1. I practice in an ACO/Patient Centered Medical Home (PCMH) part-time but also practice in a different location that is not an ACO/PCMH, am I in an Advanced APM, MIPS or a MIPS APM? Each NPI/TIN combination is subject to participation in MIPS or an Advanced APM. It is important to first determine whether your ACO/PCMH is one of the recognized Advanced APMs for 2020. The complete list of Advanced APMs include: Bundled Payments for Care Improvement (BPCI) Advanced Comprehensive ESRD Care (CEC) – Two-Sided Risk Comprehensive Primary Care Plus (CPC+) Medicare Accountable Care Organization (ACO) Track 1+, 2, 3, Basic Level E, and ENHANCED Track Next Generation ACO Model Oncology Care Model (OCM) – Two-Sided Risk Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1-CEHRT) Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model) Maryland All-Payer Model (Care Redesign Program) Maryland Total Cost of Care Model (Maryland Primary Care Program and Care Redesign Program) For a list of Other Payer Advanced APMs, please see CMS’s 2020 and 2019 Comprehensive List of APMs. The list of 2019 MIPS APMs includes, but is not limited to: BPCI Advanced Model CEC - LDO arrangements and Non-LDO one- and two-sided risk arrangement CPC+ MSSP ACOs – Tracks 1, 1+, 2, & 3 Next Generation ACO Model Oncology Care Model - one- and two-sided risk arrangements Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model) Maryland Primary Care Program Independence at Home Demonstration If so, it is possible that one of the NPI/TIN combinations may be exempt from MIPS participation due to participation in an Advanced APM. If under that Advanced APM you receive a qualifying participant (QP) determination, then you are exempt from MIPS participation for all other NPI/TIN combinations. To achieve the QP determination, you must exceed a defined threshold for either the number of Medicare patients you see through the APM or the amount of Medicare payment you receive through the APM. To learn more about the QP determination and Advanced APM participation, please see PAI’s Advanced APM Overview. Use the CMS APM Lookup tool to determine your status. Medicare Payment Count Method Medicare Patient Count Method QP 50% of Medicare Part B payments are received through a Medicare Advanced APM 35% of Medicare Part B patients are seen through a Medicare Advanced APM PQ 40% of Medicare Part B payments are received through a Medicare Advanced APM 25% of Medicare Part B patients are seen through a Medicare Advanced APM All Payer Payment Count Method All Payer Patient County Method QP Step 1: Receive 25% of Medicare Part B payments are received through a Medicare Advanced APM Step 2: 50% of all payments are received through a Medicare Advanced APM and Other Payer Advanced APM Step 1: 20% of Medicare Part B patients are seen through a Medicare Advanced APM Step 2: 35% of all patients are seen through a Medicare Advanced APM and Other Payer Advanced APM PQ Step 1: Receive 20% of Medicare Part B payments are received through a Medicare Advanced APM Step 2: 40% of all payments are received through a Medicare Advanced APM and Other Payer Advanced APM Step 1: 10% of Medicare Part B patients are seen through a Medicare Advanced APM Step 2: 25% of all patients are seen through a Medicare Advanced APM and Other Payer Advanced APM Pages Advanced APMs1. I practice in an ACO/Patient Centered Medical Home (PCMH) part-time but also practice in a different location that is not an ACO/PCMH, am I in an Advanced APM, MIPS or a MIPS APM?2. Is it too late to be in an advanced APM for 2020? 2021?3. If I am in an alternative payment model (such as an ACO), do I still have to participate in MIPS?4. How does CPC+ work with MACRA?5. What Advanced APMs are available in 2020?6. How do I participate in an Advanced APM?7. What is an Other Payer Advanced APM?8. What is the All-Payer Count?9. How is my QP/PQ determination made under the Medicare Count Methods and/or All-Payer Count Methods? Comments are closed.
