What is MIPS in Healthcare: Understanding What it Means for Me

what is mips in healthcare

If you’re in the medical field and have wondered “what is MIPS in healthcare,” this article is for you. MIPS stands for merit-based incentive payment system, and the proper management of this system is essential to the functioning of your healthcare organization. As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the CMS, or Centers for Medicare and Medicaid Services, must utilize a Quality Payment Program to promote higher-quality and lower-cost healthcare across the United States of America.

Your MIPS performance score will impact you as a clinician by increasing or reducing the payment adjustment on your claims under Medicare Part B. Because of this, it is crucial for any healthcare provider planning to work with Medicare and Medicaid patients to fully understand the system and how it can impact their practice.

The MIPS system, or its alternative APM, determines how well individual clinicians perform within the program and rewards them accordingly. If you’re looking for a simple way to improve your MIPS system ratings, using an effective and professional billing service like PracticeForces for your healthcare organization can turn things around quickly. To learn more about medical billing solutions by PracticeForces, call today at (727) 499-0351 to speak to one of our friendly staff members.

How the MIPS System Works

There are four performance categories used to assess each clinician to build the MIPS score. These combine to explain “what is MIPS in healthcare?”.


MIPS eligible clinicians score on six different quality measures within the quality category. Clinicians select these measures from a more extensive list and can strategically choose them to increase scores. Again, working with experts like the team at PracticeForces can help you ensure you’re selecting the best possible measures to emphasize your practice’s strengths and earn the highest score.

Improvement activities

This category measures how innovative your practice has been and helps to keep progress moving forward in the healthcare field. Consistent participation in qualifying improvement activities is essential to maintaining a high MIPS score. Clinicians struggling with this requirement should explore AAPM&R Practice Improvement Projects (PIPs) as a cost-effective option to raise their scores.

Promoting Interoperability

Commonly referred to as meaningful use, your score on this section depends mainly on the effectiveness of your communication. Ensure that you file paperwork and send communications to patients promptly to score well here. If you’re struggling to manage your current workload, a medical services company like PracticeForces can help streamline your process.


The most straightforward category to explain, the cost score is calculated using two numbers: Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost (TPCC) over each performance year. Maintaining budget neutrality and charging reasonable fees for service can improve your score here.

Take Control

Now that you’ve read this article answering the question ” what is MIPS in healthcare,” you understand how vital this system can be to your practice. To learn about other aspects of the healthcare field or for their resources like a thorough telemedicine guide, visit the PracticeForces website today. Then, if you’re ready to maximize the benefits the MIPS system can have for your practice, call (727) 499-0351 today.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

Related Posts


Do you want to streamline your reimbursements?

Subscribe for actionable tips and insights to grow your medical practice >

Call Now Button