CMS distributing Alternative Payment Model bonuses

The Centers for Medicare & Medicaid Services (CMS) will begin distributing the 2021 Alternative Payment Model (APM) incentive payments this month.

Physicians and clinicians who met the criteria to be Qualifying APM Participants are eligible for the bonus payments. To be considered a qualifying participant, you must participate in an advanced APM and see a certain percentage of patients, or receive a certain percentage of payments, through that advanced APM. Qualifying participant status is based on the 2019 performance year, while payments are based on the 2020 calendar year (referred to as the base year). The bonus is 5% of the estimated aggregate payment amounts for Medicare Part B covered professional services that the qualifying participants provided across all their tax identification number/national provider identifier (TIN/NPI) combinations during the base year. CMS makes the payment to the qualifying participant’s billing organization associated with the advanced APM.

Qualifying participants do not need to do anything to receive their payments. However, if you believe you were eligible and did not receive a payment, it may be because CMS cannot verify your Medicare billing information. CMS has published a public notice with the names of qualifying participants for whose billing information the agency cannot verify. If you find your name on that list, you will need to contact Medicare. Instructions on how to do that are included in the public notice. If you do not verify your information by November 1, 2021, CMS will not be able to issue your APM Incentive Payment.

More details are available by logging into the Quality Payment Program (QPP) website. Additional resources are also available in the 2021 Learning Resources for QP Status and APM Incentive Payment ZIP file. If you have questions, you can contact the QPP Help Desk at qpp@cms.hhs.gov or 866-288-8292.

— Erin Solis, Manager, Practice and Payment at the American Academy of Family Physicians