MIPS & Quality Payment Program
MIPS reporting you can see coming, not discover in March
MIPS scores clinicians on four performance categories and adjusts future Medicare Part B payments. We help you choose measures and a reporting path, fix data capture at the source, monitor data completeness through the year and reach submission with no surprises.
- Quality · Cost · Promoting Interoperability · Improvement Activities
- MVPs
- APP Plus for MSSP ACOs
- CPT II capture
Who it's for
Built for the teams that run this program
Independent practices and groups
MIPS-eligible clinicians who report through their EHR or a registry and want to stop scrambling at year end.
Shared Savings Program ACOs
ACOs reporting the APP Plus quality measure set across participant TINs with different EHRs.
Specialty groups considering MVPs
Groups evaluating whether a MIPS Value Pathway fits their specialty and patient population better than traditional MIPS.
Design & launch
How we design and launch it
A reporting plan is set early in the year and checked monthly.
- 1
Eligibility and path
Confirm who is MIPS-eligible, at what level you report (individual, group, subgroup or APM entity), and whether traditional MIPS, an MVP or the APM Performance Pathway applies.
- 2
Measure selection
Choose quality measures you can capture reliably, with benchmarks you can score on, including the required outcome or high-priority measure.
- 3
Collection type
eCQM, MIPS CQM, Medicare Part B claims or Medicare CQM, chosen to match your EHR and registry, since each measure is benchmarked by collection type.
- 4
Data capture fixes
Structured fields, CPT II codes and templates so the numerator is captured at the visit, not reconstructed later.
- 5
Interoperability and activities
Promoting Interoperability measures, the 180-day performance period, security risk analysis, and Improvement Activities with their documentation.
Gate: Mid-year score projection.
- 6
Submission readiness
Validated data, completeness checks, attestation files and a submission calendar with owners.
Operations
How the program runs day to day
The four MIPS performance categories
Default weights for traditional MIPS in the 2026 performance year. Weights can be reweighted in some circumstances.
Quality
- Default weight
- 30%
- What it measures
- Performance on selected quality measures, generally six including one outcome or high-priority measure
Cost
- Default weight
- 30%
- What it measures
- Claims-based cost measures CMS calculates; nothing to submit, but attribution and documentation still matter
Promoting Interoperability
- Default weight
- 25%
- What it measures
- Use of certified EHR technology: e-prescribing, health information exchange, patient access and public health reporting
Improvement Activities
- Default weight
- 15%
- What it measures
- Attested activities such as care coordination, patient engagement and behavioral health integration
What we monitor through the year
- Data completeness: the share of eligible patients reported for each measure, against the 75% threshold.
- Measure performance by clinician and site, compared with the published benchmarks.
- Gaps that can still close this year, sent to care teams as work lists.
- Promoting Interoperability numerators and the continuous 180-day window.
- Improvement Activity evidence collected as the work happens.
MVPs and the APM Performance Pathway
MIPS Value Pathways (MVPs)
Smaller, specialty-focused measure sets that combine quality, cost and improvement activities with foundational interoperability and population health measures. CMS has said it intends MVPs to replace traditional MIPS over time.
APP Plus for Shared Savings Program ACOs
MSSP ACOs report quality through the APM Performance Pathway using the APP Plus measure set, with eCQM, MIPS CQM or Medicare CQM collection types. CMS proposed trimming APP Plus to eight measures for 2027 (proposed as of September 2026).
Documentation & compliance
Documentation and compliance essentials
Rules for the 2026 performance year, with a sample of the CPT II codes we build into templates.
CPT II capture examples
Category II codes report the result of a measured service. They support claims-based reporting and supplemental data for payers.
Blood pressure control
- CPT II codes
- 3074F · 3075F · 3077F
- What they report
- Most recent systolic below 130, 130–139, or 140 or higher
Blood pressure control
- CPT II codes
- 3078F · 3079F · 3080F
- What they report
- Most recent diastolic below 80, 80–89, or 90 or higher
Diabetes glycemic status
- CPT II codes
- 3044F · 3051F · 3052F · 3046F
- What they report
- Most recent HbA1c below 7.0%, 7.0 to below 8.0%, 8.0 to 9.0%, or above 9.0%
Measure specifications define which codes count for each collection type. Check the current specification before mapping.
Readiness essentials
- Data completeness of at least 75% of eligible patients for each quality measure (the threshold CMS set through the 2028 performance period).
- A performance threshold, set by CMS each year, above which payment adjustments are positive.
- A current security risk analysis and the required Promoting Interoperability attestations.
- Documentation for each Improvement Activity kept for six years in case of audit.
- Payment adjustments apply two years after the performance year.
KPIs we track
What we measure with you
Projected MIPS score
Category-by-category projection, updated monthly.
Data completeness by measure
Eligible patients with data, against the 75% threshold.
Measure performance rate
Each measure's rate by clinician, against benchmark deciles.
Structured capture rate
Visits where the measured value lands in a structured field or CPT II code.
PI numerators
Progress on each Promoting Interoperability measure.
Submission checklist
Open items, owners and due dates before the submission window.
Baselines and targets are set from your own data at the start of an engagement. We do not promise specific results.
FAQs
Common questions
Should we report traditional MIPS or an MVP?
It depends on your specialty, the MVPs available and the measures you can capture well. We compare both options on your data before the year is far along.
We are in an ACO. Do we still need MIPS help?
MSSP ACOs report quality through APP Plus, often across many EHRs, so eCQM data quality becomes an ACO-wide problem. Participant clinicians may also need Promoting Interoperability reporting. We help on both.
Do you submit our MIPS data?
Submission is done by your practice, ACO, EHR vendor or registry. We prepare and validate the data and the submission plan.
Related services
Programs that work alongside this one
ACO Programs (MSSP, ACO REACH, LEAD)
Quality reporting, benchmarks and participant readiness.
Learn morePractice Transformation & Quality Improvement
HEDIS and Star measures, care gap closure, AWV campaigns and care team redesign.
Learn moreEHR Enhancement & Optimization
Templates, macros, alerts, order sets, education and registry reports that capture the work.
Learn moreAnnual Wellness Visits (AWV)
Visit design, campaigns and the risk and quality capture an AWV enables.
Learn more
Ready to simplify the complex?
Book a consultation.
A working conversation about your patients, payers, EHR and staffing, and whether this program fits. Please do not send patient information.