2023 MIPS Guide; An Overview of MIPS Healthcare Changes

2023 MIPS Guide

MIPS is one option to engage in the Quality Payment Program (QPP), which was established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The program reimburses Medicare Part B-covered professional services for MIPS eligible providers who provide high-quality patient care. MIPS Healthcare Eligible clinicians choose one of three payment tracks annually: 

  1. Merit-Based Incentive Payment System (MIPS) and
  2. Advance alternate payment model (APM). 
  3. MIPS Value Pathways (MVPs)

MIPS assesses your performance across various criteria that contribute to better quality and value in our healthcare system.

2023 MIPS Healthcare Eligible Clinicians

If you are eligible for MIPS in 2023, you must:

  • You must typically submit measure and activity data for quality, improvement efforts, and Promoting Interoperability performance areas. (If appropriate, we gather and calculate statistics for the cost performance category for you.)
  • Your success in the MIPS performance categories, each with a different weight, will result in a MIPS final score ranging from 0 to 100 points.
  • Whether you receive a negative, neutral, or positive MIPS payment adjustment is determined by your ultimate MIPS score.
  • Your MIPS payment adjustment will be applied to reimbursements for Medicare Part B covered professional services beginning January 1, 2025, depending on your performance during the 2023 performance year.

Add Your Heading Text HereWhat is MIPS in Healthcare?

In medical billing, MIPS Healthcare is the program that will determine Medicare payment adjustments. Using a composite performance score, ECs (eligible clinicians) may receive a payment bonus, a payment penalty, or no payment adjustment.

MIPS consultants can help you understand the new system’s requirements and guide your practice to achieve maximum results.

a group or by individual clinicians has financial and reputational ramifications that must consider.

Traditional MIPS Adjustments

Traditional MIPS is the initial framework for collecting and reporting data to MIPS available to MIPS-eligible practitioners. In addition to the CMS performance threshold score, clinicians and groups receive MIPS scores according to their performance in all four MIPS categories (Quality, Improvement Activities, Promoting Interoperability, and Cost).

For the 2023 performance year, the Final Rule established minimum performance criteria of 75 MIPS points. CMS continues to evaluate the performance threshold on the mean final score from the 2017 performance year. To avoid a negative payment adjustment in the 2025 payment year, clinicians and groups must earn 75 MIPS points again in 2023.

There will be no extra performance threshold for exceptional performance in 2023, as finalized in the 2022 MIPS Final Rule. The performance year 2022 is the final one in which clinicians might receive an exceptional performance bonus.

MIPS Healthcare 2025 payment Adjustment

The payment adjustments for 2025 outlined in the table below reflect the removal of the additional adjustment for exceptional performance. MIPS scores at or below 18.75 points would earn the full -9 percent penalty.

Final Score 2023Payment Adjustment 2025
75.01 – 100 pointsPositive MIPS payment adjustment greater than 0% on a linear sliding scale
75 points0% MIPS payment adjustment
75 points0% MIPS payment adjustment
18.76 -74.99 pointsNegative MIPS payment adjustment between -9% and 0% on a linear sliding scale
0 – 18.75 pointsNegative MIPS payment adjustment of -9%

MIPS Healthcare Participation Option

Clinicians can participate as either individuals or in groups. When reporting as a group, all ECs reporting within the TIN (tax identification number) must be included in the group’s reporting. Each national provider identifier (NPI) within the TIN will receive a MIPS final score. A TIN cannot be split into several groups.

  • An Individual (can be defined as an NPI (single National Provider Identifier) tied to a single Tax Identification Number (TIN); OR
  • The term group refers to at least two clinicians (identified by their individual NPIs) sharing a common TIN. At least one clinician must be individually eligible for MIPS.

Important: For a given performance year, the decision to report individually or as a group applies to all MIPS categories. In some categories, a clinician cannot opt to report as an individual while reporting as a group in others. If clinicians choose to report as a group or individually, they must consider the financial and reputational implications.

