How do APMs and MIPS interact in MACRA?

• A. Participation in an APM has no effect on MIPS status.
• B. APMs always require MIPS scoring even if in APM.
• C. Non-APM clinicians are exempt from MIPS scoring.
• D. Participation in an APM may exempt clinicians from MIPS or provide favorable incentives; non-APM clinicians go through MIPS scoring.

Answer: (D)

MACRA sets up two pathways for Medicare payment: MIPS and Advanced APMs. The idea is that participating in a qualifying Advanced APM can lift you out of MIPS completely or at least tilt the financial incentives in your favor, while those not in an APM must go through the MIPS scoring system and face its payment adjustments. In practice, if a clinician or practice is in a qualifying Advanced APM, they may be exempt from MIPS reporting and could qualify for additional incentives tied to the APM’s performance. If you’re not in an APM, you participate in MIPS and are evaluated across its performance categories to determine adjustments. So the statement that APM participation may exempt from MIPS or provide favorable incentives, whereas non-APM clinicians go through MIPS scoring, captures how MACRA links the two tracks.