Merit-Based Incentive Payment System
Performance-Based Payment Adjustment System
Smiles for Life is included in a new oral health–related Improvement Activity within the Centers for Medicare & Medicaid Services’ (CMS) 2026 Merit-based Incentive Payment System (MIPS). The designation underscores CMS’s recognition of oral health as a critical component of whole-person care and strengthens the integration of oral health competencies across primary care settings.
What is the Merit-based Incentive Payment System (MIPS)?
MIPS for primary care providers involves a performance-based payment adjustment system that evaluates the quality of care delivered to Medicare beneficiaries. This program aims to shift Medicare physician payment towards value-based care and evaluates clinicians across 4 performance categories: Quality, Improvement Activities, Promoting Interoperability, and Cost.
Required Steps:
To fulfill requirements for this new activity, Medicare-participating physicians must complete the following steps aiming to enhance coordination between medical and dental teams and ensure timely follow-up care for patients:
1. Smiles For Life courses - Taking the Oral Examination and
Geriatric Oral Health courses will satisfy the educational requirement of the
activity. You can submit the course certificates. If you need to reprint a
certificate, please check out our FAQs on how to access your certificate.
2. Document oral health findings in the patient record.
3. Implement a referral process to meet oral health needs. Information about
structured referrals can be found here.
4. Collaborate with local dental providers.
The Safety Net Medical Home Initiative Primary Care Oral Health Integration Guide is a helpful document to begin integrating oral health services in your primary care setting.
Website Links
Four Components:
Providers submit the quality and promoting interoperability measures and improvement activities that they collected/performed during the performance year. The 4 performance categories are scored and make up your MIPS final score. Your final score determines the payment adjustment applied to your Medicare Part B claims. The MIPS data can be collected and reported in multiple ways. You can participate as an individual, group, virtual group or APM Entity.
Reports can be submitted online at the Quality Payment Program QPP Portal.
The MIPS performance year begins on January 1 and ends on December 31 each year, with data submission required by March 31 of the following calendar year. Providers must report data collected during the performance year to determine their MIPS final score which, in turn, affects their Medicare Part B payment claims payment adjustment. Payment adjustments will be applied to Medicare Part B claims during January 1 to December 31 of the year following data submission. For example, if you collect data between January 1 and December 31, 2025 (i.e., the performance year), you must report your data by March 31, 2026, and you'll receive a MIPS payment adjustment between January 1 and December 31, 2027 (i.e., the payment year).