Medicare Compliance & Reimbursement

Tip: Transitions may require more elaborate technical equipment.

There are many things to consider when starting or joining an Advanced Alternative Payment Model (APM). The higher-level path for Part B clinicians receiving Medicare pay through the Quality Payment Program (QPP) can be tricky to navigate and expensive to set up.

Consider these five important factors before participating in an Advanced APM, advises industry expert Mike Schmidt, vice president of client success and regulatory affairs for Eye Care Leaders in Charlotte, North Carolina.

1. Look at the dual-sided financial risk of the Advanced APM.
2. Review the administrative and clinical workflow requirements associated with participation, such as the need to track patients attributed to the APM Entity.
3. Analyze the need for electronic integration between the participant's EHR and the APM Entity's quality data warehouse
4. Compare the anticipated QPP payment adjustment, which may be higher in MIPS than for Advanced APMs.
5. Evaluate, select and vet the Advanced APM Entity. There may be multiple ACOs operating in your region which may be candidates.

Bonus: "Consider whether you really want to participate due to QPP considerations, or if you are simply interested in receiving referrals from the APM Entity," cautions Schmidt. "It may be possible to receive referrals as an associate without having to be listed as an official participant, in which case your QPP strategy is unaffected."