Understanding MIPS-APMs

Certain Alternative Payment Models (APMs) include MIPS eligible clinicians as participants and hold their participants accountable for the cost and quality of care provided to Medicare beneficiaries. This type of APM is called a “MIPS APM,” and participants in MIPS APMs receive special MIPS scoring under the “APM scoring standard.”

As finalized in the Quality Payment Program rule, under the Merit-Based Incentive Payment System (MIPS), CMS will assign scores to MIPS eligible clinicians in the improvement activity performance category for participating in MIPS APMs.

Most Advanced APMs are also MIPS APMs so that if an eligible clinician participating in the Advanced APM does not meet the threshold of having sufficient payments or patients through an Advanced APM in order to become a Qualifying APM Participant (QP), the eligible clinician will be scored under MIPS according to the APM scoring standard.

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