APM Incentive Payment Extended through 2023

In December 2022, Congress enacted provisions of the Advanced Alternative Payment Model (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 the 2025 payment year.

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 the 2023 performance period (2025 payment year) at the same levels that were in effect for the 2022 performance period.

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 the Centers for Medicare & Medicaid Services (CMS) is unable to verify your Medicare billing information.

If you don’t receive your payment after initial payments are made, a public notice will be posted with a list of names indicating that you will need to verify your Medicare billing information.

If you don’t verify your Medicare billing information by the date in the notice, then CMS will not be able to issue your APM Incentive Payment. For more details, review the APM Incentive Payment Extension Frequently Asked Questions (FAQs).

Learn more about APMs by visiting the APM webpage.