To be considered a qualifying participant, you must participate in an advanced APM and reach a designated percentage of patients seen or payments received through that advanced APM. As defined by QPP, eligible clinicians who meet the applicable patient count or payment amount thresholds for a given performance year are eligible for a 5% bonus payment.
Note that although qualifying participant status is based on the 2019 performance year, payments are based on the 2020 calendar year, known as the base year. The 5% bonus is calculated based on the estimated aggregate payment amounts for Medicare Part B covered services the qualifying participant provided across all their tax identification number/national provider identifier combinations during the base year. Payment goes to the billing organization associated with the qualifying participant’s advanced APM.
Qualifying participants, no action is needed on your part; payments are sent automatically. If you think you are eligible for a bonus, however, and didn’t receive one, it may be because CMS can’t verify your billing information.
To address this issue, CMS has created a zip file for downloading that includes an Excel spreadsheet listing the names of qualifying participants whose billing information the agency is unable to verify. If your name is on that list, contact Medicare using instructions given in the 2021 APM Incentive Payment Notice Billing Information Collection Form that is also included in the zip file. Note that you need to verify your information and submit the required form by Nov. 1, 2021, for CMS to be able to issue your incentive payment.
If you’re a qualifying participant who earned the 5% bonus but your name is on the CMS list and you don’t act to verify your information, you’re just leaving money on the table, said Erin Solis, AAFP manager of practice and payment.
“If you’ve done the work, you deserve the bonus,” she said. “It only takes a few steps to make sure CMS has your current billing information, so don’t miss out.”
Note that completed forms must be emailed to the QPP APM Help Desk by the deadline. Forms submitted through any other means will not be accepted or processed. You can also contact the Help Desk at 866-288-8292 with questions about the submission process.
Additional information and resources, including a QP Methodology Fact Sheet and 2021 Incentive Payment Fact Sheet, may be downloaded from the QPP website.