Changes to APM Incentive Payments and Participation Thresholds: What Healthcare Providers Need to Know for 2023

It's our responsibility to keep providers updated on the latest regulatory changes that could impact their practices. One of the most significant changes coming in the 2023 performance period is a decrease in the APM Incentive Payment from 5.0% to 3.5% of the QP’s estimated aggregate payments for covered professional services in the performance year. This means that providers who meet the criteria for being a Qualified Participant (QP) in an Advanced Alternative Payment Model (APM) will receive a lower payment than in previous years.

For those who may not be familiar with the concept of APMs, they are a new payment model that was created as part of the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015. This model incentivizes healthcare providers to focus on value-based care, which focuses on improving patient outcomes and reducing healthcare costs rather than on the volume of services provided.

To participate in an APM, healthcare providers must meet certain thresholds, such as the QP payment amount and patient count thresholds. The QP payment amount is the amount of Medicare Part B payments that a provider must receive through an Advanced APM to qualify as a QP. The patient count threshold is the percentage of providers that must be attributed to an Advanced APM to qualify as a QP.

For the 2023 performance period (2025 payment year), the QP payment amount and patient count thresholds will remain frozen at 50% and 35%, respectively, at the same levels that were in effect for the 2022 performance period. This means that providers must continue meeting these thresholds to participate in Advanced APMs and receive higher incentive payments.

It's critical to note that if a provider meets the requirements to be a QP in the 2023 performance period, they will not need to do anything to receive their payment in 2025 unless CMS cannot verify their Medicare billing information.

Healthcare providers mustmust stay informed about the changes and updates to healthcare policies and regulations, such as the changes to the APM Incentive Payment and the QP payment amount and patient count thresholds. These changes can impact their practice financially and may affect the care they provide to their patients. Providers can stay informed by keeping up with industry news, attending conferences and webinars, and working with healthcare consultants and advisors to ensure they meet the requirements to participate in Advanced APMs and receive the highest possible incentive payments. If you'd likeke to know more about APMs, MIPS, or other payment programs, feel free tfeel free to o please message us.