This content is excerpted from EyeNet’s MIPS 2023: A Primer and Reference; also see the Academy’s MIPS hub page.
Under MIPS, future Medicare Part B reimbursement is subject to a payment adjustment based on current clinician performance, with your 2023 MIPS final score determining whether your 2025 payment adjustment is positive (a bonus), neutral (no adjustment), or negative (a penalty), as shown below.
Table: Bonuses and Penalties
|2023 MIPS Final Score
||2025 Payment Adjustment
||Maximum penalty of –9%
||Penalty on a sliding scale (see table below)
||Neutral (no penalty, no bonus)
||Bonus on a sliding scale
Table: Payment Penalty
If your 2023 MIPS final score is less than the 75-point performance threshold, your 2025 Medicare Part B payments will be reduced as shown below.
Determining the Payment Adjustment
The performance threshold is 75 points. Earn a bonus by scoring more than 75 points; incur a penalty by scoring fewer.
The penalties are known. If your MIPS final score is 18.75 points or lower, you will incur the maximum –9% penalty; if you score between 18.75 and 75 points, your payments will be reduced as shown in Table 1B.
The bonuses aren’t yet known. The bonuses will be funded by payment penalties. Consequently, CMS can’t estimate how much money is in the bonus pool—and how many clinicians will be entitled to money from that pool—until it has calculated the final scores of all MIPS participants, which can’t happen until the performance year is over. To date, bonuses have been quite small.
Why is there a gap year between performance (2023) and payment adjustments (2025)? CMS needs time to process clinicians’ MIPS data, determine MIPS final scores, perform targeted reviews, and calculate what the adjustment factors for bonuses will need to be in order to ensure budget neutrality.
Each summer, check how CMS has scored your previous year’s performance. You will be able to view performance feedback and your payment adjustment information when you log in to the CMS website (qpp.cms.gov/login). Check the payment adjustment information carefully. If you note any scoring errors, you can request a targeted review, but you should act swiftly. Once the final performance feedback is released, you only have 60 days to request a targeted review.
Applying the Payment Adjustment
In 2025, CMS will start applying a payment adjustment that will be based on your 2023 MIPS final score. This will be applied throughout 2025 to your Medicare Part B remittances.
Your payment adjustments are always applied at the TIN/NPI level. CMS will apply the 2025 MIPS payment adjustment to individual clinicians, and it will do so regardless of whether you participated in 2023 MIPS as an individual or as part of a group that pooled its MIPS data. CMS uses Taxpayer Identification Numbers (TINs) and National Provider Identifiers (NPIs) to identify individuals (see “Use of TINs and NPIs as Identifiers”).
What if you move to another practice after 2023 is over? Your 2023 MIPS final score will determine your 2025 payment adjustment, and this is the case even if you move to a new practice after the 2023 performance year.
Next: Your 2023 MIPS Final Score
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