MIPS Reporting Services
MIPS reporting is how Medicare Part B clinicians send quality, improvement activities, and Promoting Interoperability data to CMS each year, and the final score sets a payment adjustment two years later. NextRCM checks eligibility, plans measures, keeps the data complete, and prepares the practice's submission so the score reflects the care actually delivered.
MIPS reporting is the yearly submission of quality, improvement activity, and interoperability data that sets a clinician's Medicare Part B payment adjustment.
MIPS is easy to get wrong quietly: a missed eligibility check, measures chosen too late, or data that falls short of the completeness rule can cut a clinician's Medicare payments two years later, long after the year can be fixed.
Talk to our team- Eligibility checked once, or not at all, for each clinician and TIN
- Quality measures picked after the year is already half over
- Quality data codes missing from Part B claims for small practices
- Scores and payment adjustments nobody reviews until they hit payments
What our MIPS reporting delivers
A clear eligibility answer
Each clinician and TIN checked against the low-volume threshold, so you know who must report, who may opt in, and who is out.
A measure plan set early
Quality measures, improvement activities, and Promoting Interoperability chosen at the start of the year, while the data can still be captured.
Complete, consistent data
Quality data codes and EHR data tracked against the completeness rule month by month, not discovered short at year end.
No surprise adjustments
Feedback reports, final scores, and payment adjustments reviewed, with a targeted review request prepared when the scoring looks wrong.
What our MIPS reporting covers
Physicians, nurse practitioners, physician assistants, therapists, and other MIPS eligible clinicians who bill Medicare Part B covered professional services. DME suppliers and home health agencies are not MIPS eligible clinicians, but the practices that refer to them often are.
The rules behind MIPS reporting
Who has to report
MIPS eligible clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, CRNAs, physical and occupational therapists, speech-language pathologists, audiologists, clinical psychologists, registered dietitians, clinical social workers, and certified nurse midwives, and groups that include them.
Source: 42 CFR 414.1305
The low-volume threshold
A clinician or group is excluded with $90,000 or less in allowed charges for covered professional services, 200 or fewer Part B patients, or 200 or fewer covered professional services. Reporting is required only when all three are exceeded; exceeding one or two allows an opt-in.
Source: 42 CFR 414.1310(b)
How the final score is weighted
The final score runs from 0 to 100 points. Quality counts for 30%, cost for 30%, improvement activities for 15%, and Promoting Interoperability for 25%, unless CMS reweights a category.
Source: 42 CFR 414.1380(c)
The 75-point performance threshold
The performance threshold is 75 points for the 2026, 2027, and 2028 performance periods (the 2028 through 2030 payment years).
Source: 42 CFR 414.1405(b)
What the score does to payment
A score at the threshold gets a neutral adjustment. Scores below it get a negative adjustment on a sliding scale, reaching minus 9% at one fourth of the threshold or less. Scores above it earn a positive adjustment that CMS scales each year, so the positive amount is not fixed in advance.
Source: 42 CFR 414.1405(c)
The 75% data completeness rule
Quality measures must cover at least 75% of the patients who meet each measure's denominator: all payers for EHR and registry reporting, and Medicare Part B patients for claims reporting, through the 2028 performance period.
Source: 42 CFR 414.1340
Claims reporting and the deadline
Small practices (15 or fewer clinicians) may report quality through Medicare Part B claims processed within 60 days after the year ends. Direct, upload, and attestation submissions are due March 31 after the performance year unless CMS sets a later date.
Source: 42 CFR 414.1325
Who may submit for you
Only a QCDR, a qualified registry, or a CMS-approved survey vendor may submit MIPS data on a clinician's behalf as a third party intermediary. Other support works through the practice's own submission.
Source: 42 CFR 414.1400(a)
Checked against the eCFR and the CY 2026 Physician Fee Schedule final rule (Federal Register document 2025-19787) on November 9, 2026. MIPS rules change every year; confirm the current year on qpp.cms.gov.
Our MIPS reporting process
Eligibility and reporting level
We check each clinician's eligibility and low-volume status, then decide with you whether to report as individuals, a group, or a subgroup.
Why teams choose us for MIPS reporting
Billing and MIPS in one team
The team that codes and bills your Part B claims also tracks your quality data codes, so the claims and the MIPS data agree.
Honest about what we are
NextRCM is not a Qualified Registry or QCDR. Collection types that need one stay with one, and the practice submits under its own QPP access.
Rules checked against the source
Every threshold and weight on this page is checked against the regulation and the current Physician Fee Schedule final rule, not a vendor summary.
Planning before the year closes
Most MIPS results are decided by what is captured during the performance year, so the work starts in January, not at the March deadline.
Industry insights worth knowing
What we see move the numbers in MIPS reporting, in plain terms.
The score is set by what the year captured
MIPS quality performance depends on data recorded during the performance year, on claims or in the EHR, so measure choices made in January matter more than any work done near the March deadline.
Completeness is a rule, not a nice-to-have
Quality measures must cover at least 75 percent of eligible patients, and a measure reported on too few patients loses most of its value, so tracking completeness during the year protects the score.
Payment effects arrive two years later
The final score for a performance year adjusts Medicare Part B payments two years later, which is why a weak year can go unnoticed until the adjustment is already being applied.
MIPS Reporting questions
No. MIPS applies to eligible clinicians who bill Medicare Part B covered professional services, such as physicians, nurse practitioners, and therapists. DME suppliers and home health agencies are not MIPS eligible clinicians. The physician practices that refer to them often are, and we support those practices directly.
Important: NextRCM provides MIPS planning, data preparation, and review support. NextRCM is not a CMS Qualified Registry or QCDR and does not submit MIPS CQMs. Final scores and payment adjustments are calculated by CMS, and no score or adjustment is guaranteed. Never send patient health information through this website.
Ready to strengthen your MIPS reporting?
Start with a free billing audit: we review a sample of your recent denials and aging A/R and show you where this service fits. No cost, no obligation.