2023 MIPS reporting Performance Categories

MIPS Healthcare annually assigns a 100-point performance scale to eligible Medicare Part B clinicians, resulting in a Composite Performance Score. The Composite Performance Score, determined by the reported measures and categories, will serve as the foundation for the payment adjustment.

There are four scalable categories of MIPS,

  • Quality 
  • Promoting Interoperability 
  • Cost 
  • Improvement Activities

Note: These %age weights are designated for the year 2023 performance period. 

MIPS Consultants
MIPS Consultants

1. Quality Measure (30%)

For the 2023 performance year, CMS will maintain the current data completeness requirements. It requires physicians to report at least 70% of eligible contacts for their quality measures, regardless of insurance type. This requirement, however, rises to 75% for the performance years 2024 and 2025.

MIPS Healthcare quality measure adjustments include expanding the definition of “high priority measure” to include health equity-related measures. CMS has finalized a total of 198 quality measures for the performance period 2023, which include:

  • Changes to 76 existing quality indicators;
  • The addition of nine new quality measures (one of which is a new administrative claim measure);
  • 11 quality measures were removed, and
  • Addition/removal of quality measures from multiple specialty sets.  

The tables below outline the measures added to or removed from the 2023 Quality measure inventory, along with their collection types.

New Quality MeasuresCollection Type
#485 Psoriasis – Improvement in Patient-Reported Itch SeverityMIPS Clinical Quality Measure (CQM)
#486 Dermatitis – Improvement in Patient-Reported Itch SeverityMIPS CQM
#487 Screening for Social Drivers of HealthMIPS CQM
#488 Kidney Health EvaluationElectronic CQM (eCQM) and MIPS CQM
#489 Adult Kidney Disease: Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) TherapyMIPS CQM
#490 Appropriate Intervention of Immune-Related Diarrhea and/or Colitis in Patients Treated with Immune Checkpoint InhibitorsMIPS CQM
#491 Mismatch Repair (MMR) or Microsatellite Instability (MSI) Biomarker Testing Status in Colorectal Carcinoma, Endometrial, Gastroesophageal, or Small Bowel CarcinomaMIPS CQM
#492 Risk-Standardized Acute Cardiovascular-Related Hospital Admission Rates for Patients with Heart Failure under the Merit-based Incentive Payment SystemAdministrative Claims*
#493 Adult Immunization Status    MIPS CQM
Quality Measures Removed from Traditional MIPSCollection Type
#110: Preventive Care and Screening: Influenza ImmunizationMedicare Part B Claims, eCQM, 
#111: Pneumococcal Vaccination Status for Older AdultsMedicare Part B Claims, eCQM, MIPS CQM

2. Promoting Interoperability (25%)

In order to improve the MIPS Healthcare interoperability Category, CMS is implementing several improvements. The following changes have been made:

  • Requiring and updating the Query of Prescription Drug Monitoring Program (PDMP) measure in the Electronic Prescribing Objective.
  • Extending the Query of PDMP measure to cover Schedule III and IV medications in addition to Schedule II opioids.
  • Adding a new Health Information Exchange (HIE) Objective option, Enabling Exchange under the Trusted Exchange Framework and Common Agreement (TEFCA) measure (requiring a yes/no response), as an optional accomplish the goal.
  • Consolidating the present choices for active involvement from three to two levels for the Public Health and Clinical Data Exchange Goal, and requiring active engagement reporting for the measurements under the objective.
  • Continuing to reweight the PI category for some types of MIPS-qualified non-physician providers.

