MIPS 2025: Key Changes Healthcare Providers Must Know

How MIPS Shapes the Future of Value-Based Healthcare

Part of the Quality Payment Program (QPP), MIPS is a performance-based reward system managed by the CMS with a simple goal: to encourage better care, smarter spending, and healthier patients.

MIPS scores are based on four core categories:

• Quality: Measures how care improves patient outcomes.
• Cost: Evaluates resource use and cost efficiency.
• Promoting Interoperability: Encourages secure data sharing through certified EHR systems.
• Improvement Activities: Recognizes efforts to enhance care and patient engagement.

Your performance in these areas directly determines your Medicare reimbursement rate, resulting in either a bonus or a penalty. Because of this, maintaining strong CMS compliance and consistent performance is critical to your organization’s success. Balancing these requirements with the daily demands of your practice can be complicated, necessitating smart, automated tools such as those built into robust EHR software systems like IMS.

Key Changes in 2025 MIPS

As we near the end of 2025, your organization needs to wrap up its activities for the performance year. Here’s a breakdown of the most significant updates to the MIPS quality measures and what they mean for your reporting and performance.

• Eligibility Updates
  If you bill Medicare Part B, now’s the time to review your 2025 participation status. CMS has adjusted eligibility thresholds for both clinicians and groups, which may change whether you’re required or qualified to report under MIPS this year. 
  
  If you fall below all three thresholds, your participation is exempted—but opting in can help your team gain feedback and stay ready for future participation.
  
  Moreover, expanded hardship and exception options are still available for practices dealing with tech or staffing challenges. Be sure to confirm your eligibility before 2026 reporting begins.
  

• Performance Category Updates
  As CMS fine-tunes its performance measures, here’s what changed in how MIPS scores are calculated:
  

• Scoring and Weights
• 2025 Update: How points are counted in each area has been slightly updated; the importance of each area stays the same: Quality 30%, Cost 30%, Promoting Interoperability 25%, Improvement Activities 15%.
• Why It Matters: Even small improvements in patient care or documentation can help your overall score. Focus on what you can control in your daily work.
• Performance Threshold
• 2025 Update: You need at least 75 points to avoid a penalty.
• Why It Matters: This is your “safe zone.” Meeting it protects your Medicare claims and payments.
• Payment Adjustments
• 2025 Update: Your final score decides if you get a bonus or face a penalty.
• Why It Matters: Your performance now directly affects your 2026 Medicare reimbursements, so it’s important to track your progress.
• Category Highlights
• 2025 Update: Cost measures updated; 7 new quality measures added, 66 revised; Improvement Activities simplified; Promoting Interoperability still requires a certified electronic health record and Security Risk Analysis.
• Why It Matters: Focus on efficient care, accurate reporting, and using your EHR billing software properly. The changes are meant to make reporting easier and safer for your patients.

Understanding these updates now can help your organization stay compliant, avoid penalties, and be fully prepared for the 2026 reporting season.

• Quality Measures Updates
  Seven new quality measures were added in 2025, including areas like adult COVID-19 vaccination, ovarian cancer genetic testing, melanoma recurrence tracking, and safe CT imaging.
  
  Picking the right measures simplifies your reporting, helping maximize your performance score. Focus on what matches your specialty and patient population. Prioritize which ones are feasible to report accurately.
  

• Promoting Interoperability Updates
  Promoting Interoperability is all about making sure your electronic health record system helps you share data securely and efficiently. In 2025, there are a few updates to keep in mind, including some new reporting requirements.
  
  Completing a Security Risk Analysis is still a must to protect patient information. While every certified EHR meets the same overall standards, the way your system tracks and submits data can differ, so it’s important to understand how your specific platform works.
  
  Staying on top of these updates not only helps you earn points in the MIPS program but also keeps your patients’ data safe and your practice running smoothly.
  

• Cost Category Updates
  The way CMS calculates cost scores has been refined to better reflect real-world care and resource use. Benchmarks now use median costs and compare performance across similar practices. Adjustments for patient complexity help ensure your score is fair, even if you treat patients with higher-risk conditions.
  
  For your practice, focusing on efficient care, accurate documentation, and understanding your patient mix can make a meaningful difference in your overall MIPS performance. Paying attention to these details now can help improve your 2026 Medicare reimbursements.
  

• Improvement Activities Updates
  Improvement Activities will no longer be weighted, and the number of activities you need to report depends on how you’re submitting and your practice’s special status.
• If you’re reporting through a MIPS Value Pathway (MVP), all clinicians, groups, and subgroups must attest to 1 activity, no matter their special status.
• If you’re reporting through Traditional MIPS, the requirements vary:
• Small practices, rural practices, non-patient-facing clinicians, and those in Health Professional Shortage Areas (HPSA) need to attest to 1 activity.
• All other clinicians, groups, and virtual groups must attest to 2 activities.
  

This change simplifies reporting and makes it easier to focus on meaningful improvement efforts. Choosing the right activities that fit your practice workflow can boost your score while enhancing patient care and engagement.

Reporting Requirements 

Keeping track of key reporting deadlines is key to avoiding penalties. Here’s a quick look at your deadlines for December 2025 until Mid-2026:

You can submit your MIPS data using your certified EHR system, registry, or CMS portal. Each method has its own steps, so it's helpful to familiarize yourself with your system’s workflow to avoid common errors, such as missing data fields or incorrect measure selection.

Some pitfalls to watch out for include:

• Failing to report on all required measures
• Misunderstanding your special status requirements
• Delaying submission until the last minute
  

Preparing early and double-checking your submissions can save time and protect your Medicare reimbursements.

Your day-to-day is already fast-paced. As such, navigating MIPS shouldn’t slow you down. A clear plan can keep your practice compliant while minimizing stress. Use this quick checklist:

• Review your quality measures and select those aligned with your patient population and specialty.
• Regularly track progress on quality measures to avoid last-minute reporting errors.
• Choose Improvement Activities that fit your workflow and meet your required number based on the reporting path and special status.
• Keep complete documentation for all reported measures.
• Regularly review CMS updates to stay compliant with new requirements.
• Focus on patient care while ensuring accurate submissions and maximizing reimbursements.
• Use your EHR (like IMS) to track measures, generate reports, and monitor deadlines.
• Ensure your EHR is updated and fully capable of accurate reporting.
• Leverage IMS EHR dashboards and automated reporting to reduce errors, save time, and optimize reimbursements.

We know how stressful it can be to juggle patient care, daily operations, and ever-changing MIPS requirements. Staying compliant can feel like just one more thing on an already full plate.

That’s why understanding the MIPS 2025 updates matters. Starting early and keeping track of your performance not only protects your reimbursements but also helps your team focus on delivering the best care to patients.

Meditab’s IMS provides you with the tools you need to simplify reporting, manage your MIPS measures, and give you peace of mind to keep your practice ahead of the curve.

Turn 2025 MIPS Requirements into an Advantage

Frequently Asked Questions