decisionhealth Newsletters, Part B News - 2016 Issue 5 (May)
Watch out if you’re in a bundled service plan; most don’t fit the APM mold
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Article Overview
This article reviews CMS guidance in a proposed MIPS rule on how bundled payment arrangements relate to alternative payment model status. It is aimed at clinicians, physician groups, and coding/compliance professionals who need to understand whether participation in bundled programs affects MIPS reporting and APM qualification. The piece focuses on the general criteria CMS uses, the types of bundled programs discussed, and the broader implications for participation in MIPS-related payment pathways.
Why This Topic Matters
Participation in a bundled payment program does not automatically determine MIPS exemption or APM status. Understanding CMS’s proposed framework helps clinicians and billing/compliance teams assess program eligibility and prepare for reporting or payment methodology implications.
What You Will Learn
- How CMS distinguishes bundled payment programs from qualified alternative payment models
- Why certain bundled arrangements may not meet CMS’s APM framework
- What general features CMS associates with advanced alternative payment models
- Which broad categories of clinicians and organizations may be affected by the proposed rule
Who Should Read This
- Clinicians
- Physician groups
- Medical practice administrators
- Coding and compliance professionals
- Healthcare payment policy readers
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