MIPS FAQ

Find clear answers to your pressing MIPS questions in our FAQ section below.
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MIPS Reporting FAQ

1. What is MIPS, and why is it important?

MIPS (Merit-Based Incentive Payment System) is part of the Quality Payment Program (QPP) under Medicare Part B, designed to improve healthcare quality while managing costs. It functions as a value-based care reimbursement model, adjusting Medicare payments based on provider performance in four key categories:

MIPS Reporting Made Easy

      • Quality (30%) – Clinical performance and patient outcomes.
      • Promoting Interoperability (25%) – Use of Electronic Health Records (EHRs).
      • Improvement Activities (15%) – Practice enhancements and patient engagement.
      • Cost (30%) – Medicare spending efficiency.

MIPS participation is essential because it directly impacts Medicare reimbursements, with providers earning incentives for high performance or facing penalties for non-compliance.

2. Who is required to participate in MIPS?

MIPS applies to eligible clinicians who bill Medicare Part B and meet at least one of the following low-volume thresholds:

      • Bill more than a specified amount in Medicare Part B revenue.
      • See a set number of Medicare patients.
      • Provide a specific volume of Medicare-covered services.

Eligible clinicians for MIPS 2025 include:

      • Physicians (MD, DO)
      • Nurse Practitioners (NP)
      • Physician Assistants (PA)
      • Certified Registered Nurse Anesthetists (CRNA)
      • Clinical Nurse Specialists
      • Groups or Virtual Groups

Clinicians below these thresholds may be exempt or have the option to opt-in to earn incentives.

3. What are the key updates for MIPS in 2025?

Performance Thresholds & Scoring Updates

      • The performance threshold remains at 75 points, unchanged from 2023 and 2024.
      • Data completeness remains at 75% for all collection types through 2028.

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Changes in MIPS Performance Categories

Quality Category (30%)

        • 196 total measures for 2025.
        • Nine new measures added, including two patient-reported outcome measures.
        • Eleven measures removed and 66 existing measures updated.
        • CMS will introduce flat benchmarking for certain topped-out measures.

Cost Category (30%)

        • Six new cost measures for conditions like respiratory infections and chronic disease management.
        • Updates to two existing measures to refine cost tracking.
        • A new cost scoring methodology with median-based benchmarking.

Improvement Activities (15%)

        • Two new activities added and two modified.
        • Eight activities removed for streamlining.
        • Simplified scoring: clinicians attest to one or two activities depending on their practice size and status.

Promoting Interoperability (25%)

        • No major changes, but clinical social workers will no longer receive automatic reweighting.
        • Required submission elements include performance data, CMS EHR Certification ID, and attestation details.

MIPS Value Pathways (MVPs) and Future Transition

        • Six new MVPs introduced, expanding specialty-based participation.
        • CMS plans to phase out traditional MIPS by 2029, encouraging MVP adoption.

4. How is MIPS scored, and what are the payment adjustments?

→ Scores above the threshold earn positive payment adjustments.

→ Scores below the threshold result in negative Medicare payment adjustments (up to -9%).

→ High performers (100 points) may receive a bonus adjustment of around +2%.

5. How do providers report MIPS data?

Clinicians can report MIPS data through:

      • Electronic Health Records (EHRs)
      • Qualified Clinical Data Registries (QCDRs)
      • Medicare Claims Submission (only for Quality measures)
      • CMS Web Interface (for larger groups)
      • Qualified Registry Reporting

Providers can submit as:

      • Individual clinicians
      • Group practices
      • Virtual groups

Our MIPS compliance consulting helps identify the best reporting method for your practice to maximize scores.

6. What are the key deadlines for MIPS 2025?

      • Performance Year: January 1 – December 31, 2025
      • Data Submission Deadline: March 2026
      • Payment Adjustment Year: Adjustments for 2025 performance will be applied in 2027

7. How can providers optimize MIPS performance and avoid penalties?

To maximize scores and avoid penalties, providers should:

      • Select high-impact Quality measures relevant to their specialty.
      • Fully participate in Promoting Interoperability using certified EHRs.
      • Choose Improvement Activities that offer the most impact.
      • Monitor Cost category performance to adjust spending strategies.
      • Use real-time tracking tools to prevent reporting gaps.

Our MIPS consultants help providers streamline data collection, submission, and compliance strategies to ensure success.

8. What exemptions and special considerations apply to MIPS?

      • Providers participating in an Advanced Alternative Payment Model (APM) may be exempt from MIPS.
      • Hardship exceptions exist for issues like lack of internet access or small practice burdens.
      • Performance Category Reweighting is available if data is inaccessible due to third-party issues.

Requests for category reweighting must be submitted by November 1, 2025 via the QPP Service Center.

9. How does MIPS compliance consulting help providers?

MIPS compliance consulting helps providers by:

      • Navigating complex MIPS requirements and updates.
      • Ensuring accurate reporting and preventing errors that lead to penalties.
      • Identifying the best performance measures for maximizing scores.
      • Optimizing EHR usage to streamline Promoting Interoperability.
      • Providing MIPS audit preparation to ensure compliance.
      • Training clinical and administrative teams on documentation and submission best practices.

Our consultants stay updated on CMS rule changes and offer personalized guidance to maximize incentives and avoid penalties.

10. How can providers prepare for MIPS 2025?

      • Review eligibility and confirm reporting requirements.
      • Select appropriate quality measures aligned with your practice.
      • Leverage EHR systems to streamline reporting.
      • Monitor performance continuously using dashboards and analytics.
      • Engage with Qualified Registries (QCDRs) to simplify data collection and submission.

11. How do MVPs (MIPS Value Pathways) impact future reporting?

      • MVPs are designed to simplify MIPS reporting by focusing on specialty-specific performance measures.
      • MVPs will eventually replace traditional MIPS by 2029.
      • Six new MVPs are being introduced in 2025 for fields like dermatology and urology.
      • Clinicians must actively track MVP developments to ensure a smooth transition.

12. Can I get professional help with MIPS reporting and compliance?

Yes! Our MIPS consulting services offer:

      • Customized reporting solutions tailored to your practice.
      • Expert guidance on measure selection and compliance strategies.
      • Assistance with data collection and submission to avoid penalties.
      • Audit preparation support to maintain compliance.

By staying informed on CMS regulations, TriumpHealth helps providers navigate MIPS changes and maximize reimbursement opportunities. For additional questions, please contact us at sales@triumphealth.com or (888) 757-3836.

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