Claimocity Claims
What MIPS Measures Should I Report?
A Guide for Inpatient Providers & Facilities
Table of Contents
MIPS reporting is how Medicare evaluates and reimburses providers. Every year, providers are asked to prove the quality of their care through data, and those numbers decide how Medicare pays. For inpatient teams, that process often feels like it was designed for someone else.
Most of the official guidance focuses on outpatient clinics and private practices. Hospitalists and facility-based providers have different reporting rules, different exemptions, and less time to sort through the fine print. This causes confusion, missed opportunities, and penalties that could have been avoided.
In this guide, we cut through the noise and break down what MIPS really means in an inpatient setting. We’ll walk through how to know if you’re required to report, which measures apply to your work, and how recent CMS changes will affect next year’s performance scores.
Whether you’re a hospitalist wondering if you need to report at all, a facility administrator coordinating group submissions, or a compliance officer trying to optimize your organization’s MIPS strategy, you’ll find clear, actionable answers here.
Understanding Your MIPS Eligbility
Before you dive into measure selection and submission strategies, you need to know if MIPS reporting even applies to your practice. Not every inpatient provider falls under MIPS requirements, and understanding your eligibility status can save you significant time and effort.
Confirm Your Eligibility
Before choosing measures or planning submissions, it’s important to confirm whether you’re required to participate in MIPS at all. CMS determines eligibility each year based on billing volume, patient count, and the types of services you provide. If you meet or exceed the annual participation threshold, you’ll need to report data to avoid a penalty and stay eligible for positive payment adjustments. Learn more about how to determine your eligibility status here.
How to Report: Know Your Reporting Level
After confirming that you are eligible, your next step is deciding how to report. There is no one-size-fits-all approach, and the best option depends on how your team practices and how your facility handles data.
Individual reporting connects your MIPS data to your own NPI. It gives you full control over your score but can take extra time if you work at multiple sites or within a large group.
Individual reporting works best for:
- Solo practitioners or those with unique practice patterns
- Providers who want to optimize their own performance independently
- Clinicians whose individual measure performance significantly exceeds group averages
Group reporting combines results for everyone billing under the same Tax Identification Number (TIN). This route is common for hospitalist groups because it reflects team performance and simplifies submissions. This approach offers several advantages:
- Shared workload across your team rather than each provider tracking individually
- Larger data pools that can improve measure reliability and scoring
- Automatic facility-based scoring if 75% or more of the group’s encounters occur in inpatient or emergency settings
- Simplified compliance with one submission covering multiple providers
Facility-based scoring works differently. If most of your encounters happen in a hospital and your group qualifies, CMS can use the hospital’s quality data to calculate your MIPS score automatically. This approach removes much of the manual effort and helps keep your performance aligned with the facility’s goals.
Each method has its pros and cons. The key is to confirm how your organization reports before the performance year begins. When you know which model applies to you, it is easier to focus on the measures that actually influence your score.
The Four MIPS Performance Categories: Simplified for Inpatient Providers
MIPS measures your performance across four categories, each weighted differently in your final score. For the 2026 performance year, here’s how CMS calculates your composite score:
- Quality: 30%: Clinical outcome and process measures
- Cost: 30%: Episode-based cost efficiency
- Promoting Interoperability (PI): 25%: EHR adoption and meaningful use
- Improvement Activities (IA): 15%: Practice improvement initiatives
Sounds straightforward enough, right? Here’s where it gets a little complicated: for hospital-based providers, the rules are a little different.
Quality
While outpatient clinicians have to manually submit “Quality” data, many inpatient providers qualify for automatic facility-based scoring. If 75% or more of your group’s encounters occur in inpatient or emergency department settings, CMS calculates your Quality score using your hospital’s performance data. No manual submission required, which is a big time-saver for hospitalists.
Cost
You don’t need to submit “Cost” data. In fact, CMS calculates it from Medicare claims. For inpatient clinicians, this typically involves episode-based measures. While you can’t directly control your Cost score through reporting, understanding how CMS attributes episodes to your practice can help you identify areas for improvement.
