$10,000+ Swing for the Average Practice
The 2026 performance year (January 1 – December 31, 2026) determines your 2028 Medicare payment adjustment. With the performance threshold set by CMS, practices scoring above the threshold earn a positive adjustment; those below face penalties — all calculated against your total annual Medicare Part B allowed charges.
For a practice billing $350,000 in Medicare annually, a 9% swing equals a $31,500 difference between a penalty year and a bonus year. The exceptional performance bonus (scores above the additional performance threshold) can push total adjustments even higher.
Small practices billing under $90,000 in Medicare charges or seeing fewer than 200 Medicare patients annually are exempt from MIPS reporting — but must verify their exemption status annually.
Four Categories, One Composite Score
Final score = (Quality × 0.30) + (Cost × 0.30) + (PI × 0.25) + (IA × 0.15). Each category is scored 0–100 points before weighting. Total composite score determines your 2028 payment adjustment.
Quality
30%Submit 6 quality measures including at least one outcome measure. High-value measures: NQF 0059 Diabetes A1C Poor Control, NQF 0018 Controlling High Blood Pressure, NQF 0024 Weight Assessment and Counseling.
Cost
30%Calculated automatically by CMS using Medicare claims. Key metric: Medicare Spending Per Beneficiary (MSPB). No data submission required — but no ability to ignore it.
Promoting Interoperability
25%Electronic prescribing, health information exchange, provider-to-patient exchange, and public health registry reporting. Must report to avoid a score of zero in this category.
Improvement Activities
15%40 points required (20 for small practices). High-weighted activities (20 pts each): care coordination, beneficiary engagement, patient safety. Medium-weighted: 10 pts each.
Which Quality Measures Maximize Your Score
You must report 6 quality measures, including at least 1 outcome or high-priority measure. Vizier maps your patient panel to every eligible measure, shows your current achievement rate vs. national benchmark, and identifies which measures your denominator-eligible patients can move to the numerator before year-end.
Benchmark comparison uses national Medicare median performance data. A measure where you score at the 75th percentile earns significantly more points than one where you score at the 50th — even with identical achievement rates.
MIPS Value Pathways: A Focused Alternative
MIPS Value Pathways (MVPs) offer a streamlined reporting approach with specialty-specific measure sets that replace the traditional six-measure Quality selection. MVPs align with value-based care initiatives and connect to population health measures already prioritized by your specialty.
Vizier maps your clinical data to available MVP frameworks — including the Rheumatology, Stroke Care and Prevention, Heart Disease, and Primary Care MVPs — and models your projected score under both traditional MIPS and MVP before you commit to a submission path.
How the Final Score Maps to Payment Adjustment
Penalty zone. CMS sets the performance threshold annually. Any score below triggers a negative payment adjustment applied across all 2028 Medicare Part B claims.
Neutral zone. Scoring exactly at the performance threshold means no adjustment — neither penalty nor bonus. This is the floor to target at minimum.
Bonus zone. Higher scores yield proportionally higher positive adjustments. Exceptional performance scores (above additional threshold) can stack on top of standard bonuses.
Download the Complete 2026 MIPS Survival Guide
Detailed measure selection worksheets, benchmark data tables, submission timeline, and penalty avoidance checklist — written for practice administrators, not CMS policy analysts.