Free Resource Guide
MIPS 2026 Survival Guide:
Avoid Penalties. Maximize Bonuses.
Everything your quality director and practice administrator need to understand the 2026 Merit-based Incentive Payment System — and avoid the penalty that affects clinicians who get it wrong.
The 2026 MIPS penalty is up to -9% of Medicare Part B payments. For a practice billing $800K in Medicare annually, that is $72,000 at risk.
What Is MIPS?
MIPS — the Merit-based Incentive Payment System — is CMS's value-based payment program for eligible clinicians who bill Medicare Part B. It determines whether you receive a positive payment adjustment, no adjustment, or a negative adjustment on your Medicare claims, applied two years after the performance year.
MIPS consolidates three prior programs (PQRS, the Value Modifier, and Meaningful Use) into a single composite score. Your MIPS Composite Performance Score (CPS) is a weighted combination of four performance categories. The 2026 performance threshold — the score you must meet to avoid a penalty — is 75 points.
MIPS is not optional for most eligible clinicians. If you bill Medicare Part B and meet the low-volume threshold (more than $10,000 in Medicare billing and more than 100 Medicare patients and more than 200 covered professional services in the most recent period), you are required to participate.
The Four MIPS Categories
Quality
Report on 6 quality measures from the MIPS measure set — at least 1 outcome or high-priority measure. Data completeness threshold: 75% of eligible patients. Scores range from 0–10 per measure.
- →Select measures based on your specialty and patient population
- →Data completeness matters: 75% threshold for full credit
- →At least one outcome measure or high-priority measure required
- →CMS eCQM submission available for EHR-submitting practices
Promoting Interoperability
Demonstrate meaningful use of certified EHR technology through e-prescribing, health information exchange, patient access, and public health reporting. Base score plus bonus opportunities.
- →Must use 2015 Edition CEHRT or higher
- →Required base measures: e-Prescribing, Health Information Exchange
- →Patient access and patient education bonus measures
- →Hardship exception available for small or rural practices
Improvement Activities
Complete 2–4 improvement activities from the CMS activity inventory, covering care coordination, beneficiary engagement, patient safety, and population health management.
- →High-weighted activities earn 20 points each (2 activities = full score)
- →Medium-weighted activities earn 10 points each (4 activities = full score)
- →Primary Care Medical Home or PCMH designation: automatic full score
- →Activities must be performed for 90 consecutive days minimum
Cost
CMS calculates cost automatically from Medicare claims data. You do not submit data for this category. Scores are based on Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost (TPCC) measures.
- →You do not submit data — CMS calculates from claims
- →Most episode-based cost measures added in recent years
- →Attribution methodology based on plurality of Part B charges
- →Monitor your cost performance with Vizier claims analytics
2026 Scoring Thresholds
2026 Key Deadlines
January 1 – December 31, 2026
2026 MIPS performance year
Quality and PI measures must be collected throughout the year. Minimum 90-day reporting period applies to some measures.
October 2, 2026
2026 data submission opens
CMS opens the data submission portal for the 2026 performance year.
March 31, 2027
2026 data submission deadline
All MIPS data for the 2026 performance year must be submitted by 8:00 PM ET on March 31, 2027.
Mid-2028 (estimated)
2026 payment adjustments applied
Positive or negative payment adjustments from 2026 MIPS performance are applied to Medicare claims.
Free Download
Download the Full MIPS 2026 Guide
The complete download includes everything a quality director or practice manager needs to manage MIPS performance through 2026:
- ✓Detailed measure selection worksheet by specialty
- ✓MIPS scoring calculator (editable Excel)
- ✓Submission checklist by category
- ✓Provider-level tracking template
- ✓Exception reporting guidance
- ✓Common mistakes that trigger audits