Over the past decade, Medicare has significantly changed how it pays clinicians. Long gone are the days when clinicians can automatically earn more money by simply providing more services. While today’s clinicians do continue to receive fee-for-service (FFS) payments, they’re also increasingly held accountable for the quality of the care they render.

It all goes back to a law introduced in 2015 called the Medicare Access and CHIP Reauthorization Act (MACRA). This law reformed the entire Medicare payment system by repealing the Sustainable Growth Rate (SGR) formula for payment and replacing it with a value-based payment system. Together, MACRA and MIPS are central to Medicare’s shift to value-based care, tying portions of payment to performance and outcomes rather than volume alone.

Read on for essential updates on the 2025 MACRA and MIPS that impact medical practices and billing companies.

MACRA is the law that requires Medicare to establish value-based payment models collectively referred to as the Quality Payment Program (QPP). Implemented in 2017, MACRA repealed the SGR formula and built on meaningful use foundations to advance interoperability and patient engagement.

Since then, the Centers for Medicare and Medicaid Services (CMS) has continued to refine the MIPS within QPP to tie healthcare reimbursement more closely to quality, cost, and information exchange.

Under this program, payment models reward clinicians who provide high-value, high-quality care with payment increases, while reducing payments to clinicians who do not meet performance standards. The QPP is an incentive program that aligns reimbursement with quality, cost, and information exchange to improve outcomes and support public health. 

The QPP operates through two participation pathways: MIPS and APMs. Participants report on performance categories such as quality, cost, promoting interoperability, and improvement activities.

Patients benefit from MACRA because they receive higher-quality care through the advanced use of healthcare information and more streamlined care coordination. MACRA also promotes patient education, engagement, and empowerment. 

These changes can improve outcomes and help patients lead happier, healthier lives. For Medicare beneficiaries, the program aims to improve outcomes, reduce avoidable hospitalizations, and support public health through better coordination and the secure use of data.

Clinicians also benefit from MACRA because its payment models support them in improving patient satisfaction and providing meaningful care that aligns with value-based principles. Clinicians are paid to do exactly what they were trained (and deeply want) to do: keep patients healthy.

MIPS is one way in which eligible clinicians can comply with MACRA. The other path is through APMs, which are outside the scope of this guide.

According to the CMS, MIPS ties payments to quality and cost-efficient care, improves care processes and outcomes, increases the use of healthcare information, and reduces the cost of care. Clinicians receive a 0–100 final score that informs future payment adjustments.

In performance year 2025, there are three MIPS reporting options available to eligible clinicians:

Many Accountable Care Organizations (ACOs) participate through the Shared Savings Program, which can intersect with MIPS and the APM Performance Pathway.

Note: CMS plans to phase out traditional MIPS in future years and make MVPs the standard reporting option. Until that change takes effect, most clinicians should continue focusing on traditional MIPS.

In general, APMs are designed to create a stable and uniform set of MIPS reporting requirements that increase an eligible clinician’s confidence in moving into more risk-bearing arrangements. Many APMs, including Medicare Shared Savings Program ACOs, emphasize care coordination and may qualify as advanced alternative payment models.

For MIPS purposes, the APM Performance Pathway contributes to a clinician’s overall performance score through three weighted categories for performance year 2025:

Download the 2025 comprehensive list of APMs here.

MVPs were brand-new for the performance year 2023. Medicare created this reporting option to provide eligible clinicians with clinically related performance measures that align more closely with their specialty and scope of practice. MVPs streamline performance categories and can strengthen patient engagement and care coordination.

In an MVP, clinicians select from a smaller, more meaningful set of quality measures and improvement activities. They also report on a set of foundational measures to promote interoperability, as well as certain clinician-selected population MACRA MIPS health measures.

In 2025, eligible clinicians can choose from the following:

Eligible clinicians can report multiple MVPs. For example, an entire internal medicine group can participate as a group to report the “value in primary care” MVP, and a subset of those clinicians can participate as a subgroup to report the “advancing care for heart disease” MVP.

