CureMD Is Your Partner forMIPS Success
As part of the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program, the merit-based incentive payment system—commonly known as MIPS—continues to evolve each year to promote high-quality, efficient care while incentivizing improvements in patient outcomes.
In 2025, MIPS brings a new set of requirements, scoring methods, and performance categories. At CureMD, our experts are here to support you every step of the way, so you can ensure compliance and maximize reimbursement.
What Is MIPS?
MIPS is a CMS program that measures and adjusts Medicare payments to healthcare providers based on their performance in several categories. Providers are evaluated annually on their ability to deliver high-quality care while managing costs, improving patient experience, and adopting advanced healthcare technology.
MIPS rewards those healthcare providers who meet and exceed certain quality benchmarks and penalizes those who do not. The program encourages healthcare providers to participate in value-based care, improve care quality, and reduce healthcare costs.
MIPS 2025 Performance Categories
The four key performance categories of MIPS—which include quality, cost, improvement activities, and promoting interoperability—remain largely the same, but with new updates and weightings that reflect the shifting healthcare landscape:
Strengthening Health Equity Initiatives
In response to growing evidence of healthcare disparities, CMS has introduced new measures designed to promote care for underserved and marginalized communities. Practices that demonstrate a commitment to reducing health disparities and providing equitable care will earn greater rewards in their MIPS scores.
Key updates include the following:
- Introduction of new health equity performance measures
- Performance adjustments for practices that work toward eliminating health disparities
- Incentives for practices that serve rural and underserved areas
Quality and Cost Categories Adjusted
In 2025, the quality category will still make up the largest portion of the MIPS score, but the cost category will also receive increased weight. CMS aims to incentivize healthcare providers to deliver high-quality care while managing costs effectively.
- Quality will account for 30% of the total score (down from 35% in 2024).
- Cost will increase to 40% of the total score (up from 30% in 2024).
With cost now representing a larger portion of the MIPS score, practices will need to ensure they are not only delivering high-quality care but also optimizing their resource usage and minimizing unnecessary spending.
Revamped Promoting Interoperability Measures
The promoting interoperability category is evolving in 2025 to emphasize data exchange and patient access to information. CMS continues to push for greater interoperability between electronic health record (EHR) systems, healthcare organizations, and patients.
Key updates include the following:
- New requirements for data sharing with other providers and public health agencies
- Enhanced focus on patients’ access to their health data, including more patient-centered features
- Penalties for practices not meeting requirements for health information exchange
New and Updated Quality Measures
In 2025, CMS updated many of the quality measures used in MIPS. These updates aim to reflect the latest clinical practices and healthcare trends. Several new measures will address emerging needs in areas like telemedicine, chronic disease management, and mental health.
Practices are required to report on a specific set of measures, including:
- At least six quality measures, with at least one outcome measure
- One measure related to health equity
CMS also introduced new options for specialty practices and telemedicine providers to help ensure that their unique care delivery models are appropriately reflected in their MIPS score.
Expanded Reporting Flexibility for Small Practices
To continue fostering participation among small practices, CMS has introduced additional flexibility for practices with fewer than 15 clinicians. This includes:
- Reduced reporting requirements: smaller practices may report fewer measures
- Updated performance thresholds: new, simplified thresholds will allow small practices to participate in MIPS with a reduced burden
Key Changes in MIPS for 2025
In 2025, MIPS introduces several updates that will affect reporting requirements, performance metrics, and reimbursement rates. These changes reflect CMS’s ongoing focus on improving healthcare quality, reducing disparities, and enhancing the patient experience. Here’s a breakdown of the major changes to MIPS for 2025:
Quality (30% of Total Score)
Quality continues to be a core component of MIPS, focusing on a provider’s ability to deliver high-value care. Healthcare providers must report on a set of clinical quality measures and show evidence of improvement over time. The quality measures will include a combination of outcome measures, patient experience metrics, and other clinical benchmarks.
Key updates for 2025: New and revised quality measures that reflect changes in clinical guidelines and health priorities.
Cost (40% of Total Score)
The cost category has been expanded to now represent 40% of the total MIPS score. This category evaluates the efficiency of care by considering total healthcare spending for an attributed population. Cost measures include metrics like Medicare Spending per Beneficiary (MSPB) and Total Per Capita Cost (TPCC).
Key updates for 2025: New cost measures related to chronic disease management and telehealth utilization.
Improvement Activities (15% of Total Score)
The improvement activities category rewards practices for taking action to improve care delivery, address health disparities, and improve patient engagement. Practices must complete a set of activities designed to increase care quality, patient access, and engagement with the healthcare system.
Key updates for 2025: More activities focused on reducing health disparities and promoting team-based care.
Promoting Interoperability (15% of Total Score)
The promoting interoperability category focuses on the use of certified EHR technology. Providers must demonstrate meaningful use of EHRs to improve patient care coordination, data exchange, and patient access to their own health data.
Key updates for 2025: Expanded requirements for data sharing with other providers and public health organizations, and new measures focused on patient engagement.
How MIPS Scoring Works
Providers receive scores in each of the four categories, and those scores are combined into an overall MIPS score. The MIPS score ranges from 0 to 100 points, with higher scores indicating better performance.
The MIPS score is used to determine payment adjustments for the following year. The better a provider’s score, the more likely they are to receive a positive payment adjustment, which means higher reimbursement for services provided to Medicare patients. Conversely, poor performance results in negative payment adjustments, or reduced reimbursement.
The performance in each category is calculated as a score, and then those scores are weighted according to the percentages above. The resulting MIPS Composite Score is a final score between 0 and 100.
Step-by-Step MIPS Composite Score Process
Category Scores
A provider’s performance in each of the four categories—quality, cost, improvement activities, promoting interoperability—is scored.
Weighted Average
Each category score is multiplied by its respective weight.
Composite Score
The weighted category scores are then added together to produce a final MIPS Composite Score.
For example, if a provider scores 80 points for quality (30% weight), 70 points for cost (30% weight), 90 points for improvement activities (15% weight), and 85 points for promoting interoperability (25% weight), the composite score would be calculated as:
(80×0.30)+(70×0.30)+(90×0.15)+(85×0.25)
24+21+13.5+21.25
79.75
