Macra & Mips
MACRA and MIPS: Guiding Practices Toward Value Based Care
MACRA Explained
The Medicare Access and CHIP Reauthorization Act (MACRA) changed the way providers are paid by Medicare. Instead of relying on fee for service models that rewarded volume MACRA introduced a system designed to reward quality, outcomes and efficiency. For practices this means payment adjustments are no longer only about the number of patients you see but also about the impact and effectiveness of the care you deliver. At its core MACRA created the Quality Payment Program (QPP) which gives clinicians two pathways to participate:- MIPS (Merit based Incentive Payment System)
- APMs (Advanced Alternative Payment Models)
What is MIPS?
The Merit based Incentive Payment System (MIPS) measures provider performance across multiple areas and adjusts Medicare payments accordingly. High performing clinicians are rewarded with positive payment adjustments while underperforming ones may face penalties.
Unlike older programs that worked in silos MIPS combines several initiatives into one cohesive system ensuring providers focus on clinical quality, efficiency, patient engagement and smart use of technology.
MIPS Performance Categories
MIPS scores are based on four weighted performance areas:
- Quality – Measures patient outcomes, evidence based care and clinical best practices.
- Cost – Evaluates resource use and efficiency in delivering care without unnecessary spending.
- Improvement Activities – Rewards efforts to improve care delivery, patient safety and engagement.
- Promoting Interoperability – Focuses on the use of certified EHR systems for data sharing and patient access.
These categories are combined into a final performance score that directly influences your Medicare reimbursement.
Key Changes in MIPS for 2025
As healthcare evolves MIPS rules and benchmarks shift every year. For 2025 practices can expect
- Refined Quality Measures: Stricter benchmarks on clinical outcomes and patient experience.
- Greater Emphasis on Cost: A higher weight on cost efficiency encouraging practices to streamline resources.
- Expanded Improvement Activities: More recognition for care coordination, mental health integration and patient safety initiatives.
- EHR Requirements: Continued focus on interoperability with advanced expectations for digital health adoption.
These updates reflect a broader industry move toward value driven, patient centered care.
How MIPS Scoring Works
Each of the four categories is assigned a percentage weight. Your performance in each category is scored then combined into a Composite Performance Score (CPS) on a scale of 0 to 100.
- A higher CPS means higher incentive payments.
- A lower CPS can result in neutral or negative adjustments.
This score is compared against the performance threshold set by CMS for the year. For practices this means every point matters not just for compliance but for financial stability and growth.
Why Revneo’s Support Matters
Navigating MACRA and MIPS alone can be overwhelming. At Revneo, we help providers:
- Interpret new regulations and stay ahead of updates.
- Select the right measures tailored to their specialty.
- Accurately report data and avoid compliance pitfalls.
- Maximize scores to secure the highest possible reimbursements.
With our expertise your practice does not just “get through” MIPS. It uses it as a tool to improve care quality, strengthen compliance and unlock financial incentives.
The Bigger Picture
MACRA and MIPS are not just about meeting requirements. They represent a shift in U.S. healthcare toward accountability and value. Providers who embrace these programs can position themselves for long term success. Delivering better outcomes for patients while maintaining financial strength.
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