MIPS Consulting Services for Healthcare Providers
Maximize your Quality Payment Program score and avoid Medicare penalties with expert MIPS and MACRA support.
- HIPAA-Compliant
- U.S.-Based Experts
- Free Practice Audit
Why MIPS and MACRA Compliance Affects Every Medicare Payment You Receive
The Merit-based Incentive Payment System, known as MIPS, determines whether your Medicare reimbursements go up or down each year. A strong score means bonus payments on top of your standard Medicare reimbursement. A weak score means a penalty that reduces every single Medicare payment your practice receives, sometimes for years after the reporting period.
Most practices either ignore MIPS reporting entirely, assuming it does not apply to them, or they submit data without a real strategy and end up leaving performance points on the table. Either approach costs money.
Astral Medical Billing provides MIPS consulting services and MACRA compliance support for medical practices across the USA. We help you understand your reporting requirements, choose the right measures, and submit data correctly so you maximize your score instead of guessing.
Our MIPS and MACRA Consulting Services
Measure Selection Strategy
Not every quality measure is equally achievable for every practice. We analyze your practice data and clinical workflows to identify the measures where you are most likely to score well, rather than defaulting to generic measures that do not reflect your actual strengths.
Submission Support
We handle the technical process of submitting your data to CMS through the Quality Payment Program, whether through a qualified registry or direct EHR integration. Submission errors are one of the most common reasons practices lose points they should have earned.
Performance Monitoring
We provide quarterly dashboards showing where your score stands throughout the reporting year. This means no surprises at the end of the year and time to make adjustments if a category is underperforming.
Category-Specific Strategy
MIPS scoring is broken into four weighted categories: Quality at 30 percent, Cost at 30 percent, Promoting Interoperability at 25 percent, and Improvement Activities at 15 percent. We build a strategy across all four categories rather than focusing only on the easiest one.
MIPS Categories We Manage
Clinical outcomes and patient safety measures.
Medicare spend per beneficiary (calculated by CMS).
Patient engagement and health info exchange.
Care coordination and patient access.
Understanding the MIPS Scoring Categories
Quality
This category measures clinical outcomes and patient safety based on specific measures you report. It carries the heaviest weight in your overall score.
Cost
CMS calculates this category automatically based on Medicare spending per beneficiary attributed to your practice. While you cannot directly report this category, certain practice patterns can influence the outcome, and we help you understand what factors are affecting your cost performance.
Promoting Interoperability
This category reflects how well your practice uses certified EHR technology for patient engagement and health information exchange, including things like patient portal usage and electronic prescribing.
Improvement Activities
This category rewards activities related to care coordination, patient safety, and expanded patient access. It is often the easiest category for smaller practices to score well in with the right documentation.
MIPS by the Numbers
These figures come from CMS rules for the current performance years. They can change, so they are worth rechecking each January.
| Rule | Current figure | What it means for you |
|---|---|---|
| Performance threshold | 75 points | Score below it and Medicare payments are cut. Score above it and they can rise. CMS has set it at 75 through the 2028 performance year. |
| Maximum penalty | Up to 9% | Applied to every Medicare Part B payment in the payment year |
| Payment year | Two years later | How you perform in 2026 sets your Medicare payments in 2028 |
| Low-volume threshold | $90,000, 200 patients, 200 services | You must exceed all three in Medicare Part B to be required to report. Exceed one or two and you may opt in. |
| Small practice | 15 or fewer clinicians | Extra flexibility, including bonus points in the Quality category and relief from Promoting Interoperability |
| Data submission | First quarter of the next year | The window usually closes on March 31, so the year's data has to be clean before then |
Three Ways to Report
Which one fits depends on your specialty, your EHR, and whether you belong to an ACO.
Most common
Traditional MIPS
You choose your own quality measures and improvement activities from the full lists, report Promoting Interoperability from your EHR, and CMS calculates the Cost category from your claims.
