Claimocity Claims
Navigating MIPS Quality Measures:
What Inpatient Providers Need to Know for 2026
The practices that score highest in MIPS Quality aren’t always the ones providing the best care. They’re the ones who understand how benchmarking works and build a reporting strategy around it.
Quality measures are often where clinicians feel the most pressure in MIPS. They track your actual clinical performance over 12 months and compare it to national benchmarks. This category is highly weighted at 30% of your final score, as it is performance-based and benchmark-driven.
Most of the difficulty comes down to tracking performance consistently, documenting everything CMS might audit, and adapting to year-over-year changes in benchmarks and measure inventory. On top of that, you’re choosing between seven measure types, four collection methods, and potentially hundreds of individual measures depending on your specialty. Pick the wrong ones or submit through the wrong method, and you’ll lose points you could have earned.
For inpatient providers who already have to juggle complex workflows and high patient volume, understanding how this category works will make reporting much more manageable.
This guide breaks down what quality measures are, how the different types work, how to choose the ones that make sense for your practice, and how to report them efficiently.
What Are MIPS Quality Measures?
Quality measures track clinical performance. They answer the question: “Are your patients getting better outcomes based on the care you’re providing?” They track metrics related to things like screening rates, chronic disease management, patient-reported outcomes, and appropriate use of procedures. Since this category makes up a full 30 percent of your final score, the measures you choose can quickly shift your overall score.
Everyone reports at least six measures, and one of them needs to reflect an outcome. If an outcome measure truly doesn’t apply to your work, an intermediate outcome or high‑priority measure can step in without penalty.
Every clinician or group must report at least six measures, including one outcome measure. If no outcome measure is applicable, you can use an intermediate outcome or high-priority measure instead.
These measures look at real clinical performance through documentation, patient outcomes, efficiency patterns, and structured data captured throughout the year.
The 7 Types of Quality Measures
1. Process Measures
These track whether you performed a specific clinical activity.
Example: Measure 112, Breast Cancer Screening.
Did you screen eligible patients?
Process measures are straightforward to report, but CMS is phasing some of them out over time because they don’t directly measure outcomes.
2. Outcome Measures
These track the actual health results of your patients.
Example: Measure 398, Optimal Asthma Control.
Did the patient’s asthma improve?
Outcome measures earn you two bonus points automatically, so they’re worth prioritizing if you can report on them.
3. Intermediate Outcomes Measures
These track short-term health states that contribute to long-term outcomes.
Example: Measure 236, Controlling High Blood Pressure.
It’s not the final outcome (avoiding stroke or heart attack), but it’s a step toward it.
4. Patient-Reported Outcome Measures
The patient tells you how they’re doing.
Example: Measure 375, Functional Status Assessment for Total Knee Replacement.
These are becoming more common as CMS pushes for patient-centered care.
5. Efficiency Measures
These track whether you’re using clinical resources appropriately.
Example: Measure 439, Age Appropriate Screening Colonoscopy.
Are you screening the right patients at the right intervals?
Efficiency measures can also support your Cost category score, so they offer value in more than one place.
6. Structure Measures
These track whether you have systems in place to support high-quality care.
Example: Measure 225, Radiology Reminder System for Screening Mammograms.
Some structure measures can be automated through your EHR, which makes them simpler to complete.
7. High-Priority Measures
CMS defines certain measures as particularly meaningful for improving patient outcomes or efficiency. These don’t earn bonus points like outcome measures, but they highlight areas CMS views as clinically significant.
Why the Measures Type Matters
- Outcome measures get bonus points: Always include at least one. If you can report more, even better.
- Process measures might disappear: CMS is slowly removing process measures that don’t correlate with better outcomes. Don’t build your whole strategy around them.
- Efficiency measures help with Cost: If you’re worried about your Cost category score, efficiency measures can give you an edge.
- Structure measures can be automated: If your EHR can auto-populate data for structure measures, those are straightforward points.
Choosing the Right Quality Measures
The measure list changes every year, but your approach should stay the same. Rather than trying to navigate the full CMS measure list, focus on picking the measures that make sense for how your practice runs. Your choices can be the difference between a strong Quality score and a weak one.
Here’s what to weigh:
Start With What You're Already Doing
Don’t pick measures that require you to change your clinical workflows or track new data. Look at what you’re already documenting and find measures that align with your current practice patterns. If you’re already screening for diabetes complications, there’s probably a measure for that. If you’re managing chronic heart failure patients, pick measures tied to that population.
Prioritize Outcome Measures
You need at least one outcome measure to meet the reporting requirements, and outcome measures earn two bonus points. If you can report on multiple outcome measures without compromising your score in other areas, do it. Just make sure you’re confident you’ll perform well on them; benchmarks for outcome measures can be tough.
Consider Measure Applicability
Some measures only apply to specific patient populations. If you don’t see enough eligible patients to meet the case minimum (typically 20 patients), that measure won’t work for you. Check the denominator criteria before committing to a measure.
Look for Structure Measures You Can Automate
If your EHR can auto-populate data for structure measures, those are straightforward options that don’t require additional documentation. Examples include reminder systems, clinical decision support tools, or patient registry participation. These measures often take no additional time to complete once they’re set up in your system.
Avoid Measures You'll Score Poorly On
This may be obvious, but it’s worth saying: don’t pick measures where you know your performance is weak unless you’re actively working to improve in that area. MIPS scoring is based on benchmarks. If the 90th percentile for a measure is 95% and you’re at 75%, you’re losing points.
Specialty Measure Sets
CMS publishes optional sets that group measures by specialty. These aren’t mandatory, but they simplify selection by narrowing your options to those most relevant to your work. If a specialty set exists for your field and includes at least six measures, you can report the full set instead of choosing measures individually.
