What physicians need to know about the end of the COVID-19 state of emergency

February 07, 2023

As part of its year-end omnibus budget deal, Congress extended the Advanced Alternative Payment Model (APM) incentive payment for one additional year.

Advanced APMs are one track of the Center for Medicare and Medicaid Services (CMS) Quality Payment Program, which offers incentives for meeting participation thresholds based on levels of payments or patients through Advanced APMs.

The California Medical Association (CMA) had advocated for this extension as part of the negotiations around the omnibus legislation. CMA also continues to advocate for a greater variety of and improvement to voluntary APMs and Accountable Care Organizations so more physicians have the opportunity to participate.

The extended availability of the Advanced APM incentive payment will allow eligible clinicians who are Qualifying APM Participants (QPs) for the 2023 QP performance period to receive a 3.5% (down from 5%) APM incentive payment in the 2025 payment year. Without this change, there would have been a one-year gap with no statutory incentives for participating in the program in the 2025 payment year.

In addition, the participation threshold for becoming a QP will remain frozen: Clinicians must receive at least 50% of Medicare Part B payments or see at least 35% of Medicare patients through an Advanced APM Entity during the QP performance period.

Clinicians who are QPs for 2023 performance period will not need to do anything to receive their payments in 2025, unless the Center for Medicare & Medicaid Services (CMS) is unable to verify their Medicare billing information. QPs who do not receive their payments after initial disbursements are made will be able to check a public notice to see if they need to verify their Medicare billing information.

To learn more about the Advanced APM, visit qpp.cms.gov/apms/advanced-apms.


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