What Chiropractors Need to Know About MIPS and MACRA Compliance

Running a chiropractic practice means balancing patient care, documentation, billing, and compliance, all while staying ahead of ever-changing Medicare rules. If you’ve heard terms like MIPS and MACRA but aren’t entirely sure how they impact your clinic, you’re not alone. Many chiropractors know these programs affect reimbursements, but not exactly how or why.

Here’s the truth: understanding how MIPS and MACRA work can make the difference between earning higher reimbursements or losing thousands in penalties.

In this blog today, I’ll break down:

• What MIPS and MACRA mean in simple terms.
• How is your chiropractic clinic affected by the low-volume threshold?
• What performance categories matter most for your final MIPS score?
• Common compliance challenges chiropractors face.
• Practical ways to simplify reporting and stay compliant using modern tools like Noterro.

Let’s start with the basics.

What Chiropractors Need to Know About MIPS and MACRA?

At their core, both MIPS and MACRA are about improving the quality of care while keeping healthcare spending efficient. But let’s unpack what that really means for chiropractors.

• MACRA, or the Medicare Access and CHIP Reauthorization Act, is the law that changed how clinicians get paid. It replaced the old fee-for-service system, shifting from volume-based to value-based care. Instead of getting paid solely on the number of treatments, your performance and quality now determine your reimbursement.
  
• MIPS, or the Merit-Based Incentive Payment System, is the program most chiropractors fall under. It’s how you demonstrate compliance with MACRA and earn your score, which is a performance rating between 0 and 100 points that directly affects your Medicare payments.

What are the 4 Components of MIPS?

Your MIPS score is based on four key areas:

1. Quality: measures the effectiveness of your care. Chiropractors choose metrics that align with their practice, like patient functional outcomes or follow-up plans.
   
2. Improvement Activities: evaluates how you improve patient care processes and engagement, such as tracking outcomes or adopting wellness plans.
   
3. Promoting Interoperability: measures how well you use certified electronic health records (EHRs) like MACRA EHR systems to share and access patient information securely.
   
4. Cost: calculated automatically by Medicare based on claims data, reflecting how efficiently your clinic provides care.

Together, these form your final MIPS score, which determines whether your clinic receives a payment bonus, stays neutral, or faces a reduction.

What Is a MIPS Score and How Is It Calculated?

Each year, eligible clinicians report their performance across these four categories. Medicare then calculates a final MIPS score that decides your future payment adjustments.

Here’s how 2025 performance year scoring works:

• 0–18.75 points = full penalty (-9%)
• 18.76–74.99 points = scaled penalty (-9% to 0%)
• 75 points = neutral (no adjustment)
• 75.01–100 points = bonus payments (up to +9%)

It’s important to know there’s a two-year delay in how MIPS affects your payments. For example, your 2025 performance data impacts your 2027 Medicare payments. This makes early planning critical because what you track now shapes your financial results later.

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You might also be interested in: 9 Local SEO Tactics for Chiropractic Practices to Outrank Competition

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Who Must Participate in MIPS? Understanding the Low-Volume Threshold

Not every chiropractor has to participate in MIPS. The low-volume threshold determines eligibility based on your Medicare activity. You’re required to join if your clinic:

• Bills more than $90,000 in Medicare Part B services annually.
• Sees over 200 Part B patients each year.
• Provides more than 200 covered services annually.

If you fall below these numbers, you’re exempt from mandatory participation and potential penalties. However, you can still opt in voluntarily to earn bonus payments for strong performance.

This threshold is crucial for solo practitioners and small clinics. Many fall just below it, but choosing to report voluntarily can set your clinic apart and prepare you for future compliance requirements.

Smaller practices also get added flexibility; those with fewer than 15 clinicians receive bonus points and reduced reporting requirements, recognizing the limited administrative support these teams have.

How MIPS/MACRA Compliance Impacts Your Chiropractic Practice

I’ve talked to enough chiropractors to know that compliance feels like paperwork piled on top of paperwork. But when you understand how MIPS and MACRA fit into your practice, it stops being a burden and starts becoming a way to build a stronger business.

1. Financial Stakes

Missing MIPS requirements means losing up to 9% of your Medicare reimbursements. High performers, on the other hand, gain extra payments and strengthen long-term revenue stability.

2. Patient Outcomes

When you track metrics like functional improvement or pain reduction, you’re not only meeting compliance requirements but also improving care delivery through measurable progress.

3. Reputation

Clinics that stay compliant signal professionalism and reliability to both patients and insurers. It builds trust and sets you apart from clinics that rely on outdated systems or incomplete documentation.

When done right, compliance becomes a system that protects your income, strengthens patient care, and builds credibility for your clinic.

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Also read: How to Elevate Your Chiropractic Clinic’s Perceived Value For Free

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What Makes MIPS/MACRA Compliance So Challenging for Chiropractors?

Chiropractors in different clinic settings face unique hurdles when it comes to meeting MIPS and MACRA requirements.

1. Documentation Errors

Paper-based charting may feel familiar, but it’s one of the most significant sources of compliance issues. Notes get misplaced, details go missing, and inconsistencies appear from visit to visit. Incomplete records hurt MIPS reporting accuracy and impact patient care by breaking continuity between sessions.

2. Staff Burden

In small or mobile clinics, one person often manages everything — from treatment to billing to compliance. That level of multitasking leaves little room for precise data entry or performance tracking. The more manual the process, the greater the chance for late or inaccurate submissions that can reduce your MIPS score and reimbursement.

