MIPS 2025: Improvement Activities Category
More scrutiny, narrower scoring, and real consequences for overlooking.
A simpler framework, but no room for sloppiness
MIPS 2025 brings some major simplifications to the Improvement Activities (IA) category. CMS has removed activity weighting, reduced the number of measures that need to be reported, and made group reporting stricter. But don’t mistake simpler for easier. Planning, alignment, and documentation are more important than ever.
Let’s walk through the latest IA changes, what they mean, and how to stay ahead.
Note: We’ve recently shared blogs on the key MIPS 2025 updates and how to approach Quality reporting and Promoting Interoperability. A full breakdown of the Cost category is coming soon.
What is the Improvement Activities Category?
The Improvement Activities (IA) category is designed to encourage providers to adopt practices that improve care coordination, patient engagement, and safety. Unlike Quality or Promoting Interoperability (PI), IA doesn’t require performance data or numerator/denominator tracking. Instead, clinicians attest to completing specific activities for at least 90 continuous days in the performance year.
Each activity is meant to support better outcomes, stronger care delivery, or more efficient workflows. The challenge is choosing activities that are both eligible and operationally feasible for your practice or group.
No More Activity Weighting
Until now, activities were labelled as Medium or High and scored accordingly. Starting 2025, CMS has eliminated these weightings. Instead, clinicians must simply report on one or two activities depending on their practice type.
Small practices (15 or fewer), rural providers, non-patient-facing clinicians, and those in HPSAs: only need to report on 1 activity
Larger practices (more than 15 clinicians): must report on 2 activities
MVP participants: only need 1 activity, regardless of practice size
Why it Matters
Fewer required activities may look easier, but there’s no room for error. Choosing eligible activities early is critical, especially with fewer options on the table.
Pro Tip
Decide your activity(ies) by July so you have time to align your documentation. Don’t assume what worked last year will still do.
Group Reporting: Everyone Must Match
If you’re reporting as a group, CMS now requires that at least 50% of clinicians in the group attest to the same activity or activities.
This means coordination is key. Everyone can’t pick their own measure(s) or activities. You need alignment across the group.
Why it Matters
This is a common area for mistakes. One provider submitting something different can put your entire IA score at risk if you’re reporting as a group.
Pro Tip
Pick your group’s activity(ies) early. Communicate them clearly. Use tracking tools to monitor alignment across clinicians and avoid mismatches at the end.
Reporting Window: Just 90 Days, but Plan Ahead
To meet the requirement, clinicians or groups must attest to performing each selected activity for any continuous 90-day period during the 2025 performance year.
You don’t need to submit proof with your data, but you must retain documentation for six years in case of an audit.
Why it Matters
CMS audits happen. If you can’t show proof, the IA score could be taken back even years later impacting your Medicare Part B reimbursements.
Pro Tip
Use a tool like MyMipsScore to track activity completion and store documentation securely. Our system provides sample documentation guidance to help you prepare for audits without guesswork.
Inventory Changes: Additions, Removals, and Edits
CMS has updated the IA inventory to reflect evolving priorities in healthcare delivery.
2 new activities added
1 activity modified
4 activities removed, including the widely used “24/7 Access to Clinicians with Patient Records”
Why it Matters
If your IA strategy depended on the 24/7 access measure, you’ll need to pivot. It was a popular choice due to ease of implementation. Now it’s gone.
Pro Tip
Double-check the IA activities you reported in 2024 are still available. If it includes removed activities, switch early so your 90-day tracking can begin on time. It’s difficult to document last-minute changes properly.
Bottom Line
CMS has simplified the math for IA, but the real work lies in smart planning and group coordination.
Choose the right activities early
Align your group’s efforts
Document consistently
Avoid relying on measures that have been removed
Why it Matters
Improvement Activities are one of the easier categories to score well in, but only if you take the time to get it right. The bar is low, but the room for mistakes is even lower.
Pro Tip
Review your IA setup this quarter. Set up tracking tools. Get everyone aligned. Small steps now will save you from reporting chaos later.
How MyMipsScore can support you
Darena Health’s MyMipsScore™ simplifies the IA category, so your team isn’t left second-guessing. Our platform helps you track activity completion, ensure group alignment, and prepare clean documentation in case of an audit. Whether you’re reporting as an individual or a group, our tools reduce the guesswork and keep your reporting on track.
Ready to Strengthen Your MIPS Reporting?
Improvement Activities can quietly make or break your MIPS score. Scoring thresholds are tighter, special considerations are more limited, and missing the details could cost you. Whether you're an EHR vendor building workflows or a provider organization managing attestations, precision matters more than ever.
Contact us to see how we can help you stay aligned and ahead in 2025.
