APMs can expect slower risk increase, expanded list of advanced models

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews proposed CMS updates to the Medicare Quality Payment Program as they relate to advanced alternative payment models. It is aimed at clinicians, practice managers, and coding/compliance professionals who follow participation requirements, model eligibility, and the relationship between APMs and MIPS. The discussion covers changes to financial risk standards, medical home model treatment, and updates to the list of models recognized as advanced APMs.

Why This Topic Matters

Participation in advanced APMs can affect how clinicians are evaluated under Medicare payment programs and whether they avoid MIPS requirements. Understanding the proposed changes helps practices assess eligibility, timing, and strategic participation in these models.

Article Sections

  1. Alternative payment models

    Introduces the proposed Medicare Quality Payment Program changes for advanced alternative payment models. Summarizes broad themes related to financial risk, model eligibility, and participation considerations.

  2. Expanded advanced APM models and timing changes

    Describes updates to the CMS list of advanced APMs and the timing of when certain models may qualify. Also touches on model categories, participation status, and related program expansion.

What You Will Learn

  • How CMS is proposing to adjust advanced APM financial risk standards
  • Which general categories of models are being added or updated
  • How advanced APM participation relates to broader Quality Payment Program participation
  • What types of practitioners and organizations may be affected by the proposed changes

Who Should Read This

  • Physicians and eligible clinicians
  • Practice administrators
  • Medical group compliance staff
  • Healthcare reimbursement and coding professionals

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