Alternative Payment Models (APMs)

New developments in APMs

★ On September 5, 2024, CMS published a list of acute care hospitals (XLSX) located in one of the Core Based Statistical Areas (CBSAs) selected for mandatory participation in the Transforming Episode Accountability Model (TEAM). TEAM is a mandatory, episode-based, alternative payment model, in which selected acute care hospitals will coordinate care for people with Traditional Medicare undergoing one of the surgical procedures included in the model (initiate an episode) and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital. CMS used Core-Based Statistical Areas (CBSAs) to identify selected geographic regions for the model test. See if your hospital is one of the mandatory participants at list of acute care hospitals (XLSX). To learn more about the model, see Transforming Episode Accountability Model (TEAM) | CMS.

★ Provide Your Billing Information to Receive Your Alternative Payment Model (APM) Incentive by September 1, 2024. The Centers for Medicare and Medicaid Services issued a payment advisory notice asking APM participants to provide current Medicare billing information by September 1, 2024. The Centers need information including Taxpayer Identification Numbers to issue the APM Incentive Payment for the 2024 payment year. Check if you are on the list and access the notice for directions on how to submit your information at 2024-15644.pdf (federalregister.gov).

★ In a recent response to the proposed 2025 Inpatient Prospective Payment System (IPPS) (PDF), ASA urged the Centers for Medicare & Medicaid Services (CMS) to expand opportunities for anesthesiologists to participate in alternative payment models (APMs). As leaders in perioperative care and care coordination, anesthesiologists would be essential to the successful implementation of CMS’s proposed Transforming Episode Accountability Model (TEAM).       Read more ›

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Payment in Advanced APMs Illustrated

Your participation in an APM determines what incentive you may receive illustrated by the U.S. Centers for Medicare & Medicaid Services.

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APM Entity

An APM Entity is composed of Eligible clinicians and their associated TINs, who are listed on a participant list, or an affiliated practitioner list associated with an APM.

2024 Qualifying APM Participant

To become a QP, you must receive at least 75% of your Medicare Part B Covered Professional Service payments or see at least 50% of Medicare patients through an Advanced APM entity on the determination periods (snapshots).

2024 Partial Qualifying APM Participant (Partial QP)

Not all clinicians who participate in Advanced APMs may achieve QP status. Some may be eligible to become Partial QPs. To be a Partial QP, you must receive at least 50% of Medicare Part B payments or see at least 35% of Medicare patients through an Advanced APM Entity during the QP performance period.

To be considered an Advanced APM, the APM must meet three specific criteria:

1. Require participants to use certified electronic health record technology (CEHRT).
2. Provide payment for covered professional services based on quality measures comparable to those used in the quality performance category of MIPS.
3. Either be a Medical Home Model expanded under the CMS Innovation Center authority; or require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses.

Access the details of 2024 Advanced APMs at Advanced APMs Intro (cms.gov)

Four primary advantages to participating in the Advanced APM pathway:

1. Participants are excluded from MIPS reporting.
2. For performance years 2017-2022, participants receive a 5% lump sum bonus through 2024.
3. For performance year 2023, participants received a 3.5% APM incentive payment.
4. For performance years 2024 and beyond, eligible clinicians will receive a 0.75% payment update if they are Qualified Participants (QPs) and 0.25% if they are partial QPs. An increased physician fee schedule update based on the QP conversion factor will determine future bonus payments.