Learn about our MIPS performance categories, category weights, performance threshold, payment adjustments, reporting deadline, and much more, through the Frequently Asked Questions (FAQs) below. Please schedule a consultation if you are looking for a Security Risk Analysis (SRA) for MIPS or Expert Consultants to help you navigate the process.
Table of Contents
What are the four MIPS performance categories?
MIPS evaluates clinicians across four weighted performance categories. Quality measures the clinical quality of care delivered through reported healthcare process, outcome, and patient experience measures. Cost measures the resource utilization attributed to a clinician, calculated directly by CMS from Medicare Part B claims data, no separate reporting is required from the clinician for this category. Promoting Interoperability (PI) assesses the use of certified electronic health record technology (CEHRT) to support patient engagement and the electronic exchange of health information. Improvement Activities (IA) evaluates participation in practice-level activities that enhance clinical care, patient access, care coordination, and patient safety.
What are the MIPS category weights for the 2026 performance year?
For 2026, the four performance categories contribute the following weights to the final MIPS composite score for individuals, groups, and virtual groups, unchanged from 2025: Quality 30%, Cost 30%, Promoting Interoperability 25%, and Improvement Activities 15%. These weights shift under certain qualifying circumstances. Small practices (15 or fewer clinicians in the TIN) automatically receive reweighting of the Promoting Interoperability category to 0%, with the freed-up weight redistributed to Quality (bringing it to 40%) and Improvement Activities (bringing it to 30%). Hospital-based clinicians, non-patient-facing clinicians, and ASC-based clinicians also qualify for automatic PI reweighting to 0%, but for these groups the full 25% weight is redistributed to Quality only, bringing it to 55%, not split with Improvement Activities.
What is the 2026 MIPS performance threshold?
For the 2026 performance year, the MIPS performance threshold, the composite score required to avoid a negative payment adjustment, remains at 75 points. CMS has confirmed this threshold will hold through the 2028 performance year, which translates to the 2030 payment adjustment year. Clinicians whose final composite score equals exactly 75 points receive a neutral (0%) payment adjustment. Those who score above 75 receive a positive adjustment; those below 75 receive a negative one. Clinicians in the lowest quartile, scores from 0 to 18.75 points, are subject to the maximum negative adjustment.
What payment adjustments are possible based on 2026 MIPS performance?
For the 2026 performance year, payment adjustments will be applied to Medicare Part B payments in 2028. The maximum negative adjustment is,9% for clinicians whose final composite score falls between 0 and 18.75 points. The maximum positive adjustment is not fixed in advance, MIPS is a budget-neutral program, and the bonus pool is funded entirely by penalties collected from low-scoring clinicians, with the final maximum positive percentage calculated after the performance year closes. CMS projects that 84.04% of MIPS-eligible clinicians will receive a positive payment adjustment for 2026, 4.03% a neutral adjustment, and 11.92% a negative adjustment. Clinicians who are eligible but choose not to participate at all automatically receive the full,9% penalty on their 2028 Medicare Part B payments.
When is the reporting deadline for the 2026 MIPS performance year?
The 2026 MIPS performance year spans January 1 through December 31, 2026, with all performance data due to CMS by March 31, 2027, and the resulting payment adjustments applied to Medicare Part B payments in 2028. This two-year lag, collect in Year 1, report by early Year 2, receive adjustment in Year 3, is a consistent feature of the MIPS program cycle. Missing the March 31, 2027, submission deadline results in the full,9% payment penalty automatically applied to 2028 Medicare Part B payments, with no opportunity to cure the omission after the deadline passes.
When does CMS notify clinicians about their MIPS scores and payment adjustments?
Each year, approximately in July, CMS releases final composite scores from the prior performance year and the corresponding payment adjustments that will take effect the following calendar year. For the 2026 performance year, CMS is expected to release final scores in approximately July 2027, with the resulting payment adjustments applied to Medicare Part B payments beginning January 1, 2028. Clinicians can access their score and feedback report through the QPP portal at qpp.cms.gov at that time.
Can I appeal my MIPS score or payment adjustment?
MIPS-eligible clinicians who believe an error was made in their score calculation may submit a Targeted Review Request through the QPP portal under 42 CFR 414.1385(a)(2). The targeted review window opens on the day CMS releases final MIPS scores and closes 30 days after CMS publishes the MIPS payment adjustment factors for that payment year. This 30-day post-payment-adjustment deadline has been in effect since the 2024 performance year and its associated 2026 payment adjustment year; prior to that, the window was 60 days. Valid grounds for a targeted review include data quality issues with submitted measures, eligibility or special status errors, for example, a clinician who should have fallen below the low-volume threshold, incorrect exclusion from an APM participant list, or failure by CMS to apply automatic reweighting for which the clinician qualifies. If CMS requests supporting documentation, it must be provided within 15 days of that request.
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