MIPS Changes for 2025: What You Need to Know Now

The Merit-based Incentive Payment System (MIPS) continues to evolve, and the 2025 Medicare Physician Fee Schedule Final Rule brings several significant updates. These changes reflect the Centers for Medicare & Medicaid Services’ (CMS) ongoing commitment to refining value-based care while addressing provider concerns.

This guide explores the critical updates for the 2025 performance year, including quality reporting changes, measure updates, and strategic medical billing tips to enhance performance.

Clinicians will be assessed based on the following four categories, with weight allocations remaining the same as in previous years:

Clinicians’ combined scores from these categories will determine their Medicare payment adjustments in 2027.

Seven new measures have been added, emphasizing diagnostics and public health priorities, such as:

• #494 – Evaluating radiation dose and image quality in diagnostic CT scans.
• #508 – Tracking COVID-19 vaccination rates among adults.
• #507 – Encouraging germline testing for ovarian cancer patients.

Tip: Practices should review these new measures to ensure alignment with reporting requirements.

2. Quality Measures Removed

To improve reporting efficiency, CMS has eliminated ten measures, including:

• #104 – Androgen deprivation therapy for prostate cancer.
• #439 – Age-appropriate colorectal cancer screening.

Impact: This shift helps clinicians focus on impactful and relevant performance metrics.

Clinicians with special statuses (e.g., small practices, rural providers) now need to report just one activity to earn the maximum IA score—down from the previous requirement of up to four.

Tip: Small practices should leverage this change to reduce reporting burden and focus on patient care.

Starting in 2024, CMS recalibrated cost scoring by benchmarking clinician performance against median cost thresholds. These updates are expected to result in higher cost scores for many participants.

Tip: Providers should review cost measure reports to identify areas for improvement and mitigate potential financial risks.

• 9% Maximum Penalty: Non-compliance can lead to significant payment reductions, disproportionately impacting small and solo practices.
• Reporting Complexity: Despite simplifications, reporting requirements remain challenging for smaller organizations.
• Higher Risk for Small Practices: CMS projects that 45.65% of solo practitioners and 20.93% of small practices may face penalties.

• Stable Performance Thresholds: The minimum score to avoid penalties remains at 75 points, offering consistency.
• Support for Small Practices: CMS introduced policies allowing score reweighting when third-party intermediaries fail to submit data.
• MIPS Value Pathway (MVP): A specialty-specific reporting alternative that can help reduce administrative burden.

Tip: Small practices should explore MVP options to streamline reporting and maximize performance scores.

Recognizing the unique challenges faced by smaller providers, CMS has introduced policies such as:

1. Reweighting Flexibility: Allowing adjustments when external reporting failures occur.
2. Reduced IA Requirements: Special status clinicians only need to report one activity.
3. Technical Assistance: CMS offers support programs to guide small practices through the reporting process.

Tip: Small practices should proactively engage with CMS resources and seek professional billing support to stay compliant providers.

MIPS plays a critical role in the shift toward value-based care by rewarding clinicians for improving patient outcomes while controlling costs. The 2025 changes demonstrate CMS’s dedication to refining the program while addressing clinician concerns.

Although these updates offer opportunities for better performance, they also present challenges—especially for smaller practices that may lack resources for compliance.

Final Thought: Staying informed and adopting strategic adjustments will be key to optimizing MIPS performance, reducing penalties, and ensuring financial success.

1. Seek Professional Support: Partnering with experts can help navigate MIPS complexities and ensure compliance.
2. Evaluate Your Practice’s Readiness: Review your current performance data and identify areas needing improvement.
3. Adopt New Quality Measures: Ensure you are tracking and reporting the newly introduced quality metrics.
4. Explore Alternative Reporting Pathways: Consider MVPs to simplify reporting and focus on specialty-specific measures.

Our team of certified coders and billing experts stays up-to-date with evolving MIPS regulations to ensure accuracy and efficiency in reporting. Partner with Cloud RCM solutions for reliable medical billing services that help you stay compliant and maximize reimbursements.

Get in touch today to streamline your billing operations and optimize your MIPS performance!