As we know, Medicare is always moving the target when it comes to quality reporting requirements. One such challenge with MIPS is the penalty avoidance threshold, the minimum amount of points clinicians need to achieve in order to prevent them from receiving a negative payment adjustment on Medicare Part B claims. This article breaks down the impacts of receiving a MIPS penalty and highlights how Quantician, a CMS qualified registry, can play a role in ensuring providers dodge these penalties.

Understanding the Performance Threshold: The performance threshold in MIPS is 75 points. Clinicians or practices scoring below this 75-point threshold risk incurring a penalty on their 2026 Part B reimbursement. On the other hand, a score above this threshold will result in the opportunity to earn a performance bonus. Here’s a chart to break the penalties down further:

Diving into Bonuses: Although penalties are known, bonuses are a different story. The bonus pool is funded by the penalties and remains an uncertainty until CMS calculates the final scores of all MIPS participants. This unpredictability makes it a challenge for clinicians to estimate potential bonus amounts. Historically, bonuses have been relatively small and have made it difficult for healthcare providers to accurately project their earnings.

The Purpose of the Gap Year: The gap year between the 2024 performance year and the payment adjustment release in 2026 serves an important purpose. CMS requires time to process MIPS data, determine final scores, conduct targeted reviews, and calculate adjustment factors for bonuses to ensure budget neutrality. This time allows for a thorough and accurate evaluation of clinicians' performance before applying the appropriate payment adjustments. Always keep in mind that the bonuses are paid directly from the penalties that are inflicted. More penalties mean higher bonuses.

The Payment Adjustment: In 2026, CMS will implement a payment adjustment based on your 2024 MIPS final score. This adjustment, applied to Medicare Part B remittances throughout the year, impacts clinicians at the Taxpayer Identification Number (TIN) and National Provider Identifier (NPI) levels. Even if you move to a new practice after 2024, your final score from that year will determine your 2026 payment adjustment. Your most recent score will follow your NPI.

Ensuring Compliance and Mitigating Risks: Understanding the intricacies of MIPS becomes more difficult with every passing year, leveraging the expertise of Quantician, a CMS qualified registry, becomes crucial. Quantician provides comprehensive support to you in navigating MIPS requirements, optimizing performance, and ensuring accurate reporting. By partnering with Quantician, you can mitigate the risk of penalties, improve your MIPS scores, and reduce the administrative burden created by MIPS.