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MIPS Improvement Activities:
2027 Guide
Improvement Activities are one of the easiest MIPS categories to overlook, mainly because they feel vague. But that doesn’t mean you should ignore them. They’re worth 15% of your final score, and unlike Quality measures that require performance data, IAs are basically “yes, we did this” checkboxes. Just be sure to keep the records that show you did.
This category is one of the simpler ways to stabilize your score, especially for inpatient teams that don’t have the time or interest to dig through CMS’s definitions every year.
This guide breaks down what Improvement Activities are, what changed in 2027, how they’re scored, and how to choose the options that make sense for the way your practice actually works.
What Are Improvement Activities?
Improvement Activities are specific actions you take to improve your clinical practice, care quality, or patient outcomes. Think of them as CMS rewarding you for doing things you probably should be doing anyway, like care coordination, patient safety initiatives, using clinical decision support tools, etc.
They’re not clinical outcome measures, and they’re not cost measures. They’re essentially CMS asking: Did your practice take meaningful steps to improve how care happens? You’re not measured on results, just on whether you did the activity for at least 90 consecutive days during the year.
If you’re still new to MIPS, check out our full guide to MIPS reporting.
IA Subcategories
CMS groups activities into subcategories. You don’t need to pick from more than one. Choose the activities that fit work you’re already doing.
- Care Coordination: This includes things like medication reconciliation, care transitions, and referral tracking.
- Beneficiary Engagement: Many providers already engage in shared decision-making, patient feedback, and involving patients and families in care plans.
- Population Management: This includes identifying high-risk patients, chronic disease programs, and advance care planning.
- Patient Safety and Practice Assessment: These are clinical decision support, antimicrobial stewardship, fall screening, and patient safety tools.
- Behavioral and Mental Health: Screening and referral for depression, substance use, and tobacco use are common activities in this subcategory.
- Advancing Health and Wellness: These include things related to prevention, nutrition, and patient wellness.
Who Can Report Improvement Activities
- Individual clinicians: If you’re reporting MIPS solo, you pick your own activities.
- Groups: Groups report the same set of IAs for all clinicians. An activity counts for the group when at least 50% of your clinicians complete it during the same 90-day period.
- Virtual groups: Same rules as regular groups.
- Subgroups (under MVPs): Multispecialty groups reporting an MVP can split into subgroups of related specialties. This can be strategic if different parts of your practice are doing different improvement work.
- APM entities: Clinicians in a MIPS APM automatically receive at least half the category’s credit.
Small, rural, HPSA, and non-patient-facing clinicians need only one activity, which we cover in the scoring section.
How Improvement Activities Are Scored
Improvement Activities are worth 15% of your final MIPS score. The math is simple:
| Who you are | Points per activity | Activities for full credit |
|---|---|---|
| Most clinicians and groups | 20 | 2 |
| Small practice (15 or fewer clinicians), rural, HPSA, or non-patient facing | 40 | 1 |
| MVP reporters | Full credit for one activity | 1 |
| MIPS APM participants | At least 50% credit automatically | Depends on reporting |
Every activity counts the same. Each one has to run for at least 90 consecutive days during the performance year, and you can’t earn more than full credit. There’s no advantage to reporting extra activities.
Improvement Activities for Hospitalists and Inpatient Teams
For many hospitalists, Improvement Activities are the one category they always have to handle themselves. Hospital-based clinicians usually have Promoting Interoperability reweighted to 0%. Facility-based clinicians can have Quality and Cost scored from their hospital. Neither status covers Improvement Activities. Skip the attestation and you lose those points entirely.
The good news is that a lot of inpatient work already qualifies. Activities in the current inventory that often fit hospital medicine include:
- Advance care planning (IA_PM_21)
- Advance care planning conversations to support patient wellness and care preferences (IA_AHW_3), new for 2027
- Implementation of an antimicrobial stewardship program (IA_PSPA_15)
- Implementation of fall screening and assessment programs (IA_PSPA_21)
- Implementation of medication management practice improvements (IA_PM_16)
- Use of patient safety tools (IA_PSPA_8)
If your group reports together, pick activities at least half your clinicians take part in, like a hospital-wide stewardship program or a standard medication reconciliation workflow. Confirm each activity is still in the inventory every year before you plan around it.
What's Changing in 2027
The CY 2027 final rule adds six activities, modifies five, and removes 11, which shrinks the inventory from 95 activities to 90. For inpatient groups, the removals matter most. Three of the 11 cut activities cover care transitions, which is core hospitalist work.
