Improvement Activities (IA)

MIPS Payment Track:

Improvement Activities (IA) Performance Category

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Get the Making Sense of MACRA: Supplements Bundle to learn the basics of QPP. This downloadable resource features information about the law and reporting requirements for the MIPS track.

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MIPS: Explaining the Improvement Activities (IA) Performance Category

The Medicare Access and CHIP Reauthorization Act (MACRA) was passed and signed into law in April 2015. Under MACRA, eligible clinicians (ECs) will participate in either the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (AAPM). MIPS and AAPMs are collectively referred to as the Quality Payment Program (QPP).

With the MIPS track, ECs receive a final score based on performance in four performance categories: quality, cost, advancing care information (ACI), and improvement activities.

To give ECs more time to learn about and adjust to QPP, the Centers for Medicare & Medicaid Services (CMS) deemed 2017 a transition year to “Pick Your Pace.”

IA Reporting

The improvement activity category is a new performance category in MIPS and contains activities similar to the functions of a patient-centered medical home (PCMH). The activities are designed to improve clinical practice or care delivery that, when effectively executed, lead to improved outcomes.

Eligible clinicians must report from a list of 92 activities( Activities must be performed for a minimum of 90 consecutive days during the reporting period.

Activities are either medium-weighted (worth 10 points) or high-weighted (worth 20 points). ECs must report on four medium-weighted activities, two high-weighted activities, or a combination of both to earn up to 40 points.

Eligible clinicians in small (less than 15 clinicians), rural, or health professional shortage areas (HPSAs) will receive double points for each activity, and will need to report either two medium-weighted activities or one high-weighted activity to earn 40 points.

Eligible clinicians can report using an electronic health record (EHR), qualified registry, qualified clinical data registry (QCDR), CMS Web Interface, or via attestation. CMS will open an attestation portal in late 2017.


Participation in the Transforming Clinical Practice initiative (TCPi) is a high-weighted improvement activity.

IA Scoring

Eligible clinicians in a practice that has received PCMH recognition from the following organizations will automatically receive full credit.

  • National Committee on Quality Assurance (NCQA)
  • The Joint Commission (TJC)
  • URAC
  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • Accrediting bodies that have certified 500 or more practices (CMS will release a list at a later date)

Practices and ECs will attest that they are a recognized PCMH. If there are multiple practices reporting under one tax identification number (TIN), only one practice within the TIN needs to be recognized to automatically receive full credit.

Eligible clinicians in a Merit-based Incentive Payment System Alternative Payment Model (MIPS APM) will receive credit based on the requirements of the MIPS APM compared to the MIPS improvement activities requirements.

Eligible clinicians in an APM will automatically receive half credit (20 points).

To calculate the improvement activities category score, divide the points earned by the maximum points available (40). Take that score and multiply it by 0.15. The improvement activity category score is weighted at 15%.

Here is a breakdown (both in bullet and table form) of improvement activities credit earned by participation type:

  • Eligible clinicians = 40 (maximum points possible)
  • Certified PCMH = 40 (automatic full credit if any practice in a TIN is a certified PCMH)
  • MIPS APM = To be scored by CMS
  • APM = 20 (automatic half credit for participation in an APM)

Improvement Activities Participation

Eligible Clinicians

Certified PCMH



Improvement Activities Credit


Automatic full credit (40)

Scored by CMS

Automatic ½ credit (20)