[Federal Register Volume 86, Number 138 (Thursday, July 22, 2021)]
[Rules and Regulations]
[Page 38569]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-15652]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 414

[CMS-5534-N]


Medicare Program; Calendar Year 2021 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 
November 1, 2021 (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. 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 (CY) 
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 in CY 
2021 based on their CY 2019 QP status.
    When CMS disbursed the CY 2021 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-cm-prod-content.s3.amazonaws.com/uploads/1498/QP%20Notice%20for%20APM%20Incentive%20Payment.zip.
    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 November 1, 2021. 
After that time, any claims by a QP to an APM Incentive Payment will be 
forfeited for the CY 2021 payment year.
    The Administrator of the Centers for Medicare & Medicaid Services 
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this 
document, authorizes Lynette Wilson, who is the Federal Register 
Liaison, to electronically sign this document for purposes of 
publication in the Federal Register.

    Dated: July 19, 2021.
Lynette Wilson,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2021-15652 Filed 7-21-21; 8:45 am]
BILLING CODE 4120-01-P