Are You Ready for 2026? A Compliance Checkup for Eye Care Practices

Compliance is a challenge for every healthcare practice, including eye care. From navigating the ever-changing Merit-based Incentive Payment System (MIPS) and staying on top of annual regulatory updates to ensuring HIPAA privacy standards are met and avoiding audits, it can feel overwhelming for providers and staff.

In Q4, eye care practices are in planning mode, from finalizing budgets and reviewing staffing needs to determining goals and priorities for next year. It’s the perfect time to add a compliance check-up to the process. Regulations evolve throughout the year, so taking a step back to ensure your ophthalmology or optometry practice is compliant allows you to identify gaps, make corrections, and head into 2026 with confidence. 

Looking ahead to 2026, several essential compliance changes are on the horizon. These include new or revised data elements, as well as updates to the standards that determine what appears in a patient’s healthcare summary and within FHIR applications. Additionally, there are new requirements for internet-based, patient-requested restrictions. Collectively, these changes will shape how practices capture, share, and protect patient data. 

Practices that take a holistic approach to healthcare compliance are better positioned to stay ahead of evolving regulations, reduce risk, and improve their MIPS score. In this post, we’ll explore the critical steps your practice should take now to prepare for 2026, including ensuring your EHR is ready, confirming interoperability, evaluating MIPS performance, and reviewing other key compliance areas. 

If You’re Switching Your EHR, Evaluate Timing  

Timing is crucial for MIPS-eligible ophthalmology and optometry providers that intend to switch EHRs, as it impacts data completeness for the Quality category and performance levels for Promoting Interoperability. That’s why most practices find it easiest to switch to a new EHR in either Q1 or Q4. 

If you’re switching your EHR, plan for training that includes compliance-specific components, such as any new privacy protocols, as well as workflow optimization for Promoting Interoperability and Quality measure data capture, if applicable. Getting this right from the start helps prevent security lapses or documentation gaps. 

Confirm Interoperability 

Interoperability has always been a key focus of regulatory programs, and 2026 is no exception. Using an EHR that is ONC/ASTP certified is the first step to meeting 2026 interoperability requirements, including supporting United States Core Data for Interoperability (USCDI) standards, which serve as the baseline for electronic health information exchange.   

USCDI Updates for 2026 

The USCDI regulates the information that appears on a patient’s healthcare summary. Certified EHRs are required to update from USCDI version 1 to version 3 by January 1, 2026. This update regulates the standards applied to existing data elements, introduces new ones, such as Social Determinants of Health, and expands data classes to emphasize the capture of clinical data. 

FHIR APIs 

The USCDI update also impacts FHIR APIs, requiring them to incorporate the new and revised data elements. By supporting modern and compliant API-based integrations, your platform can connect more easily with apps, devices, and other tools. For patients, this means smoother access to their records through third-party platforms. For providers, it supports innovation in vision care, such as integrating smart imaging or AI-assisted diagnostic tools directly into workflows.  

Electronic Patient-Requested Restrictions 

Under HIPAA, patients have the right to request restrictions on how their Protected Health Information (PHI) is used or disclosed in certain situations. Historically, this process has relied on a HIPAA Use and Disclosure form that patients fill out and submit either online or in person. ONC/ASTP now mandates that patients must be able to submit an electronic request to restrict the health information that appears on their health summary. EHRs and patient portals must have this functionality by January 1, 2026. 

Action Step for Providers 

Confirm with your EHR vendor that they are certified for the interoperability standards mentioned above. You can even request documentation or certification updates to verify readiness. Staying proactive now will reduce last-minute compliance challenges later. 

Evaluate Your MIPS Strategy and Performance 

Monitoring your MIPS performance throughout the year is important, but Q4 is the ideal time for a final review. Tackling any last-minute issues now can still have a positive impact on your score before the 2025 performance year officially closes on December 31, 2025. Remember, the submission deadline is March 31, 2026. 

An evaluation of your MIPS performance score now can help you: 

• Uncover potential gaps in documentation or workflows before they affect your 2025 final score. 

• Plan for improvements in your underperforming categories in 2026. 

Strategies for Your MIPS Check-In 

• Evaluate your MIPS reports: Use your Promoting Interoperability and/or Registry dashboards to generate performance snapshots by category and see where you stand today. 

• Review required documentation: Confirm that your Security Risk Analysis (SRA) and SAFER Guide are completed and up to date. These should be reviewed annually to comply with both MIPS and HIPAA. 

• Engage your team: Ensure your entire team understands which measures they’re contributing to and develop actionable steps staff can take for a final push to improve your PY2025 score. 

• Build your audit file: Your audit file should include documentation of improvement activities, evidence of exceptions and applications, support for measure exclusions, the EHR Certification ID document, PDMP documents, and more. A complete audit file helps prevent headaches down the road.   

• Start building your 2026 strategy: Use your 2025 performance check-in to set the foundation for 2026. Identify where you’re struggling this year and start aligning next year’s measures with your practice's goals. By doing this now, you’ll head into the new performance year with a clear plan.  

Reviewing your MIPS performance now can help your eye care practice ensure compliance, finish 2025 strong, and identify opportunities to make 2026 your best year yet. Explore our MIPS services to see how our compliance experts can help your practice meet quality measures, avoid penalties, and maximize incentives. 

Evaluate Other Compliance Areas

A thorough eye care compliance check-up means looking at the full picture.  Here are some other areas to assess: 

• HIPAA: Conduct or update your security risk assessment. Confirm that access controls, encryption, and staff training are up to date. Ensure your patient portal honors patient-requested data restrictions that support HIPAA Right of Access.  

• Payer Audits: Payers are increasingly scrutinizing records for accuracy and medical necessity. Ensure your documentation process is thorough and confirm your EHR supports the latest CPT and ICD-10 code updates.  

• EHR Certification:  An EHR that participates in the ONC/ASTP Health IT Certification Program is required to maintain standards, implementation specifications, and criteria set by the U.S. Department of Health and Human Services (HHS). Choosing a certified EHR is the best way to guarantee that your system upholds the highest levels of data security, supports interoperability, and protects patient health information. 

• Documentation Standards: Ensure your practice’s procedures support clear communication with patients and co-managing providers by properly documenting referrals, patient permissions, amendments, and other critical information. 
  
  
• OSHA: Refresh your safety training logs, hazard communication plans, and incident response documentation. OSHA is often overlooked, but regular updates can reduce risk and liability.  
  
  

Preparing for 2026 Starts Now 

At Sightview, we know that keeping up with regulations can feel overwhelming, but compliance doesn’t have to be an ongoing burden. Our certified EHR is purpose-built for ophthalmology and optometry, meeting the latest compliance standards. We continuously update our platform to align with evolving regulatory requirements. With Sightview, your practice can stay ahead of new regulations effortlessly, allowing your team to focus on patient care rather than compliance headaches. 

Book a demo today to see how our platform can help your practice streamline workflows and stay compliant.