CMS Unveils Interactive Advanced APM 'Look-up' Tool

Find Out Whether You're a Qualifying Participant in 2017

October 16, 2017 12:51 pm News Staff

Eligible clinicians -- including many family physicians -- who are participating in an Advanced Alternative Payment Model (AAPM) in 2017 can use a new CMS tool to check on their status as a qualifying participant.  

[Physician typing into laptop]

CMS unveiled the interactive look-up tool(data.cms.gov) on Oct. 4 and invited 2017 AAPM participants to use it to see the results of the first qualifying participant "snapshot."

Physicians should have their 10-digit national provider identifier (NPI) handy to access the tool.

This initial look-see is based on calculations from claims with dates of service between Jan. 1 and March 31, 2017; about 75,000 NPIs are included in the first qualifying participant analysis.

CMS said it will soon update the tool with calculations from claims with dates of service through June 30.

According to Quality Payment Program (QPP) guidelines, physicians and other eligible clinicians who meet specified criteria are considered qualifying participants in AAPMs and, therefore, are excluded from participating in the Merit-based Incentive Payment System (MIPS). MIPS is the other payment track that evolved from the Medicare Access and CHIP Reauthorization Act (MACRA).

The AAFP has created numerous resources designed to help family physicians succeed in either of the two payment tracks, including a "MACRA Basics" primer that includes need-to-know details about AAPMs.

For instance, for the 2017 performance period, an AAPM entity must do one of two things before all of its eligible clinicians can be considered qualifying participants; it must either

  • receive at least 25 percent of its Medicare Part B payments through the AAPM or
  • see at least 20 percent of its Medicare patients through the AAPM.

Those qualifying percentages represent the early data that physicians now have access to through the look-up tool.

The payoff for qualifying participants is that they will receive an annual 5 percent lump-sum bonus applied to payment year 2019.

In addition, qualifying participants will receive a 0.75 percent increase to their Medicare-allowed charges under the physician fee schedule beginning in 2026.

Additional Resources
CMS: Qualifying Alternative Payment Model Participants Methodology Fact Sheet(www.cms.gov)

CMS: Supplemental Service Payments for Alternative Payment Models(www.cms.gov)