3. Complex Rules and Changing Requirements

CMS updates MIPS criteria and MACRA codes regularly. For busy chiropractors, staying updated on every change can feel impossible. Each update affects what must be reported and how it’s scored. Missing one detail or using an outdated measure can lead to penalties or missed incentives.

4. Keeping Up with Medicare Policies

Medicare adjusts policies and performance thresholds every year. Most clinics spend hours catching up without a digital system that tracks updates automatically. Manual tracking also increases the risk of non-compliance or late reporting, both of which can affect future payments.

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Also read: Chiropractic License & Certification Guide: What You Need to Know

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How Challenges Differ by Clinic Size

• Solo practitioners: Every task lands on your desk, and compliance can easily feel like a second job. Reporting and documentation often take a back seat to the client appointments.
  
• Small clinics (2–5 employees): Admins handle scheduling, billing, and compliance simultaneously, creating overlap that increases errors and delays in reporting.‍
• Medium to large clinics (6+ employees): The challenge shifts from time to consistency. Each practitioner may document differently, which complicates data consolidation for MIPS reporting and impacts accuracy.

The root problem is the same across all clinic types —disconnected systems. Paper notes, separate billing software, and manual tracking create gaps that make compliance harder than it needs to be.

When documentation, reporting, and billing work together through one connected system, like Noterro, compliance becomes less about catching up and more about staying prepared year-round.

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Related read: The Secret Business Problem You’re Probably Overlooking in Your Chiro Clinic

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How Does MIPS Relate to MACRA?

MIPS exists under MACRA. Think of MACRA as the law and MIPS as one of its main programs. Chiropractors can meet MACRA requirements through three main reporting options:

There are three main ways chiropractors can meet MACRA requirements:

1. Traditional MIPS

The standard track used by most chiropractors. You report across four categories — quality, improvement activities, promoting interoperability, and cost — to earn your MIPS score.

2. APM Pathway

This path applies to clinicians participating in Advanced Payment Models. It’s more common in larger or multi-disciplinary practices that coordinate care across specialities.

3. MVPs (MIPS Value Pathways)

The newest approach is designed to simplify reporting by focusing on speciality-specific measures. For chiropractors, this can include musculoskeletal or pain management outcomes. MVPs aim to make reporting more relevant and less time-consuming for focused practices.

Understanding which pathway fits your clinic depends on its size, structure, and resources. Solo and small clinics usually stick with Traditional MIPS, while larger or collaborative practices may qualify for the APM route.

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You might also find this helpful: Chiropractor’s Guide to Credentialing with Insurance Companies

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How to Maximize MIPS/MACRA Benefits as a Chiropractor

Compliance doesn’t have to be complicated or time-consuming when you have the right systems supporting you. The goal is to turn reporting from a stressful, year-end scramble into something that happens naturally throughout your workflow.

1. Move to Digital Charting and Patient Records

Manual charting leaves too much room for missed details and inconsistent data. Using a digital charting system like Noterro makes documentation accurate and straightforward. You can create custom SOAP notes, use predictive charting to auto-fill common details, and even dictate notes directly through Noterro Scribe. This keeps your documentation consistent and ready for reporting at any time.

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2. Consistently Record Patient Outcomes

Accurate data is what drives success under MACRA and MIPS. Structured documentation ensures every patient visit contributes measurable results, from pain reduction to mobility gains. Over time, this data builds proof of your clinic’s quality and supports stronger MIPS submissions.

3. Review and Adjust Regularly

Don’t wait until the end of the year to check your compliance performance. Monthly or quarterly reviews help you catch reporting errors early. Using Reports inside Noterro gives you a clear view of patient outcomes, billing accuracy, and practitioner performance.

4. Train Your Team and Divide Responsibilities

Compliance works best when it’s part of your clinic’s routine. Assign clear roles for documentation, billing, and reporting. Compliance happens naturally when every staff member knows what to track and why, not as an afterthought.

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Also read: 9 Hidden Operational Problems Costing Your Chiropractic Practice

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Best Practices for Ongoing MACRA Compliance

Long-term compliance isn’t about doing more work but building the proper habits. Treating compliance as part of your regular routine becomes easier to manage and far less stressful during reporting season.

1. Review Progress Regularly

Don’t wait until the end of the year to check your data. Monthly or quarterly reviews keep your reports accurate and up to date. Smaller, consistent check-ins also help you spot issues early, instead of rushing to fix them before submission deadlines.

2. Audit Your Data Frequently

Even minor documentation errors can lead to incorrect MIPS submissions or lower scores. Regular audits let you verify that client information, billing details, and quality measures are correct. It’s much easier to fix errors early than to correct them once the data has been submitted.

3. Define Clear Responsibilities

Everyone in your clinic should know their part in maintaining compliance. Assign who handles documentation, who reviews reports, and who completes submissions. When responsibilities are clearly divided, nothing slips through the cracks.

4. Track Performance Through Reports

Real-time data visibility makes compliance easier. Using reports, like those built into Noterro, you can track progress toward performance goals, measure staff productivity, and identify trends before they become problems. This keeps your clinic proactive instead of reactive.

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By following these habits, compliance stops being a year-end scramble and turns into a steady process that protects your reimbursements, keeps your records clean, and ensures your clinic stays ready for any review.

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Bonus read: How to Switch Clinic Management Software Without Losing Patient Data

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Conclusion

Compliance is about running a more innovative and credible chiropractic practice, not just avoiding penalties. MIPS and MACRA reward the effort you already put into delivering quality care. The right tools make that process simple, accurate, and rewarding.

With Noterro, you can manage documentation, automate reporting, and handle compliance in one place, without extra admin work.

Start your free trial or book a demo today and see how easy compliance can be when everything works together.