MIPS (Merit-based Incentive Payment System)
MIPS, the Merit-based Incentive Payment System, is the CMS program that adjusts Medicare Part B payments up or down based on a clinician's performance across quality, cost, improvement activities, and promoting interoperability. For the 2026 performance year the threshold to avoid a penalty is 75 points, applied to 2028 payments.
- Program
- Quality Payment Program track under MACRA
- 2026 performance threshold
- 75 points (through 2028 PY)
- Payment year for 2026
- 2028
- Categories
- Quality, Cost, Improvement Activities, Promoting Interoperability
What is MIPS?
MIPS, the Merit-based Incentive Payment System, is one of the two tracks of the Quality Payment Program that MACRA created. It ties a clinician's Medicare Part B payments to measured performance: do well and payments adjust upward, do poorly and they adjust downward. It replaced several older programs (PQRS, the Value Modifier, and Meaningful Use) with a single composite score.
MIPS is budget-neutral in its penalty-and-bonus design, so the upward adjustments for high performers are funded largely by the downward adjustments applied to low performers.
What are the four MIPS categories?
| Category | What it measures |
|---|---|
| Quality | Selected clinical quality measures |
| Cost | Resource use CMS derives from claims |
| Improvement Activities | Care-process and access activities |
| Promoting Interoperability | Certified EHR use and data exchange |
The categories are weighted and summed to a final score out of 100. Weights shift over time, so verify the current-year weighting when planning reporting.
How does scoring affect payment?
Example: a practice finishes 2026 with a MIPS score of 68. Because the threshold is 75, it falls short and receives a negative payment adjustment on its Medicare Part B payments in 2028. A practice scoring 88 clears the threshold and earns a positive adjustment. The two-year lag between performance and payment is a defining feature of the program.
- 2026 performance is scored against a 75-point threshold.
- The resulting adjustment applies to 2028 Part B payments.
- Scores below the threshold produce penalties; scores above earn bonuses.
Frequently asked questions
For the 2026 performance year the threshold is 75 points, and CMS has committed to holding it at 75 through the 2028 performance period. Clinicians scoring at or above 75 avoid a penalty and may earn an upward adjustment; those below 75 face a negative payment adjustment applied to their Medicare Part B payments two years later, in 2028.
Quality (clinical measures), Cost (resource use CMS calculates from claims), Improvement Activities (care-process activities), and Promoting Interoperability (certified EHR use and data exchange). Each carries a weight that sums to a final score out of 100, compared against the performance threshold to set the payment adjustment.
It is mandatory for eligible clinicians who exceed the low-volume threshold on Medicare Part B allowed charges, beneficiaries, and services, unless they participate through an Advanced Alternative Payment Model instead. Clinicians below the low-volume threshold are excluded, and new Medicare enrollees are exempt in their first year.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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