New
Year-End Medical Billing: Why Temp Staff Won’t Stop 2027 Denials
Read this before you hire a temp agency for your year-end medical billing crunch. Claimocity has a better way to handle the billing crunch and your year-round RCM services.
Beyond the Acronym: Why MIPS Affects Your Revenue
MIPS has been around long enough that most providers recognize the acronym. What’s less clear is how the score itself is built, and why small technical differences can lead to very different payment outcomes.
MIPS is not graded on intent or effort. It is scored on defined measures, benchmarks, and thresholds that do not always align with how care is delivered day to day. CMS also adjusts some of those rules every year, so the scoring details providers overlook can shift from one performance year to the next.
This page breaks down how MIPS scoring works in practice, from how each category earns points to where scoring risk is likely to hide. If you’re still new to MIPS, we suggest starting with this comprehensive guide to MIPS reporting.
Merit-based Incentive Payment System. That’s MIPS. Medicare uses it to adjust your reimbursement rates based on performance in four areas: Quality measures, Cost efficiency, Improvement Activities, and how well you use certified EHR technology.
Every eligible clinician gets scored on a 100-point scale. That score doesn’t affect this year’s payments. It affects what Medicare pays you two years later. That lag makes it easy to lose track of MIPS until the payment adjustment shows up.
If you exceed Medicare’s low-volume threshold, you’re already being scored whether you’re paying attention or not. Ignoring MIPS costs money. Understanding it protects your revenue.
The penalty can reach 9% of your Medicare Part B payments, and in 2027 it comes off a lower base rate. Medicare’s physician conversion factor drops 2.31% under the CY 2027 final rule.
CMS scores you in four categories, and each one is worth a set share of your final score.
| Category | Share of score | What it measures | What you do |
|---|---|---|---|
| Quality | 30% | How often you meet clinical standards on measures you choose | Report at least six measures for the full year |
| Cost | 30% | What your patients’ care costs Medicare compared with similar clinicians | Nothing. CMS calculates it from your claims |
| Promoting Interoperability | 25% | How you use certified EHR technology | Report measures and required attestations for at least 180 days |
| Improvement Activities | 15% | Work that improves how care is delivered | Attest to activities you ran for at least 90 consecutive days |
For a hospitalist, a Quality measure might be documenting an advance care plan or a patient’s current medications. Most hospital-based clinicians have Promoting Interoperability reweighted to 0%, which makes Quality worth more than half their score.
You don’t need a perfect score in every category to do well. You do need to know how each one earns points.
Each category gets its own score from 0% to 100%. CMS multiplies each one by the category’s weight and adds the results into a final score out of 100.
CMS compares your performance rate on each measure to a national benchmark split into deciles. The higher your decile, the more points you earn, up to 10 per measure. Your Quality score is the points you earned divided by the points possible.
Three rules limit what a measure can earn:
Small practices that submit Quality data get 6 bonus points added to this category.
You don’t submit anything for Cost. CMS attributes patients and episodes of care to you from your Medicare claims, then compares your costs to a benchmark for each measure. Measures that don’t meet their case minimum aren’t scored. If none of your cost measures can be scored, CMS moves the Cost weight to your other categories.
Each activity you attest to earns 20 points, and 40 points earns full credit. That means two activities for most clinicians. Small, rural, HPSA, and non-patient-facing clinicians earn 40 points per activity, so one activity gets them full credit. Each activity has to run for at least 90 consecutive days.
You earn points for your performance on measures like e-prescribing and patient access to records, reported over at least 180 consecutive days from certified EHR technology. Some attestations are all or nothing. Answering "no" on a required one, such as the SAFER Guides measure, zeroes out the whole category.
If a category doesn’t apply to you, CMS moves its weight to the others. That’s common for hospitalists:
| Scenario | Quality | Cost | Improvement Activities | Promoting Interoperability |
|---|---|---|---|---|
| Standard scoring | 30% | 30% | 15% | 25% |
| PI reweighted (hospital-based clinicians) | 55% | 30% | 15% | 0% |
| PI reweighted, small practice | 40% | 30% | 30% | 0% |
When PI drops out, Quality becomes more than half your score. For hospitalists, measure selection carries the most weight.
If you’re facility-based, CMS can score your Quality and Cost categories from your hospital’s performance in the Hospital Value-Based Purchasing Program. You still need to attest to Improvement Activities. If you also submit your own Quality data, CMS automatically uses whichever approach gives you the higher final score.
