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