The Merit-based Incentive Payment System (MIPS) is a program established by the Centers for Medicare & Medicaid Services (CMS) to measure and reward the quality and value of care provided by eligible clinicians. It functions as a composite performance metric, synthesizing results across multiple areas of practice into a single score out of 100 points. This final MIPS score directly determines whether a clinician or group receives a positive, neutral, or negative adjustment to their Medicare Part B reimbursement two years later. Therefore, a high score is directly tied to the financial health of a medical practice, acting as an incentive for quality improvement.
How the MIPS Score is Calculated
The MIPS score is a 100-point composite figure derived from performance in four distinct categories, which are weighted to reflect the program’s priorities. This framework was created under the Medicare Access and CHIP Reauthorization Act (MACRA) to transition Medicare from a fee-for-service model to a value-based payment system. Each category is scored on its own merits before its assigned weight is applied to the final score calculation.
For the 2024 performance year, the largest category weightings are applied to Quality and Cost, each accounting for 30% of the total score. The Quality category evaluates a clinician’s performance on chosen clinical measures, requiring reporting on a minimum number of cases to meet a data completeness threshold. The Cost category is calculated automatically by CMS using claims data to assess the total cost of care for attributed patients.
The remaining 40% of the score is split between two categories that focus on infrastructure and process. Promoting Interoperability (PI) is weighted at 25% and measures the use of certified electronic health record technology (CEHRT) for patient engagement and information exchange. Improvement Activities (IA) makes up the final 15% and rewards participation in activities that improve clinical practice, such as patient safety protocols or expanded access.
Defining “Good”: Performance Thresholds and Incentives
A “good” MIPS score is one that ensures a positive financial outcome for the practice, defined by the annual Performance Threshold set by CMS. For the 2024 performance year, the threshold required to avoid a negative Medicare payment adjustment is 75 points. Any score below this results in a penalty, applied on a sliding scale, which can be as large as a 9% reduction in Medicare Part B payments.
A score of exactly 75 points results in a neutral payment adjustment, meaning the practice avoids the penalty but receives no incentive bonus. Scores above the Performance Threshold qualify clinicians for a positive payment adjustment, or bonus, which increases linearly up to the maximum score of 100 points. The maximum positive adjustment is capped at 9%, though the actual percentage bonus is subject to a scaling factor.
The scaling factor is necessary because the MIPS program is mandated to be budget-neutral, meaning the total amount of positive payment adjustments must be funded by the total amount of negative payment adjustments collected. A score significantly above 75 points, such as 90 or 100, maximizes the bonus potential. The 100-point maximum is the goal for maximizing the positive payment adjustment.
Strategies for Achieving High MIPS Scores
Achieving a high MIPS score requires strategic focus on the categories where a clinician has the most control over performance. This involves understanding category reweighting rules, as certain circumstances can shift category weights. For instance, non-patient-facing clinicians, hospital-based providers, or those lacking case volume for the Cost category may have those categories automatically reweighted to zero.
For small practices, the Promoting Interoperability and Cost categories are often reweighted to zero, meaning the Quality and Improvement Activities categories each account for 50% of the total score. Practices should prioritize a high level of performance in Quality and Improvement Activities, as these two categories determine the final result. The Quality category requires reporting on at least six measures, and a successful strategy involves selecting measures with high scoring potential based on historical practice data.
The Improvement Activities category is a reliable strategy, as it only requires attestation of participation in a short-term activity for a minimum of 90 days. Clinicians should select high-weighted activities already integrated into their daily workflows to earn the full 15% of the score with minimal disruption. The method of data submission (registry, certified Electronic Health Record, or web interface) also plays a role in maximizing accuracy and completeness, which is necessary to avoid losing points in the Quality category.