Understanding MIPS Reporting for Chiropractic and PT Practices in 2025

The Merit-Based Incentive Payment System (MIPS) can adjust Medicare payments by up to 9% based on your 2025 performance, making it critical for chiropractic and physical therapy practices to understand and comply with its requirements. MIPS evaluates quality, cost, improvement activities, and EHR use, impacting reimbursements in 2027. This article explains MIPS eligibility, reporting categories, and strategies for chiropractors and physical therapists to maximize payment adjustments. Practice management tools can simplify data tracking, but the focus is on actionable steps to ensure compliance and boost revenue.

Why MIPS Reporting Matters

MIPS is part of Medicare’s Quality Payment Program, designed to reward high-quality care and penalize underperformance. In 2025, eligible providers who fail to report face a 9% payment cut in 2027, while strong performers can earn a 9% bonus. For a practice billing $100,000 annually to Medicare, this could mean a $9,000 swing. Understanding MIPS helps chiropractic and PT practices avoid penalties, increase revenue, and demonstrate value-based care, all while staying compliant with Medicare’s rules.

Who Needs to Report MIPS in 2025?

Not all practices are required to report MIPS, but those that are must comply to avoid penalties.

• Eligibility Criteria: You must report if you bill over $90,000 in Medicare Part B, treat 200+ Medicare patients, or provide 200+ covered services annually.
• Chiropractors: Most chiropractors qualify due to high Medicare patient volumes, especially for codes like 98940–98942.
• Physical Therapists: PTs often meet the threshold if they bill time-based codes like 97110 or 97140 for Medicare patients.
• Exemptions: Low-volume providers (below thresholds) or those in Advanced APMs are exempt but can opt in for bonuses.

MIPS Reporting Categories for 2025

MIPS evaluates performance across four categories, each contributing to your final score (0–100 points), which determines your payment adjustment.

1. Quality (40% of Score)

Measures clinical outcomes and patient experience.

• Chiropractors: Report measures like “Pain Assessment and Follow-Up” or “Functional Outcome Assessment.” Example: Document pain reduction after adjustments (98940).
• Physical Therapists: Choose measures like “Functional Status Change” or “Patient-Reported Pain Improvement.” Example: Track mobility gains post-97140 therapy.
• Requirement: Submit six measures (one outcome measure) for at least 70% of eligible patients.

2. Promoting Interoperability (25% of Score)

Evaluates use of certified EHR technology.

• Tasks: Use a 2015 Edition Certified EHR for e-prescribing, patient portal access, and data exchange with other providers.
• Chiropractors/PTs: Document visits (e.g., 98940 or 97110) in an EHR and share records with specialists.
• Tip: Verify your EHR meets certification standards via CMS.gov.

3. Improvement Activities (15% of Score)

Assesses practice enhancements, like patient engagement or care coordination.

• Examples: Implement telehealth for follow-ups or offer patient education on pain management.
• Requirement: Complete activities worth 40 points (e.g., two high-weighted or four medium-weighted activities).
• Tip: Choose activities that align with your practice, like “Chronic Care Management” for chiropractors.

4. Cost (20% of Score)

Evaluates resource use, calculated by Medicare based on claims data.

• Chiropractors: Focus on efficient care, like avoiding unnecessary imaging for 98940 patients.
• Physical Therapists: Optimize treatment plans to minimize sessions while achieving outcomes.
• Note: No direct reporting is required; Medicare analyzes claims automatically.

Steps to Succeed in MIPS Reporting

Follow these steps to maximize your MIPS score and payment adjustments in 2025:

1. Confirm Eligibility: Use CMS’s QPP Participation Status Tool to verify if you meet the $90,000/200 patients/200 services thresholds.
2. Select Quality Measures: Choose six relevant measures (e.g., “Pain Assessment” for chiropractors, “Functional Status” for PTs) from CMS’s 2025 MIPS Measure List.
3. Use a Certified EHR: Ensure your EHR is 2015 Edition Certified for Promoting Interoperability tasks, like e-prescribing or patient data sharing.
4. Complete Improvement Activities: Select activities like patient education or telehealth and document completion for 40 points.
5. Track Data Year-Round: Collect data for quality measures on at least 70% of eligible patients, using EHRs or practice management tools.
6. Submit Data by March 31, 2026: Use a certified EHR, registry, or CMS portal to submit 2025 data. Tools like Billing Dynamix can help track data, but any system works.
7. Monitor Performance: Check feedback reports on CMS’s QPP portal to improve your score.

Common MIPS Mistakes to Avoid

These errors can lower your MIPS score and reduce reimbursements:

• Not Checking Eligibility: Assuming you’re exempt and missing reporting opportunities.
• Incomplete Quality Reporting: Failing to report six measures or cover 70% of patients.
• Using Non-Certified EHRs: Non-compliant systems void Promoting Interoperability points.
• Ignoring Improvement Activities: Missing the 40-point requirement lowers your score.
• Late Submission: Missing the March 31, 2026, deadline results in a 9% penalty.

Benefits of Successful MIPS Reporting

Effective MIPS reporting offers these advantages:

• Higher Revenue: A high score can add a 9% bonus in 2027, e.g., $9,000 for a $100,000 Medicare practice.
• Avoided Penalties: Reporting prevents a 9% payment cut.
• Improved Care: Quality measures enhance patient outcomes and satisfaction.
• Lower Audit Risk: Compliance demonstrates value-based care to Medicare.

Tools to Support MIPS Reporting

Practice management software can simplify data tracking and submission. Systems like Billing Dynamix help collect quality measure data and integrate with certified EHRs, but any reliable tool can work. The key is to use technology to ensure accurate and timely reporting.

Conclusion

Understanding and succeeding in MIPS reporting in 2025 is essential for chiropractic and physical therapy practices to maximize Medicare reimbursements. By confirming eligibility, selecting relevant measures, and using certified EHRs, you can boost your score and secure payment bonuses. Implement these strategies and leverage reliable tools to stay compliant and financially strong.

Sources

• Centers for Medicare & Medicaid Services (CMS). (2024). 2025 Quality Payment Program Final Rule. Retrieved from cms.gov.
• American Chiropractic Association. (2024). MIPS Guide for Chiropractors. Retrieved from acatoday.org.
• American Physical Therapy Association (APTA). (2024). MIPS Reporting for PTs. Retrieved from apta.org.
• American Medical Association (AMA). (2024). MIPS 2025 Overview. Retrieved from ama-assn.org.