MIPS is hard. If you work in healthcare, you know this already. The Merit-Based Incentive Payment System decides how much Medicare pays you, but figuring out the rules sometimes feels impossible. The MIPS confusing parts trip up even experienced providers every single year.
You’re not doing anything wrong. MIPS is complicated. Most practices face the same problems. They pick measures that don’t help their score. They miss deadlines. They submit data wrong. Then they get hit with payment penalties.
Prime Well Med Solutions works with healthcare providers every day. We see where people get stuck. We know which MIPS confusing parts cause the most trouble. Let’s see what the five biggest problem areas are and give you ways to fix them.
What MIPS Does to Your Medicare Payments?
MIPS looks at four things about your practice. Quality measures. Cost measures. Promoting Interoperability. Improvement Activities. CMS puts all four together into one score.
That score matters a lot. If you do well, you can get up to 9% more money from Medicare. If you do poorly, you can lose up to 9%. Most providers end up somewhere in the middle.
The catch is that thresholds go up every year. Things will work differently from last year. You need to understand MIPS confusing parts about healthcare rules to protect your practice income and take better care of patients.
Problem 1 – Picking Quality Measures
This is one of the worst MIPS confusing parts. CMS gives you hundreds of quality measures to choose from. How do you know which ones to pick? Most providers just guess or use whatever they used before.
If your patient group changed, your old measures might not work anymore. If there’s a better measure available, you’re leaving money on the table. If you pick measures that don’t fit your workflow, your staff won’t document them right.
Look up your specialty in the CMS Measure Specifications. This tells you which measures apply to your type of practice. Pull your current performance information and see how you’re doing on each measure. Compare your numbers to the national average.
Pick measures where you already do well. Or pick ones where you can improve without too much extra work. Don’t pick measures that need complicated new steps your team will forget about.
MIPS consulting services can help with this. They have software that looks at your numbers and tells you which measures will give you the best score. They take the guesswork out of it.
Problem 2 – Tracking Information Throughout the Year
Most practices wait until December to think about MIPS confusing parts. They try to pull everything at the last minute. Then they find out they have missing information. Or incomplete measures. Or numbers that don’t make sense.
This happens because nobody tracked anything during the year. You can’t fix problems in December that happened in March. Successful MIPS healthcare reporting needs year round attention.
Set up quarterly meetings to check your progress. Look at each MIPS confusing part measure in March. Check again in June. Check in September. If something looks wrong, you still have time to fix it before the year ends.
Make your EHR system do some of the work. Set up templates that capture the MIPS confusing parts information automatically when staff document patient visits. This saves time and makes sure nothing gets missed.
Tell your whole team why MIPS matters. When everyone knows which measures you’re tracking, they pay more attention to documentation. A quick team update every three months keeps everyone on track.
Problem 3 – Understanding the Scoring System
The MIPS scoring system is confusing. CMS compares you to every other provider who reports the same measure. They split everyone into groups. Where you land in those groups decides how many points you get.
Small changes in your performance can make big differences in your score. Your score affects your payments for two years. You need to understand how this works. Guessing costs money.
Read the CMS Final Rule every year. Yes, it’s boring. Yes, it’s long. But it explains the scoring rules. You don’t need to remember everything. Just understand the main points.
Learn about decile benchmarks. CMS ranks all providers from best to worst. If you’re in the top groups, you get more points. If you’re in the bottom groups, you lose points.
Watch webinars that show scoring examples. Seeing numbers makes it easier to understand. Some websites have calculators where you can test different scenarios.
A MIPS reporting company can tell you where you stand throughout the year. They can show you what would happen if you changed certain things. This helps you make better choices instead of hoping for the best.
Problem 4 – Choosing How to Submit Your Information
CMS gives you different ways to submit MIPS information. You can use your EHR. You can submit through claims. You can use a registry. You can work with a QCDR. Each option has good and bad points.
Many practices just pick whatever seems easiest. The wrong choice can ruin your score or create audit problems later.
Think about cost first. Some EHR companies charge extra for MIPS reporting. Registries usually charge fees too. Figure out what you’re paying and what you’re getting for that money.
Think about accuracy. Claims based reporting is simple but limits which measures you can report. Registry reporting gives you more options and catches mistakes before you submit.
Think about protection. If CMS questions your information later, having a registry or QCDR backing you up helps a lot. They keep records and have processes that prove your submission is correct.
If you plan to submit on your own, test it early in the year. Upload sample files and see what errors come up. Fix problems now instead of panicking when the deadline hits.
Many practices use MIPS consulting services just for the reporting part. One small mistake in how you format files can mess up everything.
Problem 5 – Keeping Up With Changes
This might be the most annoying of all MIPS confusing parts. The rules change every single year. CMS releases a new Final Rule that changes thresholds, adds new measures, removes old measures, and tweaks how scoring works.
You’re already busy seeing patients and running a practice. Staying current with MIPS feels impossible.
Subscribe to CMS newsletters. Join their stakeholder calls. You’ll get updates as soon as they happen.
Go to industry webinars after the new Final Rule comes out. These sessions explain the changes in normal English. You don’t have to read thousands of pages of regulations.
Have a team meeting when new rules drop. Figure out how the changes affect your plan. Do you need different measures? Did submission deadlines change? Make decisions as a team.
Important Dates for 2026
Mark these dates on your calendar right now.
January 1, 2026, is when the performance year starts. December 31, 2026, is when it ends. You have January through March 2026 to submit your information. CMS will send feedback reports in July 2026. Your payment adjustments start in January 2027 based on how you did in 2026.
Missing these dates or forgetting about them causes major problems. Set reminders now so you don’t lose track.
Getting Help With the MIPS Confusing Parts
MIPS confusing parts don’t have to ruin your life. Yes, parts of it are confusing. Yes, the rules are complicated. But you can manage it in smaller pieces that make sense.
Choose measures based on your performance numbers, not guesses. Track your work all year long, not just in December. Learn how scoring works so you can make smart choices. Pick a reporting method that fits your practice. Stay updated on rule changes so nothing surprises you.
Lots of practices try to handle MIPS by themselves. Then they realize they don’t have enough time. Between patients, staff, insurance companies, and everything else, MIPS gets pushed aside.
If MIPS confusing parts stress you out, or if you’re worried about losing money, We can help. We’re an MIPS reporting company that makes everything simpler. We help you pick measures. We handle submission. We take care of technical details so you can focus on patients. We make sure you get the best score possible.
Want to talk about your practice? Contact us today. We’ll build a plan that works for you. MIPS confusing parts don’t have to hold you back anymore.
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