News: CMS requests updated billing information from qualifying APM participants

CMS released an advisory for certain clinicians who are qualifying alternative payment model (APM) participants and are eligible to receive APM incentive payments, notifying them that their current billing information must be updated to receive funds for the 2026 payment year.

Under the Medicare Quality Payment Program, an eligible clinician who participates in an 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. CMS identified eligible clinicians who attained QP status in the 2024 performance and earned a 1.88% APM incentive payment for the 2026 payment year based on aggregate paid amounts for the covered professional services they furnished in the calendar year 2025 base period.

When the agency processed the 2026 APM incentive payments, CMS reports it was unable to identify  taxpayer identification numbers (TIN) associated with some QPs and was therefore unable to disburse the payment. To successfully issue the APM incentive payment for the 2026 payment year, CMS is requesting assistance identifying current Medicare billing information for these QPs.

The agency said that all information must be received by October 13, 2026. Following that date, CMS said any claim to an APM incentive payment for the 2026 payment period based on an eligible clinician’s qualifying APM participant status for the 2024 performance period will be forfeited.

Editor’s note: To read the full advisory, click here. To read additional coverage by the American Hospital Association, click here.