MACRA QPP Center

Physicians Advocacy Institute

Frequently Asked Questions Updated for 2020

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8. What is the All-Payer Count?

  • While for the 2017 and 2018 participation years, physicians could only receive credit for APM participation if they were participating in a “Medicare Advanced APM,” (i.e., an APM administered by CMS/CMMI under Medicare Part B), beginning in 2019, physicians who are participating in APM arrangements with other payers (e.g., Medicare Advantage plans), “Other Payer Advanced APMs,” can have that participation count towards the requirements for the QPP Advanced APM pathway.

    There are four ways for physicians or other eligible clinicians to meet the QP and PQ thresholds.

    Medicare Payment Count

    based on the percentage of Medicare payments received through a Medicare Advanced APM

    Medicare Patient Count

    based on the percentage of Medicare patients seen through a Medicare Advanced APM

    All Payer Payment Count

    based on the percentage of payments received through a Medicare Advanced APM and Other Payer Advanced APM

    All Payer Patient Count

    based on the percentage of patients seen through a Medicare Advanced APM and Other Payer Advanced APM

    For additional information, see the PAI’s Advanced APM Overview.



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