The scoring rules stay the same. The new activities fall under Care Coordination and Advancing Health and Wellness, and include advance care planning conversations and clinician use of AI to improve patient care.
If your group reports care transition activities, check your plan before 2027. CMS removed several as duplicates, including care transition documentation, care transition operational improvements, and engaging patients and families in developing a plan of care. CMS, however, pointed to other activities that still recognize this work. See what else is changing in MIPS for 2027.
New Activities
- Use of Data to Improve Practice Workflows (IA_CC_20)
- Understand and Improve Diagnostic Performance (IA_CC_21)
- Systematic Screening and Intervention for Nutrition and Other Health-Impacting, Non-Clinical Issues
- Advance Care Planning Conversations to Support Patient Wellness and Care Preferences (IA_AHW_3)
- Clinician Use of Artificial Intelligence to Improve Patient Care (IA_AHW_4)
- Lifestyle Approaches to Diabetes Remediation (IA_AHW_5)
Removals
| ID | Activity | Reason CMS gave |
|---|---|---|
| IA_CC_10 | Care transition documentation practice improvements | Duplicative |
| IA_CC_11 | Care transition standard operational improvements | Duplicative |
| IA_CC_12 | Care coordination agreements that promote improvements in patient tracking across settings | Duplicative |
| IA_BE_15 | Engagement of Patients, Family, and Caregivers in Developing a Plan of Care | Duplicative |
| IA_BMH_5 | MDD prevention and treatment interventions | Duplicative |
| IA_PM_19 | Glycemic Screening Services | Duplicative |
| IA_PM_20 | Glycemic Referring Services | Duplicative |
| IA_PSPA_2 | Participation in MOC Part IV | Obsolete |
| IA_CC_16 | PCP and Behavioral Health Bilateral Electronic Exchange | Obsolete |
| IA_EPA_4 | Additional improvements in access as a result of QIN/QIO TA | Obsolete |
| IA_PM_2 | Anticoagulant management improvements | Obsolete |
APM scoring. CMS also confirmed that clinicians in MIPS APMs always receive at least 50% of the Improvement Activities credit.
How to Choose the Right Improvement Activities
Picking IAs shouldn’t be complicated. Many practices either choose too many activities or pick ones that don’t align with their day-to-day work. Start with what you’re already doing, then fill gaps if needed.
Map to your existing workflows
Look at your current processes. Are you already doing medication reconciliation? Using clinical decision support? Tracking referrals? Those might already qualify as IAs. Document them properly and submit.
Consider your patient population
If you see a lot of chronic disease patients, pick IAs related to care coordination or population health management. If you’re in the ED, patient safety or discharge planning activities make sense. If you’re a hospitalist, look at stewardship, fall prevention, and advance care planning activities first.
Align with your MVP (if applicable)
If you report through a MIPS Value Pathway, choose one activity from that MVP’s list. Each MVP has its own list, so check it before you plan around an activity you already do. Hospitalists can now choose the Hospitalist MVP, available starting in 2027.
Think about group vs. individual reporting
If you’re reporting as a group, you need buy-in from at least half your clinicians. Pick activities that the majority of your team can realistically complete. If you’re reporting individually, you have more flexibility to choose niche activities.
Don't chase points
You can’t earn more than full credit, so reporting extra activities adds nothing. Pick the ones you can document most easily.
Improvement Activities are one of the more manageable parts of MIPS, especially for inpatient providers who are already stretched thin with Quality reporting. The key is picking activities that align with what your practice already does, documenting them properly, and submitting on time.
Stay Organized with Claimocity
Most IAs come down to three things: better visibility into what your team is doing, stronger care coordination, and documentation that holds up under audit. Claimocity handles all three.
Whether you need to track 90-day periods, monitor workflow changes, or align your IA choices with your broader reporting strategy, the platform helps keep everything organized in one place. No more digging for screenshots or scrambling for documentation. You stay organized, on schedule, and far less likely to lose points over avoidable gaps.
Want to take the pressure off reporting? Book a demo, and we’ll show you how it works.
Sources
- 42 CFR 414.1380: 20 or 40 points per activity, APM minimum score
- 42 CFR 414.1360: 90 consecutive days, 50% group threshold
- CY 2027 Physician Fee Schedule final rule, CMS-1848-F, 91 FR 70992 (November 9, 2026): new, modified, and removed activities at 91 FR 71545 to 71548, including the activities CMS cited as still recognizing care transitions; APM scoring; Hospitalist MVP
