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What Does Your MIPS Score Actually Cost You?
Every eligible clinician's Medicare Part B payments move up to 9% based on one composite score — two years after the performance year closes. Drag the sliders to your own revenue and projected score to see the exact dollar figure, not a generic industry average.
- Uses the exact CMS formula
- Honest about what is estimated
- Shareable results link
Methodology
Why This Calculator Gives You a Precise Penalty and an Honest Bonus Range
Below 75 points
The Penalty Is a Fixed Formula
CMS scales the negative adjustment linearly: 0% at exactly 75 points, down to the full -9% at 0 points. Because this is set in statute and doesn't depend on how anyone else in the country performed, it can be calculated exactly — which is why this calculator shows a single dollar figure for the penalty side, not a range.
Above 75 points
The Bonus Depends on Everyone Else
MACRA requires MIPS to be budget neutral — the money funding positive adjustments comes from the penalties collected that same year. CMS applies a scaling factor to the positive side that isn't finalized until every clinician's score nationwide is in. The 2026 payment year set the lowest cap on record at roughly +1.05%; other recent years have scaled closer to +1.8%. Any calculator that shows you a single precise bonus figure is guessing.
Two-year lag: whatever your score is for a given performance year, the resulting adjustment lands on Part B payments two years later — a 2026 performance-year score submitted by March 31, 2027 adjusts 2028 payments. That gap is why a quiet reporting problem today is easy to miss until it becomes a visible revenue cut. Our 2026 MIPS changes guide covers what shifted for this performance year, and our MIPS consulting service exists specifically to keep your score on the right side of 75, year-round.
Questions
Frequently Asked Questions
How accurate is this MIPS penalty calculator?
The negative-adjustment side is exact: CMS scales the penalty linearly from 0% at 75 points to -9% at 0 points by statute, so any practice can compute it precisely from Part B revenue and score alone. The positive-adjustment side is necessarily a range, not a single number — MACRA requires MIPS to stay budget neutral, so the actual bonus multiplier is not finalized until every clinician nationwide has a final score, months after the performance year closes.
Why is the bonus a range instead of an exact number?
By law, total positive adjustments across the country cannot exceed total negative adjustments collected. CMS applies a scaling factor to positive scores that depends on how many clinicians missed the 75-point threshold that year — information that doesn't exist until the whole program's scores are in. The 2026 payment year set a record-low cap of about +1.05%; other recent years have gone as high as roughly +1.8%. This calculator shows that historical band rather than inventing false precision.
What score do I need to avoid a penalty?
75 points, fixed through at least the 2028 performance year. Below 75, the adjustment is negative and scales with the shortfall. Exactly 75 is neutral. Above 75 earns a positive, budget-neutral-scaled adjustment.
When does the adjustment I calculate actually hit my payments?
MIPS runs on a two-year lag. A 2026 performance-year score is submitted by March 31, 2027, and the resulting adjustment — positive or negative — is applied to every Medicare Part B payment across the 2028 payment year. That lag is exactly why a reporting gap today is easy to miss until it shows up as a real revenue cut two years later.
Does this calculator account for small-practice bonus points or facility-based measurement?
No — this tool models the core payment-adjustment formula off a single final score, which is the number that matters for this calculation regardless of how it was built. Small practices (15 or fewer clinicians), facility-based clinicians, and groups reporting an MVP all have different paths to that final score. Our MIPS consulting team accounts for all of that when projecting your actual score.
Is this an official CMS tool?
No. This is an independent planning tool built by MedVersify using CMS's published payment-adjustment methodology. Use it to understand your exposure and plan around it — your official adjustment is calculated and issued by CMS through the Quality Payment Program.
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