Back to Blog

What is MIPS, and why is it important?

MIPS can seem like an overwhelming program. The commitment is a yearlong event, the charting burden seems never-ending, and the criteria change every year and seem to grow increasingly harder. On top of that, MIPS participation is mandatory for many clinicians, so even a few missteps can cost a pretty penny.

But not all is doom and gloom. With some organization and attention to detail, clinicians can nab bonus pay — or apply for qualifying exemptions and avoid the penalties. When the right steps can turn a harsh 9% penalty into a delightful 9% bonus, it’s fair to say those steps are worth taking.

What is MIPS in CMS, and what is the purpose?

MIPS, which stands for Merit-based Incentive Payment System, is a points-based payment program that either rewards or penalizes Medicare Part B clinicians for providing a better quality of care. The Centers for Medicare & Medicaid Services (CMS) runs MIPS under the Medicare program.

Every year, CMS scores clinicians on a 100-point system across a few categories and generates a Composite Performance Score. Based on this final score, CMS adjusts payment for Medicare services.  

The goal of MIPS in health care is to compensate clinicians for performance and value rather than just for service. It’s an effort to change business as usual and encourage a patient-first focus and better treatment outcomes — but without the threat of payment cuts.

Should you focus on MIPS in 2022?

MIPS success is important for clinicians who bill Medicare in high volume. It takes a lot of time and effort, but those who score well can earn higher rates for Medicare services. With health care margins already razor-thin, a high MIPS score can mean the difference between scraping by and thriving. In other words, it pays off.

Who can participate in MIPS in 2022?

MIPS is limited to certain types of clinicians. To participate, they must first be approved to bill Medicare Part B covered services and they need to meet the low-volume threshold. Some eligible clinicians include:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical psychologists
  • Physical therapists
  • Registered dietitians
  • Certified nurse-midwives


If a clinician first enrolled in Medicare in January 2022, they’re exempt from MIPS reporting for this first year. Those who achieve Qualifying Alternative Payment Model (APM) Participant status under the Advanced APM track may also be exempt. To achieve this status, they must:

  • See 35% of Medicare patients through Advanced APM or
  • Receive 50% of Medicare Part B payments

How is MIPS measured?

A MIPS score is based on measures in four categories, each with a different weight. The score evolves over the course of the year, but clinicians should shoot for an end goal for 2022: 75 points or higher. This is the threshold for steering clear of a painful financial penalty.

What are MIPS measures?

There are four MIPS categories to track: Quality, Cost, Improvement Activities, and Promoting Interoperability. Each one has a variety of measures, except for Cost scores. CMS calculates these from Medicare claims and matches them against benchmarks.

Clinicians choose up to 15 MIPS Quality Measures from a list of 200 and then report on them for at least 70% of cases. The top six are automatically graded, so many groups choose between eight and 10 to allow for better performance in some measures than others.

In the Improvement Activities category, clinicians choose between two and four activities that focus on patient safety and coordination and report on them for 90 consecutive days.

Promoting Interoperability measures look at how well a clinician engages with a patient and exchanges information. The score is based on MIPS measures such as; e-prescribing, providing patient access to health records, and more. It also requires a 90-day reporting period.

How to calculate your MIPS score

The Composite Performance Score is a max of 100 points, and the final MIPS score depends on the points a clinician accrues in each category. CMS weights each category differently:

  • Quality: 30%
  • Cost: 30%
  • Promoting Interoperability: 25%
  • Improvement Activities: 15%
Chart, pie chartDescription automatically generated

Risks and benefits of MIPS scores

Focusing on the MIPS score could be worth its weight in gold. The final MIPS score changes a clinician’s Medicare payment rate, so a successful year means providers enjoy up to an extra 9% bonus pay.

On the flip side, those who perform poorly take a stiff hit to the pocketbook. CMS added two new changes for 2022 that significantly affect payments:

  1. Each clinician must achieve a minimum final score of 75 MIPS points. Falling short of 75 points means they’ll automatically receive a penalty adjustment of -9% on payments in 2024.
  2. If an eligible clinician doesn’t participate, CMS will automatically lower 2024 payments by 9%.

