Navigating MIPS/MACRA Requirements in 2025
The world of healthcare reimbursement continues to evolve, and 2025 brings notable updates to the Merit-Based Incentive Payment System (MIPS) under MACRA. For medical practices aiming to avoid penalties and maximize incentives, understanding these changes is critical. In this post, we break down the key regulatory updates, strategies for success, and how Access1 can support your journey to MIPS excellence.
Losing Revenue? Falling Behind on Compliance? Here’s What Smart Practices Are Doing
Key MIPS Changes for 2025
1. Increased Performance Thresholds
The minimum Composite Performance Score (CPS) needed to avoid penalties is now 75 points (updated annually by CMS).
The "Exceptional Performance Bonus" is being phased out, heightening competition for positive adjustments.
2. Evolving Quality Measures
CMS has introduced new specialty-specific quality measures while retiring outdated ones.
Data completeness thresholds have increased, meaning practices must report on a higher percentage of eligible patients.
3. Greater Emphasis on Cost
The Cost performance category now holds greater weight, influencing final MIPS scores more significantly.
New cost measures focused on episode-based care and chronic condition management have been added. New measures include updates for Oncology, Primary Care, COPD Episode Costs, Maternity Care Episode Costs and Cardiology specialties.
4. Promoting Interoperability Requirements
CMS now mandates broader use of certified EHR systems.
Emphasis on patient data access, secure messaging, and clinical data exchange has intensified.
5. Expansion of Improvement Activities
New activities target health equity initiatives, care coordination, and behavioral health integration.
Participation in recognized programs like ACOs may yield bonus points. Specific activities include Promoting Digital Health Tools, Screening for Social Determinants of Health (SDoH), and Enhancing Chronic Care Management Programs.
Strategies to Navigate MIPS in 2025
Stay Informed and Proactive
Subscribe to CMS's Quality Payment Program updates and educational webinars.
Work with expert partners like Access1 for regulatory coaching.
Prioritize Quality and Cost Efficiency
Focus on high-impact quality measures related to your specialty.
Analyze historical cost data to identify opportunities for savings.
Strengthen Your Technology Infrastructure
Ensure your EHR meets 2025 certification criteria.
Leverage interoperability tools to facilitate seamless patient data exchange.
Maximize Improvement Activities
Engage in activities that align with both MIPS requirements and your practice’s operational goals.
Document all initiatives meticulously to ensure audit readiness.
Why It Matters
Failing to meet the updated MIPS requirements could result in a financial penalty of up to 9% on Medicare reimbursements. Meanwhile, top performers stand to earn significant positive adjustments — plus increased practice efficiency and enhanced patient satisfaction.
Partner with Access1 for MIPS Success
Access1 helps medical practices stay ahead of regulatory changes, optimize revenue cycle management, and leverage technology to meet evolving healthcare standards. Our proven strategies ensure that practices not only comply but thrive under MIPS/MACRA frameworks.
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