What is MIPS in healthcare?
In healthcare, MIPS (Merit-Based Incentive Payment System) is the CMS program that adjusts Medicare clinician payment based on performance across four categories: Quality, Promoting Interoperability, Improvement Activities, and Cost. Scores run 0–100; high performers earn positive payment adjustments and low performers receive negative ones. MIPS was established under MACRA in 2015.
Full name: Merit-Based Incentive Payment System
Short explanation
The Merit-Based Incentive Payment System (MIPS) is a CMS value-based payment program under the Quality Payment Program that adjusts Medicare clinician reimbursement based on performance across four categories: Quality, Promoting Interoperability, Improvement Activities, and Cost. MIPS applies to eligible clinicians — physicians, nurse practitioners, physician assistants, and others — who meet Medicare volume thresholds. Scores range from 0 to 100; high performers receive positive payment adjustments and low performers receive negative adjustments. MIPS was established under MACRA in 2015.
How it’s used
- CMS QPP MIPS: individual and group MIPS performance scores are published annually at qpp.cms.gov and available as public bulk data, keyed to NPI.
- CMS NPPES NPI Registry: MIPS scores are joined to NPPES records via NPI to correlate performance with provider specialty and geography.
Frequently asked questions
- What is MIPS?
- MIPS (Merit-Based Incentive Payment System) is a CMS program that adjusts Medicare payment rates for eligible clinicians based on performance scores across quality, interoperability, activities, and cost.
- Who is eligible for MIPS?
- Eligible clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists who exceed specified Medicare billing thresholds.
- What is a good MIPS score?
- In performance year 2023, the national mean MIPS score was approximately 83 out of 100. High performers (≥75 points) receive positive payment adjustments.