Newer option
MIPS Value Pathways
A smaller, pre-built set of measures and activities organized around a specialty or condition. There is less to choose and less to report, and CMS intends these pathways to replace traditional MIPS over time.
For ACO participants
APM Performance Pathway
A fixed set of quality measures for clinicians who take part in certain alternative payment models, such as a Medicare Shared Savings Program ACO.
What Has to Happen, and When
01
First Quarter: Plan
Check each clinician's eligibility in the CMS lookup tool, pick a reporting option, and choose measures your practice can realistically perform well on.
02
Spring and Summer: Capture
Make sure measures are documented in the EHR as care happens. Promoting Interoperability needs at least 180 continuous days, so it has to be under way by early July.
03
Fourth Quarter: Close Gaps
Review performance measure by measure, finish improvement activities, and fix documentation gaps before December 31.
04
Next January to March: Submit
Validate the year's data, submit it through a registry or your EHR before the window closes, and review the score and feedback when CMS releases them.
Is MIPS Worth the Effort for a Small Practice?
For a practice with modest Medicare volume, the honest question is whether reporting is worth the work. Start with eligibility. If you bill Medicare Part B $90,000 or less in a year, or see 200 or fewer Medicare patients, or provide 200 or fewer covered services, you are under the low-volume threshold and not required to report at all.
If you are required to report, doing nothing is the most expensive choice. A score of zero brings the full penalty of up to 9% on every Medicare Part B payment two years later. For a practice collecting $400,000 a year from Medicare, that is as much as $36,000.
Small practices also get help that larger groups do not: bonus points in the Quality category, and relief from the Promoting Interoperability category when they do not report it. With the right measures, clearing the 75-point threshold is realistic. Reporting sits naturally alongside billing, because much of the data comes from the same claims. See our revenue cycle management service for how the pieces fit, or a billing audit if you are not sure your documentation supports your measures.
Frequently Asked Questions About MIPS Consulting Services
Eligibility depends on your Medicare billing volume and the number of Medicare patients you see. Some small practices fall below the low-volume threshold and are exempt. We review your specific situation to determine whether MIPS reporting applies to you and what your options are if you are near the threshold.
If you are required to report and do not, you will receive the maximum negative payment adjustment, which reduces every Medicare payment your practice receives for the corresponding payment year. This is the worst possible outcome and is entirely avoidable.
Your final score is a weighted combination of your performance across the four categories: Quality, Cost, Promoting Interoperability, and Improvement Activities. The exact weighting can shift slightly from year to year based on CMS rule updates.
Yes. Small practices often have an advantage in certain categories, particularly Improvement Activities, where documented care coordination efforts can be reported relatively easily compared to larger organizations with more complex reporting requirements.
Ideally at the start of the performance year. The earlier you select your measures and begin tracking performance, the more opportunity you have to make adjustments before the reporting deadline. Waiting until the end of the year significantly limits your options.
Yes. We manage the technical submission process through approved registries or EHR integration so your data is submitted accurately and on time.
The performance threshold is 75 points, and CMS has kept it there through the 2028 performance year. A final score below 75 results in a negative adjustment to Medicare Part B payments of up to 9%, applied two years after the performance year.
A clinician or group is required to report only if they exceed all three of these in Medicare Part B during the determination period: $90,000 in allowed charges, 200 patients, and 200 covered professional services. Those who exceed one or two of the three can choose to opt in.
Related Services
Revenue Cycle Management
The full cycle, managed as one process
Medical Billing Services
End-to-end billing for independent practices
Medical Billing Audit
Check that documentation supports what is billed
Medical Billing and Coding
Certified coding that holds up to payer review
Small Practice Billing
Billing built for one to five providers
Provider Credentialing
Payer enrollment handled end to end
Denial Management
Denial analysis, appeals, and prevention
Eligibility Verification
Stop denials before the patient visit
Avoid the Penalty
Contact us to discuss your MIPS strategy for the current reporting year.