Improvement Activities
This category connects directly to the day-to-day work of inpatient teams. It rewards providers for implementing initiatives that make patient care safer and smoother, and recognizes the behind-the-scenes work that keeps patients safe and care moving smoothly, things like structuring coordination during discharge planning or improved communication between nurses and attending physicians.
Promoting Interoperability
Promoting Interoperability (PI) tracks how well providers use certified electronic health record technology. Most hospital-based clinicians qualify for automatic PI reweighting because they don’t control their facility’s EHR system. When PI is reweighted to 0%, those 25 percentage points are redistributed to Quality, making Quality worth 55% of your total MIPS score instead of 30%.
Selecting and Reporting MIPS Quality Measures for Inpatient Providers
Quality is the largest category in your MIPS score (30%) under standard scoring, or 55% if PI gets reweighted. Most inpatient providers qualify for automatic facility-based scoring, so you don’t need to do any manual submission.
Quality Reporting Requirements & Options
You’re expected to report six Quality measures (including at least one outcome or high-priority measure) with 70% data completeness. If fewer than six measures apply to your practice, you can request Eligible Measure Applicability (EMA) consideration to report fewer measures without penalty.
For hospitalists, focus on the Hospital Medicine specialty measure set, which includes hospital-wide measures like readmissions and mortality, plus condition-specific measures for heart failure, pneumonia, and sepsis management.
Automatic Facility-Based Scoring
If 75% or more of your group’s services occur in inpatient or emergency settings, CMS calculates your Quality score using your hospital’s Hospital Value-Based Purchasing (HVBP) score. This option only works for group reporting, but you can still manually report if you think you’ll score higher.
Manual or MVP Reporting
If you don’t qualify for facility-based scoring, submit Quality data through a registry/QCDR, your EHR vendor, or the CMS QPP portal. Or you can choose to report through MVPs (MIPS Value Pathways), a newer CMS reporting framework that groups related measures by specialty or care focus, like Chronic Disease Management or Heart Failure.
2026 Updates
CMS finalized changes to the Quality measure inventory in 2026, including five new measures, ten measure removals, and thirty measures with significant changes. 19 measures will be scored using topped-out measure benchmarks. Always verify your selected measures on the QPP website before the start of each performance year.
Improvement Activities (IAs) Reporting for Inpatient Settings
Improvement Activities make up 15% of your MIPS score and recognize practice improvement initiatives. The requirement is simple: report two medium-weighted activities (or one high-weighted activity) that you performed for at least 90 consecutive days during the performance year.
Activities That Match Your Work
Choose activities that reflect what your team already does:
Patient Safety Protocols: Medication reconciliation, fall prevention, or initiatives that reduce hospital-acquired conditions.
Team-Based Care Models: Multidisciplinary rounds, care transitions programs, or collaborative treatment planning.
Patient Safety in Use of AI: This is new for 2026. If your facility uses AI-based clinical decision support tools, you can earn credit for implementing safety protocols around these systems.
Documentation and Attestation
To receive credit for your Improvement Activities, you’ll need to show that the programs were implemented and maintained for at least 90 consecutive days. Keep meeting notes, policy updates, or program summaries organized throughout the year so it is easy to support your attestation.
2026 Updates
In 2026, CMS is replacing “Achieving Health Equity” with “Advancing Health and Wellness”, expanding the focus on health literacy, social drivers of health (SDOH), and smoother patient transitions after discharge. Inventory changes include three new IAs, seven changes to existing IAs, and eight removals.
Promoting Interoperability (PI) in Inpatient Facilities
Most hospital-based clinicians qualify for automatic PI reweighting. This sets PI to 0% and those points are redistributed to other parts of your MIPS score. This happens because hospitalists don’t control their facility’s EHR system. The hospital owns and manages the certified EHR technology, so it’s impossible for you to meaningfully report on PI measures.
When Do You Need to Report PI?
