MIPS Quality Reporting Services
The Merit-based Incentive Payment System determines whether your practice receives a Medicare payment bonus of up to 9% or absorbs a penalty of up to 9%. With 2026 MIPS performance directly affecting your 2028 Medicare reimbursement, every reporting decision you make this year has a six-figure revenue impact. Go Medical Billing handles your complete MIPS reporting strategy — from measure selection through final submission — so you maximize your score and protect your revenue.
What Is MIPS and the Quality Payment Program
The Merit-based Incentive Payment System (MIPS) is one of two tracks under Medicare's Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015. MIPSreplaced the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBPM), and the Medicare Electronic Health Record Incentive Program into a single, unified performance framework.
Under MIPS, Medicare evaluates eligible clinicians across four performance categories, calculates a composite score from 0 to 100, and applies a payment adjustment to the clinician's Medicare Part B reimbursement two years later. A 2026 performance year determines your 2028 payment adjustment. The adjustment can be positive (bonus), negative (penalty), or neutral depending on how your score compares to the performance threshold set by CMS each year.
For practices that bill Medicare Part B, MIPS is not optional. If you meet the eligibility thresholds and fail to report, you receive the maximum negative adjustment automatically. That means doing nothing costs your practice real money — up to 9% of every Medicare dollar you collect for an entire payment year.
The 4 MIPS Performance Categories
Your final MIPS score is a weighted composite of four performance categories. Understanding how each category is weighted and scored is critical to maximizing your overall result.
Quality (30% Weight)
Report on 6 quality measures including 1 outcome or high-priority measure. Each measure is scored on a 1-10 scale based on your performance against national benchmarks. Data completeness must meet the 70% threshold. This category replaced the old PQRS program and remains the most familiar to most clinicians.
Cost (30% Weight)
CMS calculates your cost score automatically from Medicare claims data — no separate submission required. Measures include total per-capita cost, Medicare Spending Per Beneficiary (MSPB), and episode-based cost measures relevant to your specialty. You cannot directly report cost measures, but you can influence them through efficient care patterns.
Promoting Interoperability (25% Weight)
Formerly Meaningful Use, this category requires reporting on electronic prescribing, health information exchange, provider-to-patient exchange, and public health registry reporting through your certified EHR. Requires a Yes/No attestation for security risk analysis. Measures include e-prescribing (required), health info exchange, and PDMP query where applicable.
Improvement Activities (15% Weight)
Attest to performing 2-4 improvement activities from a CMS-approved list for at least 90 consecutive days. Activities span categories like care coordination, patient safety, population management, and health equity. High-weighted activities count double — completing 2 high-weighted activities earns a perfect 40/40 score in this category.
Get a Free MIPS Assessment
We'll review your current MIPS standing, identify your optimal measure set, and project your payment adjustment.
How MIPS Affects Your Medicare Payments
MIPS payment adjustments are budget-neutral, meaning the penalties collected from low-performing clinicians fund the bonuses paid to high-performing clinicians. In 2026, the maximum negative adjustment is -9% and the maximum positive adjustment is +9%, with an additional exceptional performance bonus available for clinicians scoring above 89 points (subject to available funding).
Understanding the Performance Threshold
CMS sets a performance threshold each year. For the 2024 performance year (affecting 2026 payments), the threshold was 75 points. Clinicians scoring at the threshold receive a neutral (0%) adjustment. Scoring above the threshold earns a positive adjustment scaled proportionally up to the maximum. Scoring below the threshold triggers a negative adjustment that increases as the score drops further below the threshold.
Real Dollar Impact
For a physician billing $400,000 in Medicare Part B charges annually, a -9% penalty translates to $36,000 in lost revenue per year. Conversely, a +9% bonus adds $36,000. The spread between the worst and best outcomes for that same physician is $72,000 — a difference that grows with every additional clinician in the practice. A five-provider group billing $2 million in Medicare could see a swing of $360,000 between maximum penalty and maximum bonus. MIPS reporting is not a compliance checkbox — it is a direct revenue lever.
Payment Adjustment Timeline
MIPS operates on a two-year lag. Performance in calendar year 2026 is measured, scored, and reported back to you in 2027, and the payment adjustment applies to all Medicare Part B claims processed during calendar year 2028. This lag means that poor performance today has consequences that last for an entire payment year two years from now, and you cannot retroactively fix it once the performance year closes.
Our MIPS Reporting Services
Go Medical Billing provides end-to-end MIPS reporting that covers every stage of the process — from pre-year strategy through final submission and post-year analysis. We do not simply submit data. We optimize your score by selecting the right measures, ensuring data completeness, monitoring performance throughout the year, and making mid-year adjustments when needed.
Measure Selection and Strategy
Choosing the wrong quality measures is the most common MIPS mistake we see. Practices select measures that sound relevant but have unfavorable benchmarks for their specialty, low patient volume that triggers data completeness issues, or inverse scoring that penalizes high performance. We analyze your claims data, patient population, and specialty mix to identify the six quality measures that will yield the highest possible score. We also review your EHR's reporting capabilities to ensure the measures we select can be captured electronically without manual workarounds.
