10 tips to steer your choice about the BPCI Advanced payment model

Why This Topic Matters

BPCI Advanced can affect payment strategy, episode-based care management, and whether a practice may be considered under an advanced alternative payment model pathway. Understanding the model’s broad requirements and exclusions helps organizations evaluate financial and operational readiness before applying.

Article Sections

1. Program overview and timing

   Introduces the BPCI Advanced model, its rollout timeline, and the CMS forum updates that framed the discussion. It also situates the article around the upcoming application period.

2. Readiness considerations for participation

   Covers high-level factors practices may review when deciding whether to apply, including pending pricing information and the general steps involved in the application process. It also discusses the value of reviewing available data before making a decision.

3. Provider precedence and organizational participation rules

   Summarizes CMS guidance on how participation is determined when multiple provider types or entities are involved. It also addresses participation across tax identification numbers and special circumstances for certain participating organizations.

4. Quality, waiver, and eligibility topics

   Addresses program administration topics such as claims-based quality measurement, fraud and abuse waiver considerations, and geographic eligibility exclusions. The section focuses on general program conditions rather than detailed operational instructions.