
The final rule for the Medicare Physician Fee Schedule is here, setting the stage for the Merit-Based Incentive Payment System (MIPS) for 2025.
The report highlights vital updates and policies by the Centers for Medicare & Medicaid Services (CMS) and underscores the importance of preparing to navigate the complexities of MIPS compliance in 2025.
For healthcare practices like yours, MIPS preparation is critical. Luckily, selecting an efficient electronic health record (EHR) system can help you adapt to changes, navigate the challenges, and get your practice to the finish line.
This article highlights MIPS 2025 requirements and what your practice needs to know. We also reveal how EHRs offer a streamlined approach to reporting and automating data collection – maximizing your chances of MIPS compliance success.
MIPS Quality Measures 2025
The Merit-based Incentive Payment System (MIPS) is a performance-based program where eligible healthcare providers may earn positive or negative payment adjustments for their services to Medicare patients.
During this time, providers report the measures and activities collected during the performance period. Calculations are based on four compliance areas that eventually make up the final MIPS score.
The performance categories in MIPS 2025 include:
1. Quality: Providers are assessed on the quality of their care.
2. Improvement Activities: Providers are evaluated on their steps to improve their practices.
3. Promoting Interoperability: This category assesses using certified electronic health record (EHR) technology to improve healthcare quality and patient safety.
4. Cost: This category assesses the cost-efficiency of care provided.
The Medicare Physician Fee Schedule (PFS) final ruling outlines the CMS policies for eligible providers and groups to participate in MIPS, Alternative Payment Models (APM), and other aspects of the Quality Payment Program (QPP) for the 2025 performance year.
You can learn more about these programs and changes here.
The Physician Fee Schedule Final Ruling 2025
While the PFS final ruling introduces several changes, key aspects of the MIPS 2025 reporting requirements will stay the same. Here are some of the major changes you need to know:
- The 75-point performance threshold will remain the same for the 2025 performance period. This threshold will affect payments in 2027.
- The 75% data completeness criteria threshold will remain unchanged through the 2028 performance period/2030 MIPS payment year.
- The 2025 performance period will include 195 quality measures, with seven new measures, 10 removed measures, and 66 existing measures with substantive changes.
- For large practices with more than 15 clinicians, measures will be scored on a 1–10-point scale instead of 3-10. Small practices will keep the 3-point floor.
- MIPS measure/activity inventories will be updated to help clinicians participate in MIPS.
Improving MIPS Scores with an EHR
One of the most critical aspects of MIPS is the Promoting Interoperability category, which directly connects to your EHR. The CMS offers a Meaningful Use (MU) program that provides incentives when EHRs meet MIPS program compliance.
To be successful in the interoperability category, your EHR must be certified and capable of seamlessly exchanging health information with other systems. What does “certified” mean? It indicates an EHR system underwent rigorous testing to ensure it can accurately capture, calculate, and report MIPS measures.
For example, the EverHealth EHR is certified as a Complete EHR by the ONC-ATCB and meets MU standards. In other words, providers can use this EHR in their practice to qualify for government incentives.
This system is also beneficial because it continuously stays on top of changes to the MIPS program to ensure eligible clinicians meet the necessary requirements.
To check if your current EHR set-up is compliant with MIPS standards, consider these questions:
- Does your EHR align with MIPS 2025? Go to the CMS Qualified Payment Program (QPP) website, use the “Participation Lookup” tool, and enter your NPI to see if your system is listed on the Certified Health IT Product List (CHPL).
- If it is certified, can your EHR system handle the upcoming requirements, or are their measures outdated and do not allow your practice maximum point potential?
In our next section, we break down how EHRs can streamline MIPS reporting.
How EHRs Simplify MIPS Reporting
Once a provider has a certified EHR that meets MIPS standards, it’s essential to understand how they can use the system to streamline reporting.
Below, we list effective ways to use your EHR to maximize compliance success and establish your practice as a leader in value-based care in MIPS.