Data Collection and Validation
MIPS data quality matters as much as the data itself. We set up automated data collection workflows within your EHR, validate data throughout the year to catch completeness gaps before the reporting period ends, and flag cases where a measure's denominator is triggering but the numerator action was not documented. If your e-prescribing rate is at 68% in July and you need 70% for the Promoting Interoperability threshold, we alert you immediately — not in January when it is too late.
Submission and Registry Management
We submit your MIPS data through a qualified clinical data registry (QCDR) or qualified registry, depending on which submission method optimizes your score. Registry submission allows for quality measure reporting that may not be available through EHR direct submission or claims-based reporting. We handle the technical submission, verify acceptance, resolve any data rejection errors, and confirm final submission before the March 31 deadline.
Score Optimization and Mid-Year Review
We do not wait until the end of the year to evaluate your MIPS performance. We run quarterly score projections based on your year-to-date data, compare your current trajectory against the expected performance threshold, and recommend targeted interventions when a specific measure is underperforming. If your Quality category score is projected at 35 out of 60 in Q2, we identify which specific measures are dragging it down and what clinical or documentation changes would improve them before the year closes.
MIPS Value Pathways (MVPs)
CMS introduced MIPS Value Pathways as a simpler alternative to traditional MIPS reporting. MVPs group related quality measures, improvement activities, and cost measures around a specific clinical condition or medical specialty, reducing the number of measures you need to select and creating a more cohesive reporting experience.
How MVPs Work
Instead of choosing from the full catalog of 200+ quality measures, an MVP participant selects from a curated set of measures relevant to a specific clinical area — such as rheumatology, heart disease, or emergency medicine. The Promoting Interoperability requirements remain the same, but quality measures and improvement activities are pre-matched to the clinical focus area, simplifying selection and improving clinical relevance.
Should Your Practice Choose an MVP?
MVPs are voluntary through 2027, and the right choice depends on your practice's specialty mix, payer population, and current reporting infrastructure. For single-specialty groups whose clinical focus aligns closely with an available MVP, the simplified measure set can simplify reporting and improve scores. For multi-specialty groups or practices whose patient mix spans multiple clinical domains, traditional MIPS may offer more flexibility to choose top-performing measures. We evaluate both options for every client and recommend the path that produces the highest projected score.
MIPS Exemptions and Low-Volume Thresholds
Not every clinician who bills Medicare is subject to MIPS. CMS applies several exclusion criteria that exempt certain clinicians from the program entirely.
Low-Volume Threshold
Clinicians who fall below the low-volume threshold are automatically exempt from MIPS. The current thresholds are: fewer than $90,000 in Medicare Part B allowed charges, OR fewer than 200 Medicare Part B patients, OR fewer than 200 covered professional services to Medicare Part B patients during the performance year. If you fall below any one of these three criteria, you are excluded from MIPS and will not receive a payment adjustment — positive or negative.
Other Exclusions
Clinicians in their first year of Medicare Part B participation are excluded. Clinicians who are significantly participating in an Advanced Alternative Payment Model (Advanced APM) — such as certain ACO models, bundled payment arrangements, or PCMH programs — are excluded from MIPS and instead qualify for APM incentive payments. Clinicians enrolled in Medicare for the first time during the performance period also receive MIPS-exempt status.
Voluntary Reporting for Exempt Clinicians
Even if you are exempt, you can still choose to report to MIPS voluntarily. Voluntary reporters receive performance feedback from CMS without any risk of a negative payment adjustment. This can be valuable for practices approaching the low-volume threshold who want to build their reporting infrastructure before they become mandatory participants, or for clinicians who want to benchmark their quality performance against national standards.
Specialty-Specific MIPS Guidance
MIPS measure selection is specialty-dependent. The quality measures that maximize a cardiologist's score are completely different from those that work best for a behavioral health practice. Our team includes specialists who understand the measure sets, benchmarks, and reporting nuances for every major medical specialty.
MIPS Timeline and Key Deadlines
MIPS operates on an annual cycle with fixed deadlines that cannot be extended. Missing any deadline means losing your opportunity to report, which triggers the automatic maximum penalty.
January 1 — Performance Period Opens
The MIPS performance year begins. All quality measures, cost calculations, Promoting Interoperability actions, and improvement activities start accumulating. Your measure selection and data collection processes should already be in place before this date.
Mid-Year Check-In (July)
While not a CMS deadline, this is when we run your mid-year score projection. By July, you have six months of data — enough to identify underperforming measures, data completeness gaps, and categories where a targeted intervention can meaningfully improve your final score.
December 31 — Performance Period Closes
The last day to perform quality actions, complete improvement activities, and capture Promoting Interoperability data. Any measure actions taken after this date do not count toward the current performance year.
March 31 — Data Submission Deadline
All MIPS data must be submitted to CMS by March 31 of the year following the performance period. Registry submissions, QCDR submissions, and direct EHR submissions all share this deadline. We submit well before the deadline to allow time for error correction and resubmission if needed.
Mid-Year Following (July-September) — Performance Feedback
CMS releases final scores and payment adjustment percentages. You receive your final MIPS composite score, category-level scores, and the payment adjustment that will apply the following year. We review your feedback report with you and use it to optimize your strategy for the next performance year.
Frequently Asked Questions
Maximize Your MIPS Score
Call 888-701-6090 for a free MIPS assessment. We'll review your eligibility status, project your current payment adjustment, and show you exactly how to optimize your score.