What happens if I don’t participate in MIPS?

Eligible clinicians who choose to not participate in MIPS can face significant repercussions, including a negative payment adjustment on their Medicare Part B fee-for-service claims imposed by CMS.This is a sliding scale penalty based on nationwide performance and can change annually. In 2023, for example, the penalty was set at a -9% payment adjustment.

What happens if I don’t participate in MIPS?

The public reporting ramifications

Beyond the financial implications, non-participation in MIPS carries additional risks that could affect an eligible clinician's professional standing.

One of the key aspects of MIPS is that it includes public reporting of performance data on CMS’s Care Compare website, as well as its Provider Data Catalog. This transparency allows patients to access and compare the performance of clinicians on crucial healthcare measures.

Clinicians who opt out of MIPS forfeit the opportunity to showcase their competence and quality of care, potentially losing a competitive edge in attracting and retaining patients who are increasingly becoming more proactive and discerning in their healthcare choices. 

Failure to optimize patient care

Moreover, participating in MIPS provides eligible clinicians with valuable quality improvement data. This data is critical for identifying areas of care that need improvement. Clinicians who do not participate in MIPS miss out on these insights, which could hinder their ability to optimize their practice operations and improve patient outcomes. Thus, while the immediate concern may be the financial penalty, the long-term implications of not participating in MIPS could be even more detrimental, affecting both the reputation and operational effectiveness of a clinician’s practice.

Review the latest MIPS exemptions

It’s important to note that not every clinician is required or even recommended to participate in MIPS. CMS does offer MIPS exemptions to qualified clinicians. You can check your MIPS exemption status on CMS’s website.

Moreover, CMS now offers a more specialty-focused payment program track, known as MIPS Value Pathways (MVP); it is slated to officially replace MIPS in the coming years. The sunset date for MIPS is still undetermined.

For the latest MIPS updates, check out our guide to the 2024 Quality Payment Program Reporting Requirements. Or, to learn more about the MVP program, read our how-to guide on Getting Started with MIPS Value Pathways.

Struggling to meet your MIPS reporting requirements?

Learn more about the Medisolv MIPS Reporting Package, the proven MIPS management solution that lets you optimize your performance with drill-down precision.