Definition · Value-based care

MIPS (Merit-based Incentive Payment System)

The Merit-based Incentive Payment System (MIPS) is a Medicare Quality Payment Program track. It adjusts eligible clinicians' Part B payments based on a 0 to 100 performance score. The score combines Quality, Cost, Improvement Activities, and Promoting Interoperability. For the 2026 performance year, the threshold is 75 points and the maximum negative adjustment is -9%.

What MIPS is

MIPS was created by MACRA, the 2015 law that replaced the old Medicare payment formula for clinicians. Each year, eligible clinicians report data in four categories: Quality, Cost, Improvement Activities, and Promoting Interoperability. CMS combines them into a final score from 0 to 100 that sets a payment adjustment two years later.

For the 2026 performance year, which drives 2028 payments, the performance threshold is 75 points. CMS holds it at 75 through the 2028 performance year. Scores below the threshold get a negative adjustment, down to -9%. Scores above it can earn a positive adjustment, which is budget-neutral and scaled.

MIPS Value Pathways (MVPs) are a newer way to report, using measure sets built around a specialty or condition. For 2026 there are 27 MVPs, 6 of them new. Many quality measures depend on getting patients in for screenings and follow-up. Rivvi helps staff find those patients in uploaded reports and reach them by phone and text.

Questions

MIPS, answered

What is the MIPS performance threshold for 2026?

The MIPS performance threshold is 75 points for the 2026 performance year, which affects 2028 payments. CMS has held it at 75 through the 2028 performance year. Clinicians scoring at or above 75 avoid a negative adjustment, and scores above it can earn a positive one.

What is the maximum MIPS penalty?

The maximum negative payment adjustment is -9%, set by MACRA. It applies to Medicare Part B payments for covered professional services in the payment year. Clinicians who are required to participate and do not report generally receive the maximum negative adjustment.

What are MIPS Value Pathways (MVPs)?

MVPs are MIPS reporting options built around a specialty, condition, or episode of care. Each uses a smaller, related set of quality measures, improvement activities, and cost measures. CMS offers 27 MVPs for 2026, 6 of them new. They aim to make reporting match the care a clinician actually delivers.

MIPS vs Advanced APM: what is the difference?

MIPS adjusts fee-for-service payments based on a performance score. Advanced Alternative Payment Models, such as ACO tracks with downside risk, let clinicians who meet participation thresholds become Qualifying APM Participants (QPs). QPs are excluded from MIPS and, in 2026, get a slightly higher conversion factor: about $33.57 versus $33.40.

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What MIPS is

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