Gulf Coast Regional Extension Center

Alternative Payment Models (APMs)

What is an APM?

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. There are 2 types of APMs in the Quality Payment Program, Advanced APMs and MIPS APMs.

  • Advanced APMs: clinicians may earn a 5% incentive for achieving threshold levels of payments or patients through Advanced APMs. Under this track, clinicians are excluded from the MIPS reporting requirements and payment adjustment.
Table 1: Requirements for APM Incentive Payments for Participation in Advanced APMs (Clinicians must meet payment or patient requirements)
Performance Year 2017 2018 2019 2020 2021 2022 and later
Percentage of Medicare Payments through an Advanced APM 25% 25% 50% 50% 75% 75%
Percentage of Medicare Patients through an Advanced APM 20% 25% 35% 35% 50% 50%
  • MIPS APMs: under this type of APM, clinicians are not excluded from MIPS and may be scored using a special APM scoring standard.

APM participation can be looked up via this Centers for Medicare and Medicaid Services (CMS) tool: https://data.cms.gov/qplookup