An Alternative Payment Model (APM) is a payment approach that offers incentive payments to facilities for providing cost-efficient and high-quality care. This payment model is applicable for any type of care episode, clinical condition, or population.
In addition to the standard APM, there are other, more specific, types:
- MIPS APMs: where MIPS-eligible clinicians participate in the payment model with their CMS-approved participation list.
- Advanced APMs: a track of the Quality Payment Program (QPP) where those enrolled receive a 5% incentive for achieving threshold levels of patients or payments.
Advanced APMs are often also considered MIPS APMs. However, MIPS-eligible clinicians participating in Advanced APMs are also included in MIPS if they do not meet the set patient or payment threshold needed to become a Qualifying APM Participant.
Another alternative to becoming a Qualifying APM Participant is the All-Payer option, which requires the clinician to participate in a combination of Advanced APMs with Medicare and Other-Payer Advanced APMs.