Support for the ASM
Beginning January 1, 2027, specialists treating Medicare patients for heart failure or low back pain in selected geographic regions will be required to participate in the Ambulatory Specialty Model (ASM). With mandatory individual-level reporting, episode-based Cost attribution, and payment adjustments of ±9%, ASM represents a shift in how specialists are evaluated and reimbursed, and how your practice will need to operate.
Unlike MIPS, ASM eliminates group reporting workarounds and doesn’t allow you to opt out. Mingle Health is here to guide you through the ASM requirements, simplify the complexity, and help you succeed.
What is ASM?
ASM is a five-year mandatory payment model launched by the CMS Innovation Center aiming to improve specialty care delivery and reduce costs. Here are some important details:
- Mandatory Participation – If your practice location falls within a selected geographic region and you meet volume thresholds, your participation is required. There is no opt-out.
- Performance-Based Payment Adjustments – Your Medicare payments will be adjusted based on your Quality and Cost performance relative to your specialty peers in your region.
- 50/50 Scoring – Your composite score is split evenly between Quality measures and Cost measures.
- Episode-Based Attribution – Cost and Quality are tracked per patient episode.
Who does ASM Apply to?
ASM applies to specialists who frequently treat Medicare patients for two conditions:
- Heart Failure
- Chronic Low Back Pain
This model uses the following eligibility criteria:
- Bill under Medicare Part B
- Generate 20+ qualifying episodes per year
- Practice in a selected geographic region
What makes ASM different?
ASM Replaces MIPS for Included Episodes – If you’re in ASM, you’re not MIPS-eligible for the episodes included in ASM.
MSSP ACO Participation Does Not Exempt You – This can create dual reporting responsibilities that require coordination.
Fixed Measure Set – Unlike MIPS, there’s no measure selection and all Quality and Cost measures apply to everyone.