Advanced Alternative Payment Models

Balance risk and reward

Advanced APMs are value-based program models defined by CMS which meet minimum requirements for the use of certified EHR technology, quality measurement, and the level of financial risk placed upon clinicians. Qualifying participants in Advanced APMs can earn an annual 5% Part B incentive (paid 2019–2024) and potentially are exempt from MIPS.

Defining APMs

The Quality Payment Program (QPP) defines APMs as only those payment programs operated by CMS and excludes those run by commercials payers. These programs include:

  • CMS Innovation Center (Center for Medicare and Medicaid Innovation, or CMMI) Model (other than a Health Care Innovation Award)
  • Medicare Shared Savings Program (MSSP ACOs)
  • Demonstration under the Health Care Quality Demonstration Program
  • Demonstration required by federal law

Participating in an APM

A clinician may either join an existing APM entity, such as a Medicare Shared Savings Program (MSSP) accountable care organization (ACO) or apply to CMS to create a new APM entity in advance of the deadline.

Advanced APMS must fulfill these additional requirements:

  • Participants must use certified EHR technology
  • Payment is based on quality measures comparable to those in the MIPS quality performance category
  • APM entities must bear more than “nominal financial risk” for monetary losses or the APM is deemed a Medical Home Model expanded by the CMS Innovation Center