The Medicare Merit-Based Incentive Program System (MIPS) remains a cornerstone of the U.S. Government’s efforts to ensure quality healthcare delivery while containing costs. As we delve into the changes for the 2025 reporting year, it's crucial to understand how these adjustments will influence your MIPS reporting journey. Let’s explore the key policy updates and their implications.
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The performance threshold for 2025 remains at 75 points, mirroring preceding years. Final MIPS scores are juxtaposed against this threshold to ascertain the MIPS payment adjustment.
Clinicians must still meet a 75% data completeness threshold, up from 70% in 2023. This adjustment ensures that reported data adequately reflects quality performance.
Additionally, the Quality measure inventory has several proposed changes by way of additions and possible removal of over ten measures. Notably, CMS is proposing to flatten several topped-out measure benchmarks for certain specialty sets which see limited new measure development and limited options.
The Improvement Activities (IA) category proposes addition of two new activities, removal of eight activities, and modification to two others. The proposed new measures are:
Promoting Interoperability (PI) category measures have not seen a significant change in the proposed rule. There is an adjustment starting with the 2025 performance period where Clinical Social Workers no longer have automatic reweighting, and reweighting will only apply to MIPS eligible clinicians or groups in certain categories.
The cost category is proposed to introduce six new measures at the group clinician levels, as long as such reporters have a minimum of twenty episodes. There are also significant updates to two existing measures after re-evaluation:
Cost measurement may undergo a revision starting with the 2024 performance year (for scores released in mid-2025). This entails revising cost methodology such that median cost for a measure is set at a score based on the performance threshold for that payment year.
The latest CMS proposal indicates changes to the quality measure reporting and scoring process for thos ACOs enrolled in the Medicare Shared Savings Program (MSSP). This proposal would establish a new, eight measure quality measure set with required use by MSSP ACOs starting in 2025. More information is available about this update here.
While the final rule is not set to be released until November, 2024 we can anticipate that there are several important changes to MIPS reporting for clinicians in the coming year. Though the reporting process for MIPS is now well-established, complexities in data aggregation or EHR reporting capabilities may further complicate an already challenging annual process.
Don’t let MIPS reporting difficulties hinder your practice's success. Reach out to the Oystehr team today at [email protected] to discover how we can simplify your reporting journey and help you achieve maximum reimbursement.
MIPS, or the Merit-based Incentive Payment System, is a performance-based payment adjustment system for Medicare clinicians. Eligible participants include physicians, nurse practitioners, clinical nurse specialists, and physician assistants who bill Medicare Part B.
For 2025, the performance threshold remains at 75 points, data completeness increases to 75%, and new quality and cost measures have been introduced. There are also changes to Improvement Activities and updates for Accountable Care Organizations (ACOs).
The performance threshold for MIPS in 2025 is set at 75 points, the same as in previous years.
The 2025 updates propose adding new quality measures, especially in specialty sets like lung cancer screening and cardiovascular disease prevention, while removing certain outdated measures.
Clinicians must report on at least 75% of their patients for the quality measures they choose, an increase from the 70% threshold in 2023.
The 2025 proposal includes two new Improvement Activities focused on lung cancer screening and cardiovascular disease prevention, while eight existing activities are set to be removed.
MIPS Value Pathways (MVPs) offer streamlined reporting options by focusing on specific clinical areas. In 2025, new MVP options will be available, particularly in cost measurement categories.
Six new cost measures are being introduced, and updates are proposed for existing measures like cataract surgery and coronary intervention procedures.
Starting in 2025, ACOs participating in the Medicare Shared Savings Program (MSSP) will need to comply with a new eight-measure quality set to continue their participation.
Clinicians can maximize their MIPS score by carefully selecting quality measures, participating in improvement activities, and using certified EHR technology to track and report performance data accurately.
Failing to meet the MIPS threshold results in a negative payment adjustment to Medicare Part B reimbursements for the following year.
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Our new behavioral health intake application, built on Oystehr, allowed us to build a solution that is customized for our use including scheduling, insurance validation, and direct integration with our eClinicalWorks EHR.
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Chief Medical Information Officer at PM Pediatric Care
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