Understanding MIPS Performance Categories for 2025
The Merit-based Incentive Payment System (MIPS) is a vital part of the Quality Payment Program (QPP), impacting Medicare reimbursement for eligible clinicians. For the 2025 performance year, CMS has introduced updates and refinements to ensure the program evolves with the changing landscape of healthcare. This blog dives deep into each performance category, highlights key changes, and offers strategies to help you thrive.
The Four MIPS Categories for 2025
1. Quality (30% of Final Score)
Quality remains the largest contributor to your MIPS score, with 195 quality measures available for 2025. This year introduces seven new measures, removes 10 outdated measures, and modifies 66 existing ones. CMS also continues using a flat benchmarking methodology for certain topped-out measures to promote meaningful participation.
Key Updates:
New measures focus on areas like diagnostic imaging, biomarker testing, and patient vaccination status.
Removal of measures, such as #439 (Age Appropriate Screening Colonoscopy), reduces redundancy.
Quality data submissions must meet 75% completeness criteria and include numerator and denominator data for at least one measure.
Strategy Tip: Focus on measures that align with your practice’s strengths and meet or exceed benchmarks. Avoid low-scoring measures that may dilute your performance.
2. Cost (30% of Final Score)
Cost is calculated automatically using CMS administrative claims data. For 2025, CMS introduced six new episode-based cost measures, including those for chronic kidney disease, prostate cancer, and respiratory infections. Cost measure benchmarking has also been updated to reflect median performance thresholds.
Key Updates:
New cost measures include both acute and chronic conditions, reflecting real-world care scenarios.
Errors or significant changes impacting cost measures can now qualify them for exclusion under the new cost measure exclusion policy.
Strategy Tip: Review CMS benchmarks for cost measures that apply to your patient population. Proactively manage resource utilization and coordinate care to minimize unnecessary expenses.
3. Promoting Interoperability (25% of Final Score)
This category focuses on the secure exchange of health information and patient engagement. While there are no major structural changes for 2025, clinicians such as clinical social workers will no longer qualify for automatic reweighting.
Key Updates:
Data submissions must include performance data, required attestations, CEHRT IDs, and performance period dates to be valid.
Clinicians can delegate data submission to third-party intermediaries without penalty.
Strategy Tip: Ensure your EHR system supports patient engagement features like portal access and direct messaging. Review your performance data regularly to identify areas for improvement.
4. Improvement Activities (15% of Final Score)
This category highlights your commitment to advancing care delivery. For 2025, CMS offers 104 activities, including two new ones focused on lung cancer screening and cardiovascular disease risk reduction. CMS also removed weightings for activities to simplify scoring.
Key Updates:
Small practices, rural clinicians, and other special statuses need only attest to one activity.
New activities, like “Save a Million Hearts,” target specific public health priorities.
Strategy Tip: Choose activities that bring tangible value to your practice and patients. For example, implementing cardiovascular screening protocols can enhance patient outcomes while fulfilling MIPS requirements.
Key Changes for 2025
Beyond category-specific updates, CMS has introduced overarching changes to improve flexibility and fairness:
MIPS Value Pathways (MVPs): Six new MVPs were added for specialties like gastroenterology and urology, and population health measures will be automatically calculated for participants.
Data Submission Enhancements: CMS will score the most recent valid data submission for each category, ensuring higher scores are prioritized.
Simplified Scoring: Updated methodologies make it easier for clinicians to achieve meaningful participation.
Why 2025 MIPS Matters
Your performance in 2025 determines your Medicare payment adjustment in 2027, with potential incentives or penalties of up to 9%. Early planning and strategic execution are critical to maximize rewards and avoid penalties.
How Chirpy Bird Can Help
Navigating MIPS can feel overwhelming, but you don’t have to do it alone. At Chirpy Bird, Inc., we offer:
Expert guidance: Tailored strategies for your practice, whether you use an EHR, registry, or other systems.
Pay-as-you-go services: Flexible support for measure selection, reporting, and compliance.
Penalty mitigation: Proactive planning to help you avoid costly Medicare penalties and earn incentive dollars.
The 2025 MIPS performance period is already underway—don’t wait to get started! Contact Chirpy Bird, Inc. today to ensure you’re on track for success.
Ready to soar with MIPS? Reach out now and let us help you achieve your goals!
