[Federal Register Volume 90, Number 144 (Wednesday, July 30, 2025)]
[Notices]
[Pages 35862-35863]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-14434]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5542-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), Department of
Health and Human Services (HHS).
ACTION: Notice.
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SUMMARY: This advisory is to alert certain clinicians who are
qualifying Alternative Payment Model (APM) participants (QPs) and have
earned an APM incentive payment that CMS does not have the current
information needed to disburse the payment. This advisory provides
information to QPs on how to update their Medicare billing information
so that CMS can disburse APM incentive payments.
DATES: August 29, 2025.
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 or exceeds the applicable payment amount or patient count
thresholds for a performance period is a qualifying APM participant
(QP) for that year. For payment years 2019 through 2026, which
respectively correspond to the QP performance periods for 2017 through
2024, an eligible clinician who attains QP status for a year earns a
lump sum APM incentive payment that is paid in the payment year. For
payment years 2019 through 2024, 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. For the 2023
performance year and 2025 payment year Congress, via section 4111 of
the Consolidated Appropriations Act, 2023 (Pub. L. 117-328), reduced
the APM incentive payment from 5 percent to 3.5 percent. For the 2024
performance year and 2026 payment year the APM incentive payment is
reduced from 3.5 percent to 1.88 percent.
[[Page 35863]]
II. Provisions of the Advisory
The Centers for Medicare & Medicaid Services (CMS) has identified
those eligible clinicians who attained QP status in the 2023
performance period and earned a 3.5 percent APM incentive payment for
the 2025 payment year based on aggregate paid amounts for the covered
professional services they furnished in the calendar year (CY) 2024
base period.
When the 2025 APM incentive payments were processed, CMS was unable
to identify the taxpayer identification number (TIN) or TINs associated
with some QPs and therefore was unable to disburse the payments. To
successfully issue the APM incentive payment for the 2025 payment year,
CMS is requesting assistance identifying current Medicare billing
information for these under 42 CFR 414.1450(c)(8), if we have not
identified any TIN associated with the QP to which we can make the APM
Incentive Payment, we will attempt to contact the QP via a public
notice to request their Medicare payment information.
CMS has compiled a list of QPs for whom we were unable to identify
any associated TIN to which we can make the APM incentive payment.
These QPs, and any others who anticipated receiving an APM Incentive
Payment but have not, should follow the instructions to provide CMS
with updated Medicare billing information at the following web address:
https://qpp-cm-prodcontent.s3.amazonaws.com/uploads/3369/2025%20QP%20Notice%20for%20APM%20Incentive%20Payment.zip.
If you have any questions concerning submission of information
through the QPP website, please contact the Quality Payment Program
Help Desk at 1-866-288-8292.
In accordance with 42 CFR 414.1450(c)(8), all information must be
received by September 1, 2025. After that date, any claim to an APM
incentive payment for the 2025 payment period based on an eligible
clinician's QP status for the 2023 QP performance period will be
forfeited. To facilitate payment, please include all required
documentation as specified in the previous link. If CMS is still unable
to process the APM incentive payment based on the Medicare billing
information received in response to this advisory, the submitter will
not be notified.
CMS will hold all timely submitted information and process the
remaining 2025 APM incentive payments simultaneously as soon as
possible after the deadline. It may take up to 3 months to complete the
validation and verification process before these APM incentive payments
are disbursed.
III. Collection of Information Requirements
This advisory is intended to alert certain QPs that CMS is
requesting assistance identifying current Medicare billing information
so that we can disburse APM incentive payments. This request for
follow-up information is exempt from the requirements of the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501 et seq.) as specified under
implementing regulation 5 CFR 1320.3(h)(9) with regard to the
clarification of responses.
The Administrator of the Centers for Medicare & Medicaid Services
(CMS), Mehmet Oz, having reviewed and approved this document,
authorizes Chyana Woodyard, who is the Federal Register Liaison, to
electronically sign this document for purposes of publication in the
Federal Register.
Chyana Woodyard,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2025-14434 Filed 7-29-25; 8:45 am]
BILLING CODE 4120-01-P