MIPS-eligible clinicians earn a performance score from 0-100 based on the data they report to Medicare. This final MIPS score determines future Medicare Part B payment adjustments, which are applied 2 years later (for example, 2025 data affects 2027 payments).

The MIPS performance year runs from January 1 to December 31 for quality and cost. Promoting interoperability requires 180 consecutive days, while improvement activities vary based on those selected.

For the 2025 performance year under traditional MIPS, the final score is based on four weighted categories:

See the appendices of the 2025 Quality Payment Program Fact Sheet for full details on new, revised, and removed measures.

A clinician’s final MIPS score (0–100) directly affects Medicare Part B reimbursement 2 years later. For performance year 2025, the following score ranges determine the payment adjustment applied in 2027:

The 4 performance categories that potentially drive the final MIPS score are: 

Clinicians can use this tool to determine MIPS eligibility based on data from the performance period. The following are considered eligible clinicians under MIPS:

MIPS reporting options apply to eligible clinicians at the individual, group, or virtual group level.

Eligible clinicians may participate at one or more of the following levels:

Participation choices can vary by MIPS reporting option, including traditional MIPS, the APM Performance Pathway, or MVP.

Clinicians are exempt from MIPS if they meet the low-volume threshold:

The MIPS Determination Period involves CMS reviewing past and current Medicare Part B claims and Provider Enrollment, Chain, and Ownership System (PECOS) data for clinicians and practices twice each performance year. Each review analyzes 12 months and determines MIPS eligibility and low-volume status.

Clinicians and practices generally must exceed the low-volume threshold during each segment of the Determination Period to be eligible for MIPS. Clinicians within the low-volume margin may still opt to join MIPS.

Determinations are assessed for individuals and for groups. A clinician may be exempt when reporting solo but required to participate if reporting as part of a group that surpasses the threshold.

Secure maximum reimbursements with our free, proven MIPS strategy guide.

Private practices may face specific challenges when trying to meet MIPS requirements because they often operate with a smaller budget for training. This can leave clinicians and medical coders unaware of performance year 2025 changes, which increases the risk of missing quality measure reporting opportunities. Reporting also reflects value-based payment realities in everyday clinical practice.

The good news is that there are plenty of free resources tailored to small practices. These include a newsletter, a quick-start guide for small practices, and more.

Here are some important MIPS facts for small practices (i.e., practices with 15 or fewer clinicians identified by National Provider Identifier):

To see whether your medical practice is considered a small practice, visit Participation Lookup.

The following strategies will help medical billers promote revenue integrity.

Each quality measure may require specific documentation to justify reporting. Confirm accurate and complete entries to support MIPS data, and standardize note templates. If your team previously used the Physician Quality Reporting System (PQRS), verify how those measures map to current MIPS quality measures.

Confirm coders capture all required data elements for MIPS reporting. Check for valid exclusions and correct modifier use. Proper modifiers can influence payment adjustments and overall reimbursement.

When Medicare applies MIPS payment adjustments, look for:

Monitoring these indicators helps interpret performance and identify root causes that affect revenue.

These reporting requirements align with the performance year and the key dates below. For more MIPS deadlines, see the CMS deadlines page:

MIPS continues to shape how Medicare pays clinicians, with 2025 bringing updated category weights, new and revised measures, and multiple reporting options. Traditional MIPS remains the default pathway, though CMS plans to phase it out in favor of MVPs in future years. 

For now, clinicians should confirm their eligibility, select the most relevant measures, and ensure documentation and submissions are accurate and timely. Staying on top of deadlines and scoring changes is key to protecting Medicare Part B reimbursement under value-based care.

For step-by-step guidance and resources to help your practice succeed under MACRA and MIPS, visit Tebra’s MIPS Resource Center.