October 2026Dataset Refreshed: Expanded to 15.17M+ Unique Contacts
[email protected]+1 727-617-0017

What are MIPS and MACRA?

Also called: MIPS / MACRA Quality Reporting, Quality Payment Program, Merit-based Incentive Payment System

MACRA is the 2015 U.S. law that created Medicare's Quality Payment Program. Its main track, the Merit-based Incentive Payment System (MIPS), adjusts Medicare Part B payments to eligible clinicians up or down based on their performance on quality, cost, improvement activities and interoperability.

By John Britton, VP of Marketing, MedicalProspects · Updated November 4, 2026 · Healthcare Organizations

Why it matters for healthcare sales and marketing

MIPS scores affect clinicians' Medicare payments, so practices and health systems invest in quality reporting, registries, analytics and workflow tools that help them score well. Vendors selling those tools reach practice administrators, quality leaders and physician owners.

How it works

  • MACRA replaced Medicare's previous physician payment formula and created the Quality Payment Program.
  • Two tracks: MIPS, and Advanced Alternative Payment Models (APMs) for clinicians taking on more risk.
  • MIPS categories: Quality, Cost, Improvement Activities and Promoting Interoperability.
  • Result: a final score that leads to a positive, neutral or negative payment adjustment in a later year.
MIPS scoring: four categories (quality, cost, improvement activities, promoting interoperability) combine into a final score that sets a payment adjustment.
MIPS combines four performance categories into a score that adjusts Medicare payments.

Example

Illustrative scenario. A quality reporting software company targets practice administrators and quality managers at mid-sized specialty groups, timing campaigns before the annual reporting deadline.

Common mistakes

  • Assuming every clinician participates. Eligibility rules exclude some clinicians and practices.
  • Ignoring the calendar. Reporting deadlines drive buying.
  • Pitching only physicians. Administrators and quality staff usually run reporting.

Related terms

  • Value-Based CareValue-based care is a payment approach that rewards healthcare providers for the quality and cost of care rather than only the number of services they deliver, as in traditional fee-for-service.
  • HEDIS and CMS Star RatingsHEDIS is a widely used set of health plan performance measures maintained by the National Committee for Quality Assurance (NCQA). CMS Star Ratings score Medicare Advantage and Part D plans from one to five stars, partly using HEDIS results, and affect plans' bonus payments and enrollment.
  • Electronic Health Record (EHR)An electronic health record (EHR) is the digital system a hospital or practice uses for patient charts, orders, documentation and billing. Products that integrate with the EHR are usually evaluated by IT, clinical informatics and the departments that use them.
  • Accountable Care Organization (ACO)An accountable care organization (ACO) is a group of doctors, hospitals and other providers that agree to be jointly accountable for the cost and quality of care for a defined group of patients, sharing in savings when they meet quality and spending targets.

Put it to work

Sources

  1. Quality Payment Program, CMS

← Back to the healthcare GTM glossary