Here’s how to find out if you’re a 2021 qualifying participant for Medicare’s Alternative Payment Model

The Centers for Medicare & Medicaid Services (CMS) updated its Quality Payment Program Participation Status Tool this month based on the first snapshot of 2021 Alternative Payment Model (APM) data. The data is from Medicare Part B claims with dates of service between Jan. 1 and Mar. 31. The tool now allows users to look up their 2021 APM Qualifying Participant (QP) status and Merit-based Incentive Payment System (MIPS) participation status.

If you qualify as a QP, you are:

• Eligible for the 5% APM incentive bonus,
• Eligible for APM-specific rewards,
• Exempt from participating in MIPS.

To view your individual QP or APM participation status:

• Visit the QPP Participation Status Tool,
• Enter your 10-digit National Provider Identifier (NPI).

To check your 2021 eligibility at the APM entity level:

• Log in to the CMS Quality Payment Program (QPP) website (download the QPP Access User Guide to learn how),
• Browse to the Taxpayer Identification Number(s) affiliated with your entity,
• Access the “details” screen to view the eligibility status of every clinician based on their NPIs.

To learn more about how CMS determines QP and the APM participation status for each snapshot of data, visit the APM Determination webpage on the QPP website. For more information on APMs, visit the QPP APM webpages. For a comprehensive list of APMs (PDF), 2021 Learning Resources for QP Status and APM Incentive Payment (ZIP), and additional materials, visit the QPP Resource Library.

If you have questions, you can contact the Quality Payment Program at 1-866-288-8292 from 8 a.m. to 8 p.m. ET Monday through Friday, or via e-mail at QPP@cms.hhs.gov. Individuals who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

— Kent Moore, Senior Strategist for Physician Payment

Posted on Jul 23, 2021 by Kent Moore