Ensuring HIPAA Compliance and MIPS Alignment
Protecting patient data is not just a regulatory requirement but also a critical factor in maintaining patient trust. Most EHR systems come with built-in safeguards to ensure compliance with HIPAA regulations.
Here are a few security standards your system should include:
- Encryption: Your EHR must use advanced encryption methods to protect sensitive patient information.
- Security Access Controls and Audits: Security access controls (i.e., multi-factor authentication) and automated audits will ensure a system complies with HIPAA and other measures critical for MIPS.
- Cloud Computing: Cloud providers often have strong disaster recovery plans to ensure data availability in case of breaches or other emergencies.
Improving Clinical Decisions and Patient Outcomes
EHR systems can identify gaps in care and ensure your practice meets MIPS requirements. Some systems also feature built-in analytics to highlight areas where you can optimize your MIPS scores, leading to elevated value-based care and higher reimbursements.
How can EHRs improve clinical outcomes? The American College of Surgeons reveals:
- EHRs allow providers to work with different clinicians involved in a patient’s care in one central location. This synthesizing and sharing of treatment options and plans helps minimize care gaps.
- EHRs provide alerts notifying providers about critical laboratory values or high-risk states.
- These platforms can cross-check a patient’s medication list across different systems, preventing potential drug interactions and adverse events.
Reducing Staff Workloads and Easing Workflows
EHR system automation is a game-changer for MIPS compliance. With features like real-time data tracking and auto-generation of reports, these solutions ensure that providers consistently meet requirements.
These systems also enable seamless integration of patient data into MIPS reporting workflows, ensuring compliance efforts are both holistic and secure.
These automated tools also improve practice management workflows. Automating tasks like appointment scheduling, medical billing, and prescription management allows providers to spend more time in value-based care and less on paperwork.
Automates Data Capture
Accurate clinical data reporting for MIPS is critical for earning high scores. It is also important because it directly impacts a provider’s reimbursement, with potential financial penalties for incorrect reporting.
Proper clinical data sharing also improves quality measurement and patient safety, which is at the heart of any healthcare organization.
An integrated EHR can simplify this process by automating the capture and reporting of key data, reducing the time spent on manual data collection.
What are some key reporting features to look for? Consider these:
- Real-Time Analytics: These analytics can help providers monitor their performance on various MIPS measures and adjust as needed to improve scores.
- Benchmarking: A system should allow providers to benchmark their performance against peers. This gives insights into areas where they shine and those that need improvement.
Prepares for MIPS Audit
Preparing for audits is another vital aspect of MIPS participation. EHR systems store comprehensive patient data and help keep your practice audit-ready by:
- Safeguarding complete and accurate records.
- Eliminating redundancies in data entry.
- Generating detailed logs of MIPS submissions.
- Keeping a clear paper trail that satisfies audit standards.
This thorough preparation mitigates risks and ensures confidence during any audit review.
Improves Patient Communication
MIPS also awards practices that promote patient engagement. EHRs help improve engagement by giving patients access to their medical records (patient portals), allowing them to become advocates in their own healthcare.
Some EHRs also have messaging capabilities, allowing easier communication between patients and providers. These features reduce no-shows and ensure continuity of care, which is essential for achieving high MIPS scores.
For example, EverHealth’s EHR offers Text Reminders. This feature allows providers and staff to send patients custom HIPAA-compliant reminders in advance of scheduled appointments with a series of messages. Patients can then confirm via phone or email, automatically updating their appointment into the EHR app or desktop.
The Opportunity Ahead
MIPS is not just a compliance mandate; it’s also an opportunity to elevate your patient care and strengthen revenue stability. By aligning your practice with CMS priorities, you can drive better patient outcomes while positioning your organization for long-term success.
Are you ready for 2025?
Ready to streamline your MIPS reporting and maximize your score? Contact EverHealth today to learn about our EHR solutions tailored to your needs.