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Advanced Alternative Payment Model (APM)

Advanced Alternative Payment Model in Hackensack, New Jersey

An Alternative Payment Model (APM) is a payment approach that gives a new way for Medicare to compensate healthcare providers for serving high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Advanced APM

The most advanced alternative payment models qualify eligible APM providers for even higher levels of reimbursement tied to performance. These will be a subset of APMs and will not include all payment models. Participants may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.

Eligible APMs are the most advanced APMs that meet the following criteria according to the MACRA law:

  • Mandate participants to use certified EHR technology
  • Reimburse participants based on quality measures comparable to those in MIPS
  • Require participants to bear more than nominal financial risk for monetary losses or be part of a medical home

Overview of APMs

Alternative Payment Model (APM)

  • CMS Innovation Center model
  • MSSP (Medicare Shared Savings Program)
  • Demonstration under the Health Care Quality Demonstration Program
  • Demonstration required by Federal Law

Advanced Alternative Payment Model (Advanced APM)

  • An Alternative Payment Model
  • Base payment on quality measures comparable to those in MIPS
  • Require use of certified EHR technology
  • Either (1) bear more than nominal financial risk for monetary losses OR (2) be a medical home model expanded under CMMI authority

Physician-Focused Payment Model

  • An Alternative Payment Model
  • Medicare is a payer
  • Eligible clinicians that are eligible professionals (EPs) are participants and play a core role in implementing the APM’s payment methodology
  • Targets are the quality and costs of services that EPs participating in the APM provide, order, or can significantly influence.

Visit this site for the CMS Innovation Center models: https://innovation.cms.gov/

Open this file for a table of Advanced APM: https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf

Examples of APMs can be found here: https://qpp.cms.gov/docs/QPP_How_to_Design_an_APM.pdf

Reach Us Today to Know How We Can Help You in Participating as an Advanced Alternative Payment Model (APM)

Contact Information

277 Prospect AvenueHackensack, New Jersey

855-544-0475

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