01/30/2023

The Advanced Alternative Payment Model (APM) Incentive Payment is Extended for One Additional Year

In December 2022, Congress enacted provisions of the Advanced APM Consolidated Appropriations Act, 2023 that extended the availability of an APM Incentive Payment, allowing eligible clinicians who are Qualifying APM Participants (QPs) for the 2023 QP Performance Period to receive a 3.5% APM Incentive Payment in the 2025 payment year. Without this, there would have been a one-year gap with no statutory incentives for Advanced APM participation for payment year 2025. For the 2023 QP Performance Period and the associated 2025 payment year, the APM Incentive Payment will decrease from 5.0% to 3.5% of the QP’s estimated aggregate payments for covered professional services in the performance year. Additionally, the QP payment amount and patient count thresholds for participation in Advanced APMs will remain frozen at 50% and 35%, respectively, for performance period 2023 (payment year 2025) at the same levels that were in effect for performance period 2022. 

What Do I Need to Do in Order to Receive the APM Incentive Payment? 

Similar to previous years, if you meet the requirements to be a QP in the 2023 performance period, you will not need to do anything to receive your payment in 2025, unless CMS is unable to verify your Medicare billing information. If you do not receive your payment after initial payments are made, a public notice will be posted with a list of names which indicates that you will need to verify your Medicare billing information. If you do not verify your Medicare billing information by the date in the notice, then CMS will not be able to issue your APM Incentive Payment. 

For additional information regarding the legislative change, this can be found on page 3711 in section 4111 of the Consolidated Appropriations Act, 2023. 

Questions? 

Read the Frequently Asked Questions on our website or contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292.  

For additional information on the QPP APMs, please visit the QPP APM website.