Advanced Alternative Payment Model

Advanced Alternative Payment Models (APMs) are a subset of APMs that reward eligible clinicians and practices to earn greater payment incentives for taking on some risk related to their patient’s outcomes. In order to be considered an Advanced APM, the APM must meet three specific criteria:

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

Why participate in an Advanced APM?

There are three primary advantages to participating in the Advanced APM pathway:

  • Participants are excluded from MIPS reporting
  • Participants and APMs receive a 5% lump sum bonus through 2024.
  • Beginning in 2026 and beyond, eligible clinicians will receive a 0.75 percent payment update.

The Centers for Medicare & Medicaid Services (CMS) have posted several models that are eligible Advanced APMs in 2020. Eligible clinicians and their groups should also check their participation status to see if CMS has determined your APM status.