CMS can add up to 10 bonus points to your final score if you treat medically and socially complex patients. The final rule keeps this bonus unchanged for 2027.
Medicare converts your MIPS performance into a payment adjustment two years later. Below 75 points, Medicare cuts your Part B payments on a sliding scale, from 0% at 75 points to the maximum 9% cut at 18.75 points or below. Above 75, every point earns a positive adjustment, but those bonuses are funded by penalties and stay small, as we explain in what counts as a good MIPS score.
A 9% penalty hurts. A hospitalist billing $800,000 in Medicare payments annually loses $72,000 if they fail badly enough in their MIPS reporting. That’s not a rounding error. That’s hiring budget, equipment upgrades, or take-home pay.
But the good news is that you don’t need a perfect score to avoid penalties. If you’re above 75 points, you’re in positive adjustment territory. Every point above that threshold increases your bonus.
MIPS scoring comes down to one number: your final score. That score determines whether your Medicare payments are adjusted up, down, or not at all.
The minimum score to avoid a penalty is 75 points, and CMS has kept it there through the 2028 performance year. Below 75, the penalty grows on a sliding scale, about 0.16% for every point you fall short, until it reaches the full 9% at 18.75 points. Above 75, the positive adjustment grows with your score, but it stays small because MIPS is budget neutral. For the 2027 performance year, CMS projects the largest positive adjustment at about 1.34%.
In practice, the risk is rarely a disastrous year. It’s a solid year that still ends up short because Quality or Cost didn’t score as expected. For a hospitalist billing $800,000 a year to Medicare, a score of 70 means a cut of about 0.8%, or $6,400. A score of 50 means about 4%, or $32,000.
Choose measures where you already see enough patients and where your current workflow captures the data. If you routinely document advance care plans or current medications as a hospitalist, that’s a quality measure waiting to be claimed. You need to make sure you’re capturing it in a way MIPS recognizes.
Pull your quality measure reports every quarter. Set calendar reminders. If you’re underperforming on a measure in March, you can course-correct. Discover it in November and you’re stuck with nine months of data you can’t change.
Most hospitalist practices already run care coordination programs, medication reconciliation initiatives, or quality improvement committees. Those count as Improvement Activities. Keep a simple log of what you’re doing and when. "Participated in weekly care coordination rounds from January through December" works as documentation for Medicare.
Hospitalists usually document in the hospital’s EHR, which they don’t control, so confirm early how quality data will get from that system to your registry or submission method.
Medicare patients count toward your MIPS score. But if you’re reporting on a quality measure that applies to all payers, your commercial and Medicaid patients count too. Understanding your denominator helps you pick the right measures. Look at your patient mix and choose measures where your volume is strongest.
The CY 2027 final rule keeps the performance threshold at 75 points. The change most practices will notice is a new requirement to report at least one MIPS core measure as part of your Quality set, unless you’re in a small practice. Skip it without attesting that none applies, and one of your measures scores zero.
The new core measure requirement is the clearest example of how a small miss turns into lost points. For a hospital-based group with Promoting Interoperability reweighted, skipping an applicable core measure can cost up to about 9 points on the final score.
For every update, including the move to MVP-only reporting in 2031, see what’s changing in MIPS for 2027.
MIPS compliance takes time that most providers don’t have. Between patient rounds, documentation, and the actual work of medicine, tracking quality measures and attesting to improvement activities often falls to the bottom of the list. That’s where revenue gets lost. And not in a way that can be recovered through claims denial management.
Claimocity built MIPS tracking directly into your charge capture workflow. You’re not bolting on another system or learning new software. You’re documenting encounters the same way you always have, while MIPS tracking happens automatically in the background.
Claimocity handles the administrative burden of MIPS so you can focus on patient care without sacrificing compliance. You get to reclaim hours every week that would otherwise go to manual data entry and attestation management.
If you want MIPS compliance to feel routine instead of disruptive, schedule a demo to see how Claimocity handles MIPS inside the workflow you already use.
Read this before you hire a temp agency for your year-end medical billing crunch. Claimocity has a better way to handle the billing crunch and your year-round RCM services.
Palliative care is growing despite challenges to make these services as profitable as hospice care. Learn how to close the gap with better billing.
From cardiologists who provide critical care to rheumatology consultations, know how CPT codes are used for inpatient care in 2026 and 2027.
Ease your provider experience with us.