Advanced Alternative Payment Model (AAPM) - Frequently Asked Questions

Advanced Alternative Payment Model (AAPM) - Frequently Asked Questions

What is an Alternative Payment Model (APM)?

MACRA defines any of the following as a qualifying Alternative Payment Model (APM):

  • An innovative payment model expanded under the Center for Medicare & Medicaid Innovation (CMMI), with the exception of Health Care Innovation Award recipients;
  • A Medicare Shared Savings Program (MSSP) accountable care organization (ACO);
  • Medicare Health Care Quality Demonstration Program or Medicare Acute Care Episode Demonstration Program; or
  • Another demonstration program required by federal law.

In order for a clinician to receive a bonus payment through an APM, the APM must be considered an Advanced APM (AAPM) by meeting the following eligibility requirements:

  • Use of quality measures comparable to measures under MIPS;
  • Use of a certified electronic health record (EHR) technology; and
  • Assumes more than a “nominal financial risk” OR is a medical home expanded under the CMMI.

Which Alternative Payment Models (APMs) are eligible for the bonus?

Only AAPMs are eligible for the 5% bonus. The following APMs apply to primary care and are Advanced APMs (AAPMs) for the performance period beginning in 2018:

  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings Program (MSSP) Tracks 1, 2, and 3
  • Medicare Accountable Care Organization (ACO) Track 1+
  • Next Generation ACO Model
  • Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)
  • Additional models will be announced by CMS as they are approved

To receive the 5% AAPM bonus, the eligible clinician (EC) must be considered a qualifying participant (QP). ECs are considered QPs if they receive a certain percentage of payments or see a certain percentage of patients through the AAPM. For the 2018 performance year, the payment threshold is 25% and the patient count threshold is 20%. QP determinations will be made at the group level. Participants who do not meet the QP thresholds may be considered a partial QP if they receive 20% of their payments or see 10% of their patients through an AAPM. Partial QPs can elect to participate in MIPS and will be scored under the APM scoring standard.  

When will I know my QP status?

CMS will make QP determinations three times during the performance period. QPs will be identified on the following schedule: March 31 of the performance period; June 30 of the performance period; and August 31 of the performance period. To be included in the QP calculations, an EC must be on the AAPM’s participation list during at least one of these determination snapshots. Once determined to be a QP, an EC will retain QP status for the performance period even if he or she is not included in the AAPM’s participation list during all determination snapshots. For example, an EC included on the participation list and determined to be a QP during the March 31 snapshot, but not included on the participation list during the June 30 snapshot will be considered a QP for the performance period. ECs can check their QP status using the CMS Qualifying Participant Lookup Tool(data.cms.gov).
 

How will I be paid under an APM?

If you are a QP, from 2019 through 2024, you will receive an annual 5% lump-sum bonus. The amount of the bonus is based on your Medicare Part B payments from the previous year’s claims. This bonus will be in addition to the incentive paid through existing contracts with the AAPM. Beginning in 2026, QPs will qualify for a 0.75% increase in Medicare Part B PFS payments
 

How do I know if I’m in MIPS, an AAPM, or a MIPS APM?

Most physicians will move through MIPS until more AAPMs become available. However, family physicians interested in an AAPM model need to be prepared to start on the MIPS track.

Last updated: January 2018