In 2025, your MIPS score can determine whether you are a winner or loser in terms of your Medicare reimbursements. The performance threshold will be 75 points, meaning if you do not get 75 points or higher you may be penalized up to 9% which will significantly impact your revenue!
The rules are evolving—new quality measures, updated scoring methods, and increased pressure on cost performance mean providers need a smarter approach to stay ahead. It’s no longer enough to just report; you need to optimize. This guide breaks down everything you need to know—from selecting the right MIPS reporting services to improving healthcare quality reporting and protecting your healthcare billing. Whether you’re a solo provider or part of a larger practice, here’s how to take control of your MIPS score in 2025 and maximize it.
The Merit-Based Incentive Payment System (MIPS) is a performance-driven payment modality under Medicare’s Quality Payment Program – an incentive that began in 2017 to reimburse providers for the provision of high-quality, cost-effective care, replacing the prior programs, like PQRS and the value-based modifier.
MIPS is based on four categories and your MIPS score in 2025 will uniquely be constituted by:
Each category is evaluated separately, and then viewed as one total 0 – 100 MIPS score. That score determines if you will received:
For most Medicare providers who meet eligibility criteria, MIPS is obligatory. Choosing the correct MIPS reporting services, reporting on healthcare quality accurately, and understanding how your performance affects healthcare billing are paramount to all success.
There are changes to the program that are very significant. If you are not aware of these changes, you may lose points and risk penalties. Here is important information you should know for 2025.
Quality Measures Have Changed
You don’t report cost data—it’s pulled from your Medicare claims.
Before you start reporting, it’s important to know if you’re required to participate in MIPS—and how you can report.
You’re required to participate in MIPS if you:
These thresholds are based on performance year 2025 data. If you meet all three, you’re mandatorily included in MIPS.
If you fall below one or more thresholds, you may still:
This can be helpful for small practices preparing for future participation.
You can report as:
Each method affects your score and how it’s calculated. Reporting as a group can sometimes help balance out low scores across providers.
There are several reporting options:
Many providers pursue this option because of ease and support. How you implement MIPS depends a lot on your EHR system, the size of your practice, and how much support you feel you need.
Quick Tip: If you are not sure which way is best for you, P3Care MIPS reporting service will help assess your options and help you set it up.
Even experienced practices can lose points—and revenue—by making small mistakes in MIPS reporting. These errors often go unnoticed until it’s too late and penalties are already locked in. Here are some of the most common issues to avoid:
Choosing measures that don’t match your specialty or patient population can bring your score down, even if you’re delivering quality care.
Missing the 75% data completeness rule or submitting after the deadline can cost you full credit—no exceptions.
Since cost is calculated automatically by CMS, many providers overlook it. But it makes up 30% of your score, and high costs can silently drag you below the 75-point threshold.
If your activities aren’t properly documented, CMS may reject them—even if you completed them. That’s a loss of 15% of your total score.
Some practices don’t review performance until the year ends. At that point, it’s often too late to fix anything.
P3care MIPS reporting service helps catch these issues early. It ensures your healthcare quality reporting is accurate and your healthcare billing isn’t affected by avoidable penalties.
To achieve maximum benefits from MIPS in 2025, you need more than simple reporting. Each component of the program will have consequences for your score and your healthcare billing. Here, I will provide the most beneficial information for each category:
You must report six quality measures, including at least one outcome or high-priority measure. These should reflect the care you provide.Selecting Measures incorrectly can adversely affect your score, regardless of your performance.
To receive full credit, you also need to satisfy the rule around data completeness: reporting each measure for at least 75% of eligible patients. MIPS reporting services can assist in selecting appropriate measures and ensuring that you meet all CMS standards for healthcare quality reporting.
Cost makes up 30% of your total MIPS score, and it’s calculated automatically from your Medicare claims—you don’t submit it manually. CMS now uses a standard deviation model to compare your costs to national benchmarks.Even slight differences in spending can potentially influence your score.
To improve in this area, concentrate on decreasing avoidable services, reducing readmissions, and improving care coordination. Managing cost appropriately increases your MIPS score but also enhances your billing performance long-term.
This category is worth 15% of your MIPS score. In 2025, CMS eliminated a “high” and “medium” weighting system. Now just complete the required elements to successfully receive credit.
Choose activities that fit your workflows, such as care coordination, safety, or telehealth use. Reports for MIPS services will be beneficial to see your completion reports, and you will get to full points.
Promoting Interoperability is 25% of your score and promotes how your EHR distributes data, patients have access to their information, and electronic prescriptions. You are required to use a certified EHR and perform the required actions: with a patient portal and exchanging information and e-prescribing.
Some providers have exclusions, however, you will still report if you meet the exclusion. Make sure the system is connected and is working, especially if you are relying on it for MIPS reporting.
Reporting alone is not sufficient and you need tracking performance during the year. Utilize Dashboards, Monthly Reviews, and Audit checks to identify and correct errors early on.
Missed data, incomplete reports, or incorrect coding are just a few ways that cause lost points. A trusted MIPS reporting service for physicians can help to get it right, submit on time, and avoid MIPS penalties in 2025.
Managing MIPS reporting on your own can be stressful—especially with the constant rule changes, data requirements, and risk of penalties. That’s why many providers now use MIPS reporting services to handle the process from start to finish.
A good reporting service helps you:
MIPS reporting in 2025 plays a direct role in how much your practice earns from Medicare. With a 75-point threshold and penalties as high as 9%, there’s no room for incomplete data or reporting mistakes.
Choosing the right measures, managing costs, and tracking performance year-round are key steps to staying compliant. That’s why many providers rely on experienced partners like P3Care, who offer dedicated MIPS reporting services to help simplify the process, avoid penalties, and protect your healthcare billing.
Start early, stay informed, and treat MIPS as part of your long-term growth strategy—not just an annual task.
If your MIPS score is below 75 points, you could face a payment adjustment of up to 9% on your 2027 Medicare reimbursements.
Yes. MIPS allows reporting as an individual, group, APM entity or as an MVP pathway. Group reporting usually helps balance performance of the providers.
While a MIPS reporting service is not mandatory, it’s a best practice to work with a MIPS reporting service (such as P3Care MIPS services) because it cuts down on errors, improves your score and verifies that your submission meets Quality Payment Program requirements.
If you don’t meet the 75% reporting minimum- you will lose points for any measures you don’t meet that reporting minimum.
Your MIPS score will directly affect your Medicare reimbursement. If you receive a good MIPS score it likely will include bonus payments, and if you had a low score the consequences is penalties which reduce your healthcare billing revenue.