If you work in a setting where you control the EHR, or if your group chooses to report PI voluntarily, here’s what you need to know:
Minimum reporting period: 90 consecutive days
Certified EHR technology (CEHRT): Required; if the system isn’t certified, PI receives a zero
Core measures: e-prescribing, health information exchange, patient access to health information, and public health registry reporting
2026 Updates
The 2026 rule continues these reweighting policies for hospital-based clinicians. CMS is also requiring the use of the updated 2025 SAFER Guides, and finalized the suppression of the electronic case reporting (eCR) measure.
Cost Measures and Administrative Claims for Inpatient Reporting
The Cost category is fully claims-based, so there’s nothing to submit. CMS calculates your score from Medicare administrative claims. For inpatient clinicians, this category makes up 30% of your MIPS score and focuses on episode-based cost measures that track total spending across entire care episodes.
What It Means for Your Performance
Since Cost is claims-based, you can’t influence scoring through reporting. Instead, use CMS feedback to understand how episodes are attributed to your group and find areas for improvement, such as care coordination, preventable complications, or readmission patterns.
2026 Updates
CMS did not introduce major cost category inventory changes for the 2026 performance year. Always verify which episode measures apply to your specialty and confirm current case minimums on the QPP website before the performance year begins. Starting in 2026, new cost measures will go through a two-year feedback period before counting towards the final score. Additionally, non-physician practitioners will be excluded from total per capita cost (TPCC) attribution when they belong to a group whose other clinicians are already excluded based on specialty.
Submitting Your MIPS Data and Staying Organized
Once you know which measures apply and how your reporting structure works, it’s time to plan your submission process. MIPS data can be submitted through several approved methods:
- Qualified Registry or QCDR: You can submit through a registry to track and validate your data before it reaches CMS. This makes sense for teams that want more control and immediate feedback. Submitting through a registry lets you track and validate data before it reaches CMS. This is ideal for groups that prefer more control or want real-time feedback.
- EHR Vendor: Many electronic health record systems connect directly to the QPP portal, which simplifies data submission but requires coordination, so make sure your IT team is looped in.
- CMS QPP Portal: Individual clinicians and groups can manually upload or attest data through the CMS website. This method works well for small groups but can be time-consuming.
No matter which route you take, documentation is critical. Keep copies of what you submit so audits are simple and next year’s reporting is faster. Revenue cycle management tools that integrate with your workflow make this process automatic, so you’re always audit-ready without the extra effort.
Avoiding Penalties and Maximizing Incentives
MIPS is designed to reward strong performance, not just compliance. Providers who meet or exceed the performance threshold earn positive payment adjustments, while those who fail to report or score below the minimum face reductions. Payment adjustments can significantly impact your Medicare reimbursements, which means every decision throughout the year can have a financial impact.
The smartest approach is to treat MIPS as a year-round routine, not an end-of-year rush. Check your feedback reports often, track progress in each category, and use technology to handle data collection behind the scenes. Staying proactive keeps you ahead of deadlines and helps turn MIPS from a compliance task into a performance advantage.
Simplifying MIPS with Claimocity
Keeping up with CMS updates, category weights, and submission deadlines can feel like a full-time job. Claimocity’s integrated reporting and compliance tools can simplify everything and give you your time back. Our integrated reporting tools track the measures that matter to you, apply hospital-based exemptions automatically, and organize data in real time so you always know where you stand. We built Claimocity for the way inpatient providers actually work. It pulls the right information from your daily workflow and translates it into compliant, accurate reports without the need for any extra logins or late-night paperwork.
With Claimocity, you spend less time managing data and more time focusing on patient care. The process becomes simpler, cleaner, and more intuitive, like technology is finally working for you, not the other way around.
- See your MIPS performance in real time
- Skip manual tracking and redundant paperwork
- Keep your reporting accurate, compliant, and stress-free
With Claimocity, you can finally feel like you have MIPS reporting under control. You can see exactly where they stand, stay organized, and move through compliance with confidence instead of guesswork.
Schedule a quick demo today and see how easy MIPS compliance can be when it fits seamlessly into your workflow.
