Doctors need to do more than just treat their patients. They have to show they’re delivering high-quality care.
This is where MIPS in healthcare steps in.
If you’re a healthcare provider, knowing about MIPS isn’t just helpful, it’s a requirement. It influences your pay, how your services are rated and how your practice grows.
In this blog, we will explain what MIPS is, what it means, and why it is something you should be aware of in 2025 and beyond.
Let’s get started!
What is MIPS in Healthcare?
MIPS in healthcare is a performance-based payment model. It incentivizes physicians and other healthcare professionals to provide high quality care to those enrolled in Medicare.
It evaluates their performance in four categories:
- Quality
- Cost
- Promoting Interoperability
- Improvement Activities
MIPS began as an effort to cut down on administration by consolidating multiple Medicare programs into a single model. When it’s executed effectively, MIPS can result in larger reimbursements for those providers that excel and punishments for those that don’t.
How MIPS Works in Healthcare?
MIPS in Healthcare combines some elements of the older Medicare programs into one. It heaps another layer of scrutiny onto a provider’s performance in a handful of primary categories (more on that in a bit).
According to your last MIPS score, you can get any of the following:
- An increase in payment (bonus)
- No difference (no change of the neutral adjustment)
- A penalty (negative adjustment)
Performance Categories of the MIPS
MIPS calculates your performance in four categories:
- Quality
The Quality category accounts for 45% in a MIPS score. It considers to what extent health care organizations provide safe, effective and efficient care. For instance, EHRs and smart technology let providers access accurate and real-time patient information, which minimizes errors.
Tools such as telehealth also allow patients to receive care at home, where their health can be monitored and potential issues identified more easily. When doctors use AI tools to help diagnose, they can make better decisions faster. All of this helps benefit patient care and the provider’s Quality score in healthcare.
- Cost
The cost category contributes 15% to the overall MIPS score in healthcare. It explores how well healthcare providers control costs while providing good care.
To do better, doctors can use data tools to predict costs, identify risks early and deliver care more efficiently. Hospitals can also cut costs by adhering to smart care plans and avoiding surgeries that are not necessary.
Here’s where AI tools can make a resource management more effective, reduce waste as well as make the entire process more efficient, all working for a better cost score in MIPS.
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Promoting Interoperability
Interoperability accounts for 25% of a healthcare provider’s overall MIPS score. It evaluates how well doctors and hospitals exchange patient information electronically.
This includes giving patients more ways to view their own health records and access online tools to help them manage their care. EHR (electronic health records) systems offered to providers are able to interface seamlessly with other systems to ensure that all of the patient’s providers can see updates in real time.
This serves to prevent errors, and it elevates the quality of care. And tools such as patient portals have enabled people to schedule appointments, check test results or send their doctor a message. When done right, and within the bounds of privacy rules like HIPAA, it adds to MIPS scores and enhances care for everyone.
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Improvement Activities
MIPS in healthcare consists of 3 categories in all, with one of the categories being Improvement Activities (IA) contributing 15% to the total score.
IA is based on activities that improve clinical activities and patient care. For instance, patients can view their medical records, schedule appointments with doctors and talk with health providers through patient portals.
This communication is transmitted by a real-time secure instant messaging system that is HIPAA compliant which reduces the risk of medication or treatment errors. Other providers may score well (perhaps even “high”) when they “come to the table” to discuss the coordination of care of the patient, collaboratively attack obstacles for patient safety (i.e., getting the patient’s meds right), or even utilize patient satisfaction surveys as a feedback mechanism to regularly enhance certain specific health care practices. It all adds to general effectiveness in caring for your patients, which will in turn raise the overall MIPS score.
5 Reasons Why MIPS in Healthcare Affects Your Practice
MIPS in healthcare isn’t just another government hoop to jump through, it’s directly related to the financial health of your practice.
Why MIPS in healthcare is important:
- Medicare Reimbursements – How much Medicare pays you is influenced by your performance.
- Public Rankings – Your MIPS score is reported on the CMS Physician Compare website, which impacts patients’ faith and referrals.
- Competitive Edge – Practices with high scores look more credible and are the practices most likely to interest new patients and partners.
- Incentive Payments – Good performance can open the door to contract bonuses, which can really add up to your annual income.
Common Challenges Practices Face with MIPS
MIPS in healthcare is not a walk in the park for everyone. There are numerous challenges that some service providers encounter:
- Comprehension of complex specifications
- Insufficient resources to accumulate and report data internally
- Poor EHR integration
- Constantly shifting policy
- Poor staff involvement in monitoring of performance
These factors can impact your score and result in payment penalties. While initiatives like MIPS Value Pathways aim to simplify the reporting process and make measures more relevant to specific specialties, many providers still struggle with implementation and compliance.
Hacks to Raise Your MIPS Score
You don’t have to have a built-out MIPS team to be successful. Here are some efficient to enhance your MIPS score:
- Select the most appropriate performance measures for your specialty type
- Use your EHR for better data capture
- Join Good deeds that you can document easily
- Ensure your staff are trained on the current requirements regularly
- Partner with a billing or MIPS reporting vendor if you need assistance
The best way to avoid penalties and secure bonuses is to be proactive.
How MIPS in Healthcare Impacts Reimbursements and Reputation?
Beyond the dollars and cents, MIPS in Healthcare changes how other people see your practice:
- Lower scores = payment cuts.
Even the absence of a few reports can cost you thousands.
- Scores are public
Patients will see your ratings online when picking a provider.
- Performance is checked by payers and networks.
Your MIPS score impacts whether you qualify for certain contracts or value based programs. A strong MIPS strategy is necessary to ensure that your practice’s income is protected. It is to help you rise above your competition in the healthcare industry.
Wrapping Up
MIPS in Healthcare is not merely a government scoring system—it’s a direct connection between how you treat patients and how you get reimbursed. It has the power to increase your income, raise your position and career in the community, and create new opportunities for you.
Partnering with our MIPS reporting company can provide the expertise and support needed to navigate the system effectively.
Could you use guidance on MIPS or strategies to bump up your scores?
Contact Prime Well Med Solutions today!
