Tag Archives: David Byron

Requirements for Qualifying Advanced APM Participant status increases

Accountable care organizations (ACOs) participating in Advanced Alternative Payment Models (Advanced APMs) are eligible to qualify for a payment bonus equal to 5% of Medicare Part B revenue and avoid Merit-based Incentive Payment System (MIPS) payment adjustments and reporting requirements.

For ACOs to receive the 5% bonus, they must achieve Qualifying Advanced APM Participant status (QP status) by meeting the eligibility criteria outlined by the Centers for Medicare and Medicaid Services (CMS). In 2021, the requirements for an ACO to achieve QP status will increase significantly over 2020 requirements, making it substantially harder for many ACOs to qualify.

In this paper, Milliman’s David Byron and Chris Smith explore 2021 QP status criteria and actions ACOs can take to ensure they continue to qualify for the 5% bonus, even during a pandemic.

How will the coronavirus affect Medicare Shared Savings Program ACOs?

The COVID-19 pandemic has created many uncertainties for providers and accountable care organizations (ACOs), which can seem overwhelming. Medicare Shared Savings Program (MSSP) ACOs are particularly concerned about the potential for 2020 results to decrease because of the virus. In this paper, Milliman actuaries discuss eight key considerations for MSSP and other risk-sharing arrangements as they assess the impact of COVID-19.