[Federal Register Volume 88, Number 145 (Monday, July 31, 2023)]
[Rules and Regulations]
[Page 49309]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-16140]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 414

[CMS-5538-N]


Medicare Program; Alternative Payment Model (APM) Incentive 
Payment Advisory for Clinicians--Request for Current Billing 
Information for Qualifying APM Participants

AGENCY: Centers for Medicare & Medicaid Services (CMS), Health and 
Human Services (HHS).

ACTION: Payment advisory.

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SUMMARY: This advisory is to alert certain clinicians who are 
Qualifying APM participants (QPs) and eligible to receive an 
Alternative Payment Model (APM) Incentive Payment that CMS does not 
have the current billing information needed to disburse the payment. 
This advisory provides information to these clinicians on how to update 
their billing information to receive this payment.

DATES: Updated billing information must be received no later than 
September 1, 2023 (see SUPPLEMENTARY INFORMATION for details).

FOR FURTHER INFORMATION CONTACT: Tanya Dorm, (410) 786-2216.

SUPPLEMENTARY INFORMATION: 

I. Background

    Under the Medicare Quality Payment Program, an eligible clinician 
who participates in an Advanced Alternative Payment Model (APM) and 
meets the applicable payment amount or patient count thresholds for a 
performance year is a Qualifying APM Participant (QP) for that year. 
For payment years 2019 through 2024, which corresponds to Performance 
Periods for 2017 through 2022, an eligible clinician who is a QP for a 
year based on their performance in a QP Performance Period earns a 5 
percent lump sum APM Incentive Payment that is paid in a payment year 
that occurs 2 years after the QP Performance Period. The amount of the 
APM Incentive Payment is equal to 5 percent of the estimated aggregate 
paid amounts for covered professional services furnished by the QP 
during the calendar year immediately preceding the payment year.

II. Provisions of the Advisory

    The Centers for Medicare & Medicaid Services (CMS) has identified 
those eligible clinicians who earned an APM Incentive Payment for the 
calendar year (CY) 2023 payment year based on their QP status for the 
2021 QP performance period.
    When CMS disbursed the CY 2023 APM Incentive Payments, CMS was 
unable to verify current Medicare billing information for some QPs and 
was therefore unable to issue payment. In order to successfully 
disburse the APM Incentive Payment, CMS is requesting assistance in 
identifying current Medicare billing information for these QPs in 
accordance with 42 CFR 414.1450(c)(8).
    CMS has compiled a list of QPs we have identified as having 
unverified billing information. These QPs, and any others who 
anticipated receiving an APM Incentive Payment but have not, should 
follow the instructions to provide CMS with updated billing information 
at the following web address: https://qpp.cms.gov/resources/resource-library.
    If you have any questions concerning submission of information 
through the website, please contact the Quality Payment Program Help 
Desk at 1-866-288-8292.
    All submissions must be received no later than September 1, 2023. 
After that time, any claims to an APM Incentive Payment for the CY 2023 
payment period based on an eligible clinicians' QP status for the 2021 
QP performance period will be forfeited.
    All submissions received by September 1, 2023, will be processed 
together on one date as soon as practicable after September 1, 2023. 
CMS will not notify the submitter if we are unable to process the APM 
Incentive Payment based on the billing information submitted for an 
eligible clinician.
    The Administrator of the Centers for Medicare & Medicaid Services 
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this 
document, authorizes Evell J. Barco Holland, who is the Federal 
Register Liaison, to electronically sign this document for purposes of 
publication in the Federal Register.

    Dated: July 25, 2023.
Evell J. Barco Holland,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2023-16140 Filed 7-28-23; 8:45 am]
BILLING CODE 4120-01-P