A 9% penalty all year is a hefty price to pay for most businesses, but especially for clinicians. Ignoring MIPS can put a serious dent in profits.

MIPS 2022: Success with ChartPath

One of the best ways to achieve high scores in the MIPS program is to monitor performance all year long. With EHR software like ChartPath, clinicians can track performance against MIPS benchmarks and shorten reporting time with a simple click. With charting contributing 30% of the MIPS score and Interoperability at 25%, finding ways to improve these areas can significantly impact scoring.

Learn how ChartPath can simplify the process. Schedule a demo to chat with our MIPS experts about boosting your score and successfully navigating MIPS while delivering quality, patient-focused care.

Get Our Free MIPS 101 Guide

In this eBook you’ll learn: the purpose of MIPS, MIPS participation and measures, risks and benefits of scoring, and how the right technology can track performance to increase your MIPS score.
Download Now

More from the Blog

ChartPath Announces New Automation Platform for Long-Term and Post-Acute Care Practice

ChartPath, a leading EHR solution for long-term and post-acute care practices, today announced plans for a new automation platform that will allow clinicians and caretakers to select from a menu of helpful solutions and integrations tailored to their unique business and care needs.

Read Article

Referral Patterns in Healthcare: The Key to Growth

With so much competition in the long-term and post-acute care (LTPAC) market, maintaining growth takes work. Because of the rapid expansion of the over-65 demographic, it’s essential that LTPAC organizations and referring physicians understand the impacts of referral patterns in healthcare.

Read Article

HCC Coding Basics: Run a Better Practice

Learn about HCC coding and how to run a better practice. Using HCC codes in an EMR helps ensure that patients with multiple chronic conditions receive appropriate resources for their care and that clinicians receive fair and accurate payments for the services they provide. This helps reduce costs and improve the overall efficiency of the healthcare system.

Read Article

ChartPath EHR Announces Enhanced Integration with PointClickCare

ChartPath, the leading EHR solution for long-term and post-acute care practices, today announced new enhancements to its ongoing integration with PointClickCare, a leading healthcare technology platform enabling meaningful collaboration and access to real–time insights.

Read Article

Promoting Interoperability Changes for 2022: Ace Your MIPS

If you participate in the Merit-based Incentive PaymentSystem (MIPS) program, you may know the Promoting Interoperability (PI)requirements. For participating clinicians, PI can account for up to 25% of your MIPS score. If you are unsure of PI requirements and are not meeting them, you may end up on the wrong side of a penalty. And your PI activities need to have started by October 1st because it’s your last chance to make the best impression. The Centers for Medicare & Medicaid Services (CMS) measures you on a 90-day reporting period. 

Read Article

Documentation Frustrations in Health Information Exchange for LTPAC

Patient documentation is often scattered across healthcare systems: a diagnosis here, a newly prescribed medication there, and test results in three different places. Unfortunately, electronic medical records (EMR) often don’t transfer efficiently across healthcare entities—if they transfer at all. This inability to easily share important data can cause healthcare information silos.

Read Article

What Risk-Based Payment Models Mean for You - APM

Risk-based payment models aim to shift the basis of Medicare reimbursement rates from volume to value, but two different kinds exist. Here's a breakdown of advanced payment models and how ChartPath can help.

Read Article

What Risk-Based Payment Models Mean for You – MIPS

Risk-based payment models aim to shift the basis of Medicare reimbursement rates from volume to value, but two different kinds exist. Here's a breakdown of MIPS and how ChartPath can help either way.

Read Article

Goodbye COVID Free Pass, Hello MIPS Exceptions

The Merit-based Incentive Payment System (MIPS) free pass may not return in 2022. The Centers for Medicare & Medicaid Services (CMS) exempted many clinicians from MIPS reporting in 2020 and 2021 due toCOVID-19. But most clinicians will have to report their 2022 MIPS data when the window opens in January 2023. However, clinicians can still file for one of two hardship exceptions that simplify the process.

Read Article

Ready to take control of your LTPAC practice?

Great! Because we can't wait to show you how.
Back to Blog
This is some text inside of a div block.