9. How is my QP/PQ determination made under the Medicare Count Methods and/or All-Payer Count Methods? Under the Medicare Option, only payments and patients from Medicare FFS patients are considered. All-Payer Combination Option, there is a minimum threshold for Medicare patients/payments that must be met before the All Payer options kick in. The All-Payer options, therefore, do not replace or supersede the Medicare Option, and instead utilize a pair of calculations using first the Medicare Part B patient/payment count method, and then the All-Payer patient/payment count method for services furnished through Other Payer APMs. 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 For additional information, see the PAI’s Advanced APM Overview. 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.
