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MIPS / Value-Based Payment Estimator
Project your estimated 2024 performance year MIPS Final Score and potential Medicare payment adjustment. See how each category contributes to your score and get a compliance action plan targeting above-threshold performance.
Estimate Your MIPS Score & Payment Adjustment
Payment adjustment is applied to all Medicare Part B allowed charges. Find this on your CMS Provider Remittance Advice or QPP participation status report.
Average of your individual quality measure scores (1–10 scale, normalized to 100). Find this in your QPP performance feedback. If estimating: 60–70 is typical without optimization; 80–90+ is achievable with AAPC-certified coding and measure selection.
Full reporting of all base score measures typically yields 80–100. Check your QPP dashboard or ask your EHR vendor for your PI reporting status.
Browse activities at QPP.cms.gov
High-weight activities include PCMH, care coordination, TCPI
Max raw score: 40 points (normalized to 100). Small practice: each medium activity counts as 40 pts, reaching maximum with 1 activity.
The Cost category is calculated entirely by CMS from your claims data — you cannot report or optimize it directly. If you have your prior year QPP performance feedback, enter your Cost score. Otherwise, leave blank to use the neutral midpoint estimate (52.5/100).
Enter your performance data to see the projection
Estimated Final Score, payment adjustment, category breakdown, and compliance action plan appear here
Understanding MIPS
The 4 MIPS Performance Categories Explained
Your MIPS Final Score is a weighted average of four categories. Understanding what drives each category is the foundation of a targeted above-threshold strategy.
| Category | 2024 Weight | How Scored | Provider Control | XMB Role |
|---|---|---|---|---|
| Quality | 30% | Average of 6+ measure scores (1–10) against CMS national benchmarks | High | AAPC-certified specialty coding, measure selection, data accuracy |
| Promoting Interoperability | 25% | Based on 2015 CEHRT usage, base score measures, and performance measures | Moderate | CEHRT configuration guidance, PI measure reporting strategy |
| Improvement Activities | 15% | Self-attested activities; medium = 20 pts, high = 40 pts, max raw = 40 | Very High | Activity selection, attestation strategy, workflow integration |
| Cost | 30% | CMS calculates from claims using TPCC and MSPB measures against benchmarks | Low — CMS-Calculated | Cost-conscious coding patterns, episode measure awareness |
Quality Category Strategy
Selecting the right 6 measures for your specialty is the single highest-leverage MIPS decision. Measures with favorable national benchmark positions allow below-average performance rates to still earn top decile scores. XMB’s MIPS team maps your specialty to the optimal measure set annually as benchmarks change.
Medical Coding ServicesPI Reporting — Don’t Leave 25% on the Table
Many practices score below 80 on PI simply because they are not reporting all available base score measures or not activating bonus measures in their EHR. Full PI reporting requires minimal clinical workflow change and is a straightforward path to 80–100 points in this category.
MIPS Reporting ServicesImprovement Activities — Easiest Full Score
IA is the most straightforward category to maximize. Two medium-weight or one high-weight activity achieves the full 40-point maximum. Small practices achieve maximum with just one activity. Activities like expanded access, care coordination, and chronic care management often overlap with existing care delivery workflows.
QPP IA Library ›Cost Category — Understanding Your Score
The Cost category is 30% of your score but is entirely calculated by CMS from your claims. Practices can review their Cost performance in QPP feedback reports annually. High Cost scores relative to benchmarks are correlated with AAPC-accurate coding (avoiding upcoding patterns), appropriate patient attribution, and episode measure awareness.
QPP Performance Feedback ›Common Questions
MIPS & QPP — Frequently Asked Questions
What is MIPS and how does it affect my Medicare payments?
MIPS (Merit-based Incentive Payment System) is a CMS program under MACRA that adjusts Medicare Part B payments based on performance across Quality, Promoting Interoperability, Improvement Activities, and Cost. A Final Score below the 75-point performance threshold results in a negative payment adjustment of up to −9% on all Medicare Part B allowed charges two years after the performance year. Scores above 75 receive a positive budget-neutral adjustment; scores above 89 may qualify for exceptional performance bonuses. Learn more at QPP.cms.gov.
What is the 2024 MIPS performance threshold?
The 2024 MIPS performance threshold is 75.0 points. Scores below 75 receive a negative payment adjustment scaling from 0% (at 74.9) to −9% (at 0). The additional performance threshold for exceptional performance bonuses is 89.0 points. Small practices with 15 or fewer clinicians receive an automatic +6-point bonus applied to their Final Score, meaning a raw score of 69 qualifies as 75 for a small practice. Performance year 2024 results affect Payment Year 2026.
Can I be excluded from MIPS?
Clinicians below the low-volume threshold are excluded from mandatory MIPS participation. For 2024, exclusion applies if you have Medicare Part B allowed charges of ≤$90,000, ≤200 Medicare patients, or ≤200 covered professional services during a 12-month determination period. Advanced APM participants who achieve Qualifying Participant (QP) status are also exempt. Hospital-based providers, ambulatory surgical center-based providers, and those with approved hardship exceptions may qualify for PI reweighting. Verify your status at QPP.cms.gov.
Why can’t I know my exact positive MIPS adjustment in advance?
Positive MIPS adjustments are budget-neutral — meaning CMS takes the total dollar value of all negative adjustments and distributes it proportionally among above-threshold performers. The exact positive adjustment percentage depends on: (1) how many clinicians score above the threshold, (2) by how much they exceed it, and (3) the total size of the negative adjustment pool. CMS cannot calculate these until all 2024 performance year data is collected, cleaned, and adjudicated — typically 18 or more months after the performance year closes. This is why positive adjustments are presented as ranges based on historical QPP data.
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