What is MIPS

Four performance categories, single composite score.

MIPS scores performance in four categories — each contributes a weighted percentage to the final MIPS score (0-100):

Quality (30%)

Performance on quality measures — specialty-specific measure sets available. Clinicians select 6 measures (including at least one outcome measure). Performance calculated against established benchmarks. Former PQRS program succeeded by Quality category. Largest single category by weight.

Cost (30%)

Performance on cost measures calculated by CMS from claims data — no reporting required from clinicians; CMS calculates based on Medicare claims. Includes Total Per Capita Cost, Medicare Spending per Beneficiary, and episode-based cost measures. Former Value Modifier succeeded by Cost category.

Promoting Interoperability (25%)

Inherits from Meaningful Use — CEHRT use, patient access to records, health information exchange, public health registry reporting. See our Meaningful Use to MIPS transition page for historical context. Requires using certified EHR technology.

Improvement Activities (15%)

Participation in activities that improve clinical practice or care delivery. Clinicians attest to participation in activities from a CMS-defined library. Smaller weight but typically easier to score highly on with attestation to relevant activities.

How MIPS score translates to Medicare payment.

Each category generates a score; categories weight together into composite MIPS score (0-100). Score compared to performance threshold:

• At or above threshold: neutral or positive payment adjustment. Higher scores = larger positive adjustments.
• Below threshold: negative payment adjustment. Lower scores = larger negative adjustments.
• Exceptional performance: historically rewarded with additional bonus; exceptional performance bonus phasing out by 2024 performance year.
• Budget neutral: positive adjustments are funded by negative adjustments from low performers. The program creates winners and losers.

Payment adjustments apply two years after performance year — 2024 performance year affects 2026 payments. CMS MIPS overview for current thresholds and adjustment magnitudes.

Eligibility framework.

MIPS-eligible clinicians: physicians (MD, DO, DPM, DDS, OD, DC), PAs, NPs, CNSs, CRNAs, PTs, OTs, qualified speech-language pathologists, qualified audiologists, clinical psychologists, registered dietitians/nutrition professionals, and certified nurse-midwives.

Low-volume threshold exemption: clinicians under low-volume threshold are exempt from MIPS. Current threshold: ≤$90K in allowed Medicare Part B charges AND ≤200 Part B patients AND ≤200 covered professional services during determination period. Practices below ANY of these thresholds can be exempt; practices above all three must participate.

Small practice considerations: practices with 15 or fewer clinicians receive small-practice bonus and can re-weight Promoting Interoperability category if unable to score it. Making these designations known during MIPS operation matters. See our MIPS consulting.

The evolution toward specialty-specific MIPS.

MVPs (MIPS Value Pathways) are specialty-specific curated measure bundles replacing individual measure selection within each category. Each MVP has a defined set of quality measures, improvement activities, and cost measures relevant to a specific specialty or clinical area. Participating in an MVP simplifies measure selection and often produces better performance than ad-hoc measure selection.

Current MVP availability covers many major specialties. MVP enrollment is voluntary; traditional MIPS participation remains available. CMS direction strongly favors MVP expansion over time.

Practical MVP evaluation: check whether specialty-relevant MVP exists, evaluate MVP measure set fit against practice patterns, compare projected performance under MVP vs traditional MIPS, and make participation decision based on fit. Our MIPS consulting includes MVP evaluation.