2025 MIPS payment adjustments have gone into effect for eligible clinicians that participated in the Quality Payment Program in performance year 2023. While many clinicians are seeing positive payment adjustments, it comes somewhat bitter sweet. Here are a few of the key highlights and takeaways that clinicians should be aware of as they begin seeing their payment adjustments have an impact on claims reimbursements in 2025.

Historical MIPS Payment Adjustments *The maximum payment adjustment for top performers in PY 2023 will be +2.15% on Medicare payments in 2025

Key Takeaways The Merit-based Incentive Payment System (MIPS) Positive Payment Adjustment formula is based on a clinician's final score and the MIPS performance threshold for the applicable year. The adjustment is budget-neutral, meaning the total bonuses are constrained by the penalties collected from lower-performing clinicians. Below we have outlined the key contributing factors that impacted the current MIPS payment adjustments.

Final Score Factor

• If a clinician’s final MIPS score is above the performance threshold, they receive a positive adjustment.
• The higher the score, the greater the adjustment.

Scaling Factor Score

• Since MIPS is budget-neutral, the actual adjustment depends on how many clinicians receive positive vs. negative adjustments.
• CMS adjusts the scaling factor to redistribute penalties into bonuses.
• Typically, it is less than 1, meaning positive adjustments are reduced proportionally.

Change Healthcare Cyber Attack

• Allowed Eligible Clinicians to file the Extreme and Uncontrollable Circumstances (EUC) exemption until March 31st of 2024.
• Providers that were approved for the EUC automatically received a 0% or neutral payment adjustment which eliminated any penalties that could have been issued.

<u>General Formula for MIPS Positive Payment Adjustment:</u> Payment Adjustment = (Final Score Factor) x (Scaling Factor) x (Maximum Positive Adjustment)

Related CMS Updates Medicare Physician Fee Schedule was cut by 2.83% which amounts to a negative payment adjustment overall. There is a bipartisan bill known as the “Medicare Patient Access and Practice Stabilization Act of 2024” that would eliminate the reduction and then add an additional 2% positive adjustment to account for inflation. If the bill passes in April 2025, Medicare reimbursements could increase by up to +6.85%.