Choosing Your Method of Participation
You choose how to participate in the Quality Payment Program based on your practice size, specialty, location, or patient population; you must choose one of two tracks: The Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). You are eligible to participate in the MIPS track if you bill more than $90,000 to Medicare, provide care to more than 200 Medicare patients per year, provide more than 200 covered professional services under the Physician Fee Schedule and you are a: Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Clinical Psychologist, Physical Therapist, Occupational Therapist, Speech-Language Pathologist, Audiologist, Registered Dietician or a Nutrition Professional.
An APM is a payment approach that can apply to a specific clinical condition, a care episode, or a population that gives added incentive payments to provide high-quality and cost-efficient care. Advanced APMs are a subset of APMs and let practices earn more for taking on some risk related to patients’ outcomes. You may earn a 5% Medicare incentive payment and be exempt from MIPS reporting requirements and payment adjustments if you have sufficient participation in an Advanced APM. Some current Advanced APM options include Medicare Shared Savings ACOs Tracks 1+, 2 & 3, Next Generation ACOs, and Comprehensive Primary Care Plus (CPC+). In order to qualify for the 5% APM incentive payment for participating in an Advanced APM during a payment year, you must either meet a percentage threshold of payments for covered professional services on attribution-eligible Part B beneficiaries or see a certain percentage of attribution-eligible beneficiaries through the Advanced APM during the associated performance year.