Medicare Compliance & Reimbursement

Refresher: Starting with the 2021 performance year, the Centers for Medicare & Medicaid Services (CMS) added the Alternative Payment Model (APM) Performance Pathway (APP). This basic reporting option was designed specifically for Merit-Based Incentive Payment System (MIPS)-eligible clinicians participating in MIPS APMs.

In the seventh installment of Medicare Compliance & Reimbursement’s QPP testing series, we look at APPs and how this reporting option works.

1. What three performance areas are MIPS providers measured on for the APP reporting option?

a. Cost, Quality, and Improvement Activities
b. Cost, Improvement Activities, and Promoting Interoperability
c. Quality, Improvement Activities, and Promoting Interoperability
d. Cost, Quality, and Promoting Interoperability

2. What is required to become a Qualifying APM Participant (QP) for the 2024 performance year?

a. receive at least 75 percent of Medicare Part B payments or see at least 50 percent of Medicare patients through an Advanced APM Entity during the QP performance period
b. receive at least 50 percent of Medicare Part B payments or see at least 75 percent of Medicare patients through an Advanced APM Entity during the QP performance period
c. receive at least 20 percent of Medicare Part B payments or see at least 50 percent of Medicare patients through an Advanced APM Entity during the QP performance period
d. receive at least 80 percent of Medicare Part B payments or see at least 25 percent of Medicare patients through an Advanced APM Entity during the QP performance period

3. How many and what are the snapshot dates for the APP reporting option for the 2024 performance year?

a. Two, June 30 and December 31
b. Four, March 31, June 30, August 31, and December 31
c. Six, January 31, April 30, July 31, September 30, December 31
d. None of the above

4. How might a MIPS-eligible clinician participating in an APM Entity receive a MIPS payment adjustment that’s based on something different than the APM Entity’s final score?

a. They refused to submit measures
b. They have a lower score from an MVP
c. They have another higher score from individual or group participation
d. All of the above

5. What categories require APM entities to aggregate performance data for APP reporting?

a. Cost and Quality
b. Improvement Activities and Promoting Interoperability
c. Cost and Promoting Interoperability
d. Quality and Improvement Activities

6. What determines how you submit data under the APP reporting option?

a. Performance category and technology used
b. Specialty and scope of practice
c. EHR and state you practice in
d. Number of Medicare patients and snapshot dates

7. How many administrative claims are individual providers participating in an APM Entity required to submit?

a. 1
b. 2
c. 3
d. 4

8. True or False: The 2024 performance year will be the final year for Medicare Shared Savings Program Accountable Care Organizations to report through the CMS Web Interface for the APP reporting option.

a. True
b. False

9. How many months must MIPS-eligible clinicians collect measures data if reporting under the APP option?

a. 3 months
b. 6 months
c. 9 months
d. 12 months

10. True or False: MIPS-eligible clinicians participating in an ACO in the Medicare Shared Savings Program cannot report Traditional MIPS or an MVP.

a. True
b. False

Answers: 1) c 2) a 3) b 4) c 5) d 6) a 7) b 8) a 9) d 10) b