Learn About MIPS
Reporting Requirement
Scoring Logic
Quality
PI
IA
Cost
Summary
Quality Scoring Logic
For 2025, CMS has updated the Quality category scoring logic. Some of the key changes to MIPS quality category scoring logic are:
Max
points
60
30% of final score
Choose 6 quality measures to report on out of 190 quality measures approved by CMS. This must include at least 1 Outcome measure or 1 High Priority Measure (if an outcome measure is not available).
Outcome/High Priority measures are either of the following types – Appropriate Use measure, Patient experience, Patient safety, Efficiency, Care coordination or opioid-related quality measure.
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CMS automatically calculates up to 4 administrative claims measures for individuals, groups, virtual groups, and APM Entities when applicable and when case minimums are met. These measures include:
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Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate. (This measure is only applicable to groups and virtual groups).
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Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA).
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Hospital Admission Rates for Patients with Multiple Chronic Conditions.
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Acute Unplanned Cardiovascular-Related Admission Rates for Patients with Heart Failure.
CMS will automatically score each of these measures if the clinician/group meets the criteria.
Improvement percent score
Clinicians/practices can earn up to 10 percentage points based on the rate of their improvement in the Quality performance category from the previous year.
Topped Out measures
A special scoring cap of 7 points is applied to the measures that are identified as Topped Out.
An alternative benchmarking methodology is finalized for a subset of topped out measures that belong to specialty sets with limited measure choice and a high proportion of topped out measures, in areas that lack measure development, which precludes meaningful participation in MIPS. This ensures fairness where performance has clustered at the top.
Quick tip: Maximum score cannot exceed 100%
*Maximum number of points = Number of required measures x 10