Some specialties have robust measure sets with 10+ options, while others have only a few. Specialty sets are optional; you can always mix and match individual measures instead, especially if the set doesn’t align well with your patient population.
For inpatient providers: Most specialty sets are designed for outpatient-focused fields such as cardiology, dermatology, or orthopedics. If you’re a hospitalist or primarily work in inpatient settings, you’ll likely be selecting individual measures rather than relying on a specialty set.
How to Report MIPS Quality Measures in 2026
Once you’ve selected your measures, you’ll need to choose how to report them. Your reporting path depends on your EHR setup, practice size, and whether you’re working with a registry.
eCQMs (Electronic Clinical Quality Measures): Pulled directly from your EHR. Highly structured and often the strongest option if your EHR supports them and your data quality is reliable.
MIPS CQMs: More flexible than eCQMs and compatible with EHRs, registries, or even paper workflows. Solid fallback if eCQMs aren’t available.
QCDR (Qualified Clinical Data Registry): Created by CMS-approved registries and tailored to specific specialties. Often the best fit for specialists using a registry.
Medicare Part B Claims: Limited to very small practices and only covers Medicare patients. Fewer measures use this pathway each year.
Submission Methods
You can report through Medicare Part B claims (if eligible), upload data in the QPP portal, or have your EHR or registry submit via API. Most practices choose registry or API submission because these options reduce manual work and improve accuracy.
General Reporting Requirements
All clinicians must:
- Report six measures, including one outcome measure
- Submit a full 12-month performance period
- Meet data completeness standards
- Use a qualifying submission method
- Report a full specialty measure set if choosing that option
For a deeper walkthrough of how to choose the right measures and reporting pathway, see our guide:What MIPS Measures Should I Report?
How Quality Measures Impact Your Payment
Quality often feels like the most demanding part of MIPS, and there’s a reason for that. This category has a larger financial impact, so the highs and lows show up more clearly in your payment adjustment. Measures supported by complete data and consistent performance tend to lift your results, while weaker areas make a clearer dent here than in the other parts of MIPS. Breaking down how CMS scores each measure can help you focus your efforts where they matter most.
Performance Rate
Your consistency becomes part of your bottom line. CMS looks at how reliably you meet each clinical goal across eligible patients. CMS looks at how reliably you meet each clinical goal across eligible patients. Your performance rate is calculated using a numerator and denominator: the denominator is your full eligible patient population for that measure, and the numerator is the subset that met the performance goal. For example, if you have 100 eligible patients for a diabetes screening measure and 90 of them were screened, your performance rate is 90%.
Data Completeness
If the data isn’t complete, you leave money on the table. CMS requires that most eligible patients be included in each measure. Missing data can reduce your score even when your performance rate is high, limiting your ability to earn full credit.
Case Minimums
Low patient volume can limit your scoring potential. Most measures require at least 20 cases to qualify for full scoring. If you fall below that threshold, CMS may cap the score, which can bring down your overall payment impact.
Benchmark Availability
Your score depends on how you compare to clinicians nationwide. CMS compares your performance rate to all other providers who reported the same measure. If the benchmark at the 90th percentile is 95%, you may need to hit 95% or higher to earn the full 10 points for that measure. If you score 80%, you may earn fewer points based on where that rate falls within the distribution. Benchmarks vary by measure and shift year to year, which means the difficulty of earning full points changes along with them. That shift has a direct effect on your final payment.
Best Practices for Better Quality Performance
Select Measures Strategically
Pick measures where you already perform well and have strong documentation. If you know your screening rates are high or your chronic disease management is solid, choose measures that reflect that. Don’t pick measures where you’re consistently below benchmark unless you’re actively working to improve in that area.
Optimize Your Submission Method
Assess your EHR capabilities before committing to a collection type. If your system supports eCQMs and the data quality is reliable, that’s often your strongest option. If not, a registry like Patient360 can handle the submission logistics and reduce the administrative burden on your team.
Document Everything
CMS can audit your MIPS data. Keep source documentation for every measure you report, including how you calculated performance rates, which patients were included in the denominator, and any exclusions you applied. If you can’t validate your data during an audit, CMS may adjust or remove the measure from your score.
Review Year-to-Year Changes
CMS updates the quality measure inventory annually. Measures get retired, benchmarks shift, and new measures get added. Review the final rule each year to confirm your planned measures still exist and check if reporting requirements have changed.
Align Measures with Clinical Workflows
Integrate quality measure tracking into your existing workflows rather than treating it as a separate reporting task. If your team is already documenting care coordination or chronic disease management, build measure reporting into those same processes. This reduces duplicate work and improves data accuracy.
Make Reporting Manageable with Claimocity
You’re already doing the clinical work. The problem is proving it in a format CMS accepts, within their timelines, using collection types that match your EHR setup.
Most quality score problems aren’t quality problems. Practices lose points because they picked measures with tough benchmarks, didn’t track data completeness throughout the year, or submitted through a method that limited their measure options. By the time they realize the issue, the performance period is over and there’s no fixing it.
That’s what happens when your data is scattered across multiple systems. Reporting becomes guesswork instead of strategy. Claimocity brings all your measure activity, documentation, and performance insights into one place so you can make decisions with confidence. You see where you stand on each measure in real time, not just at year-end. If a benchmark shifts or your data completeness drops below 70%, you know before it costs you points. Our platform tracks your performance throughout the year, aligns your measure selection with your submission method, and keeps your documentation audit-ready without requiring extra administrative work from your team.
If you want reporting to feel more manageable and less reactive, book a demo today!
