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Compare to Choose

Eligibility
MIPS 
Advanced 
APM Program
 
Eligible clinicians that meet the following requirements and have been enrolled as eligible clinicians in
Medicare for more than a year.

Eligible clinicians that meet a minimum volume threshold of of patients or payments through an Advanced APM.

 
MIPS Requirements


Minimum Volume Threshold

2019

Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered
Nurse Anesthetists

25% of patients or payments

2020

Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists

25% of patients or payments

2021

Most Medicare eligible clinicians unless otherwise specified

50% of patients or payments

2022

Most Medicare eligible clinicians unless otherwise specified

50% of patients or payments

2023+  

Most Medicare eligible clinicians unless otherwise specified

75% of patients or payments

The New APM Categories Defined
APMs, MIPS APMs, and Advanced APMs

Advanced APMs
In order for an APM to qualify as an Advanced APM, it needs to meet all of the following criteria:

  • Requires participants to use certified EHR technology;
  • Base payment provided for covered professional services on quality measures that are comparable to the MIPS quality performance category measures; and
  • Be either an expanded Medical Home Model or bear more than a nominal amount of risk for monetary losses.

MIPS APMs
A MIPS APM is an APM that does not meet all the Advanced APM criteria, but does meet the criteria to be considered an APM as a part of one of the following categories:

  • CMMI models under section 1115A (not a Health Care Innovation Award);
  • The Medicare Shared Savings Program;
  • Demonstrations under the Health Care Quality Demonstration Program; or
  • Demonstrations as required by Federal law.

APMs
The term "alternative payment model" can be attributed to any payment model used by a payer that includes positive or negative payment adjustments that are determined by a physician's performance on quality measures across an episode of care, an episode group, a patient group, or the physician's entire patient population.

Payment Updates
MIPS
Advanced
APM Program
2019
0.5%0.5%
2020
0%0%
2021
0%0%
2022
0%0%
2023
0%0%
2024
0%0%
2025
0%0%
2026+
0.25%0.75%

Payment Incentives and Adjustment Factors
MIPS Adjustment
Factor
MIPS Additional
Incentive Payment
Adjustments
Advanced APM Program
Payment Incentive
2019
+- 4%≤10%+ 5%
2020
+- 5%≤10%+ 5%
2021
+- 7%≤10%+ 5%
2022
+- 9%≤10%+ 5%
2023
+- 9%≤10%+ 5%
2024
+- 9%≤10%+ 5%
2025
+- 9%00
2026+
000