM?

While qualifying participants in a MIPS APM will not be eligible for the 5 percent bonus payment, they will have MIPS special reporting requirements and receive special MIPS scoring under the “APM scoring standard.” This will help relieve the burden of full participation in the MIPS program.

Also, note that most Advanced APMs are also MIPS APMs. In these cases, a clinician who fails to meet the eligibility requirements to qualify in an Advanced APM may instead be scored under MIPS, according to the APM scoring standard.

You can also find CMS Resources here and ASA FAQs here for all things MACRA.