Beginning with the 2023 performance period, CMS will discontinue automatic reweighting for the following clinician types:

  • Nurse practitioners
  • Clinical nurse specialist
  • Physician assistants
  • Certified registered nurse anesthetists 

In the performance period 2023, the agency will maintain automatic reweighting for the following:

  • Clinical social workers
  • Physical therapists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Clinical psychologists
  • Occupational therapists
  • Registered dieticians or nutrition professionals
PI ObjectiveMeasureMaximum Points
Electronic Prescribinge-Prescribing10 points
Query of PDMP10 points
Health InformationExchangeSupport Electronic Referral Loops by Sending Health Information15 points
Support Electronic Referral Loops by Receiving and Reconciling Health Information15 points
Health Information Exchange Bi-Directional Exchange*30 points
Participation in TEFCA30 points
Provider to Patient ExchangeProvide Patients with Electronic Access to Their Health Information25 points
Public Health and Clinical Data ExchangeReport the following 2 measures:Immunization Registry ReportingElectronic Case Reporting25 points
Report one of the following 
measures:Syndromic Surveillance ReportingPublic Health Registry ReportingClinical Data Registry Reporting
5 points (bonus)

3. Cost Category (30%)

  • For the 2022 MIPS performance period, 25 cost measures are set. 
  • CMS determines costs using claims data.
  • Not any data submission is required.
  • The performance of an EC is compared to a benchmark and a score of 1 to 10 is assigned. The cost category score is the average of all cost measures that have been scored.
  • CMS is also beginning to prioritize and conceptualize four more episode-based cost measures.

Other Considerations

If your case doesn’t reach the minimum threshold for any of the 25 criteria used to get a score, your score will be lower. In the final MIPS Healthcare score calculation, the cost performance category will be worth zero points, while the other performance categories will each be worth 30%. (Or categories).

4. Improvement Activities (15%)

Except for inventory updates, there are no significant changes to the MIPS Improvement Activities (IA) category. CMS is adding four new activities to the IA inventory, altering five current activities, and eliminating five existing improvement activities, as shown in the table below.

New Improvement ActivitiesRetired Improvement Activities 
IA_AHE_10 Adopt Certified Health Information Technology for Security Tags for Electronic Health Record Data (Medium)IA_BE_7 Participation in a QCDR, that promotes the use of patient engagement tools
IA_AHE_11 Create and Implement a Plan to Improve Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients (High)IA_BE_8 Participation in a QCDR, that promotes collaborative learning network opportunities that are interactive
IA_EPA_6 Create and Implement a Language Access Plan (High)IA_PM_7 Use of QCDR for feedback reports that incorporate population health
IA_ERP_6 COVID-19 Vaccine Achievement for Practice Staff (Medium)IA_PSPA_6 Consultation of the Prescription Drug Monitoring program
 IA_PSPA_20 Leadership engagement in regular guidance and demonstrated commitment to implementing practice improvement changes
 IA_PSPA_30 PCI Bleeding Campaign

Hurry up & outsource your MIPS Reporting to NEO MD and enjoy incentives

The 2023 performance period is rapidly approaching; thus, physicians should familiarize themselves with the requirements of the Final Rule to comprehend the possible implications for their reporting practices next year. Meanwhile, the 2022 MIPS reporting year is already underway. As the conclusion of the reporting period approaches, it is critical to focus efforts on achieving the current performance year reporting requirements.

NEO MD MIPS consultants work with a variety of practices to help them provide—and report on—the best quality of care measures, regardless of their EHR and PM platforms.

Top Motivation to Work with NEO MD

NEO MD stood best among competitors’ Revenue Cycle Management Companies due to the following cores;

  • Our experts work hard to reduce your front-end denials by 20%.
  • Claim first level acceptance ratio; 95-97%
  • We have consistently increased the collection rate for our clients because of the faster increase in the accuracy of fees and collection.
  • Refunds adjustment and Payment posting to improve the cash flow.
  • Offer Medical Billing Services that are easily scalable at all times.
  • Offer Provider & Staff Productivity Analysis
  • Offering state-of-the-art medical billing services for small practices, medium-sized, and large ones.
  • Offer internal Medical Billing audits to uncover loopholes
  • Improve RCM system efficiency with a robust credentialing team. 
  • Provide fortnightly financial and practice overviews 
  • Deliver customized Revenue Cycle Management Services to unearth operation shortcomings.
  • Provide in-depth MIPS Healthcare Reporting services that are of high quality and error-free.

YOU CAN REACH US for MIPS consulting services at ( or (929502-3636

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