The Final Rule for MIPS is here, and healthcare providers need to understand what’s changing and what’s staying the same. If you’re wondering how this affects your practice, you’re in the right place. Let’s break down everything you need to know about the latest updates.
What’s New in the Final Rule for MIPS 2025?
The good news is that many things are staying stable this year. The Performance Threshold is still at 75 points, and the Data Completeness Threshold remains at 75%.
One of the biggest changes is in the Cost category. CMS has made scoring adjustments that should help practices. The curve is now skewed upward to match average Cost scores.
The Activities Are Simplified and Improvement
Good news for busy practices. The Improvement Activities have been simplified. MIPS healthcare participants now only need to report two activities instead of more. If you’re a small practice or non-patient-facing, you only need to report one activity. This makes things easier for everyone involved in the final rule for MIPS 2025 reporting.
New Safety Rules For The Issues Faced By Vendors
Here’s something that many practices will appreciate. There’s a new Extreme and Uncontrollable Circumstances application specifically for vendor issues. If your vendor has technical problems that mess up your submission, you can file a hardship application after the fact. This protects practices when things go wrong that are outside their control.
How the Final Rule for Reporting Works Throughout the Year?
Success doesn’t happen overnight. The reporting process is a 15-month journey that needs planning. Let me walk you through what each part of the year looks like.
January Through March Is The Planning Time
This is when you set up everything for the year. You need to choose MIPS quality measures and figure out your strategy. For Promoting Interoperability, remember the reporting period is now 180 days, so you can’t wait until the last minute.
The Cost category can be tricky. Working with an experienced registry early helps you put strategies in place to improve your score. CMS now produces patient-level reports that can show you where your costs are coming from.
April Through June Is The Testing Phase
This is when you check if your plans are working. Submit test data and make sure everything is running smoothly. If you picked a new measure and it’s not working out, now’s the time to switch.
This quarter is also good for preparing for potential audits. Talk to your registry about what documentation you need. Being ready ahead of time makes audits much less stressful.
July Through September Is The Review and Feedback
CMS releases feedback reports during this time. These reports show how you did in the previous year. Pay attention to the Cost category scores, especially. This information helps you fix problems before they hurt your final score.
The Proposed Rule comment period also happens now. This is your chance to tell CMS what you think. They have to read and respond to all comments during the 60 days. Your voice matters, so use it.
October Through December Is The Time For Final Decisions
This is when you make your end-of-year choices. Look at your data and decide if you need to make any last-minute changes. Are your measures performing well? Do you need to submit additional data? These are the questions to answer before the year ends.
January Through March Again Is The Submission Time
This is when you submit everything to CMS and start planning for the next year. If you’ve been organized throughout the year, this part should be straightforward.
What is the Final Rule for MIPS 2025 Value Pathways?
MIPS value pathways are a simpler way to participate in the program. The Final Rule for MIPS shows that CMS is serious about MVPs. They’ve added six new pathways, bringing the total to 21. About 80% of eligible clinicians can now use at least one MVP.
Here’s the best part: CMS removed the requirement to choose between population health measures. They’ll calculate all of them and apply your best score automatically. This makes MVPs easier to use.
Why Choose an MVP?
MVPs have fewer clinical quality measures to report than traditional MIPS. You also get reduced Improvement Activity requirements and better alignment with what your specialty does. Many practices find that this reduces their workload while keeping scores high.
The Future of MVPs
CMS has said that traditional MIPS will probably end eventually. MVPs will become the standard way to participate. In 2026, multi-specialty practices will need to use subgroup reporting for MVPs. Even though MVPs aren’t required yet, now’s the time to start thinking about the transition.
APM Performance Pathway Updates
For Medicare Shared Savings Program ACO reporting, changes are coming. CMS was going to sunset MIPS CQM reporting in 2025 but pushed it back at least two years. This gives ACOs more flexibility.
The new APP Plus measure set will gradually add measures over the next few years. Starting in 2025, there will be five total measures. This increases to six in 2026, and seven in 2027 and beyond.
What Makes Practices Successful?
After working with many healthcare providers, some patterns are clear. Successful practices start early in the year. They work with experienced registries who know the system inside and out. They stay engaged throughout the year instead of waiting until December.
Documentation is key. Good documentation makes everything easier, from daily reporting to handling audits. Practices that treat MIPS quality reporting as part of their regular workflow do better than those that see it as a separate task.
How Prime Well Med Solutions Can Help?
At Prime Well Med Solutions, we understand that the final rule for MIPS reporting can feel overwhelming. The rules change every year, and keeping up takes time you’d rather spend with patients. That’s where we come in.
We help practices navigate the final rule for MIPS from start to finish. Our team knows the ins and outs of quality measures, cost containment, and everything in between. We work with you to choose the right measures for your specialty and make sure your data is accurate.
Whether you’re new to the final rule for MIPS or have been doing it for years, we can help you improve your scores and reduce the burden on your staff. We handle the technical stuff so you can focus on what you do best – taking care of patients.
Getting Started
It’s never too late to start. Even if you’re joining mid-year, experienced partners, our MIPS reporting company have strategies to help you catch up. The important thing is to start now and position yourself for success.
The final rule for MIPS brings some positive changes, but it still requires careful planning and execution. With the right approach and support for MIPS, you can turn quality reporting from a headache into an opportunity for improvement and better reimbursement.
Don’t let the final rule for MIPS stress you out. Reach out to us today.
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How Healthcare Providers Can Transition MIPS to MVPs
