For eye care providers, a strong MIPS score will boost reimbursements, strengthen compliance, and enhance reputation. But MIPS for ophthalmology practices is also complex. Frequent rule changes, compliance updates, and evolving processes make it difficult for practices to stay on top of their reporting, let alone maximize their score.
To support practices looking to boost their MIPS score, we sat down with Holly Black, our Director of Operations, Sightview MIPS Services. She has decades of experience in reporting and optimization of MIPS for ophthalmology. In this Q&A, Holly shares insights on common mistakes, effective strategies, upcoming trends, and practical actions for MIPS success.
About Holly: Often referred to as a “MIPS Geek Guru,” Holly takes great pride in helping Sightview’s clients achieve regulatory success. Bringing over 35 years of clinical ophthalmology experience as a Certified Ophthalmic Technician in a multi-specialty practice, she has played a key role in managing participation in Meaningful Use, PQRS, and MACRA programs. Today, Holly continues to combine deep clinical knowledge with regulatory expertise to empower countless practices to boost their MIPS score and maximize their reimbursements.
The Merit-based Incentive Payment System (MIPS) is part of the Quality Payment Program (QPP), an initiative created by the Centers for Medicare and Medicaid Services (CMS). With this program, CMS aims to shift healthcare away from volume-based to value-based (rewarding providers for quality of care, rather than how many services they provide).
MIPS evaluates providers across four performance categories:
These four categories contribute to your final MIPS score of 0 to 100 points. Your final score determines whether you will receive a negative, neutral, or positive MIPS payment adjustment.
A: Lack of staff training and not understanding MIPS performance categories: Failing to stay current on policy changes and requirements, not understanding the measure specifications, and a lack of understanding of MIPS category weighted scores may lead to misreporting or underreporting in any category, which could potentially lower your overall MIPS score and may lead to reduced reimbursements. Ensure that all staff members are educated on all MIPS reporting requirements, data entry procedures, and how to use your EHR effectively.
A: Engaging the entire team in MIPS goals and processes: Practices can improve MIPS scores by involving the entire team. This includes training staff on MIPS requirements, discussing objectives in team meetings, and recognizing contributions to achieving goals. Create a MIPS team and appoint a team lead to monitor, track performance progress, and stay updated on MIPS changes throughout the year, and then adjust workflows based on the team lead’s findings.
A: MIPS Value Pathways (MVPs) are gaining prominence: CMS is encouraging the adoption of MVPs, which streamline MIPS reporting by focusing on specialty-specific measures and activities. While it is voluntary to report MVPs for 2025, CMS aims to eventually phase out traditional MIPS reporting and make MVP reporting mandatory. CMS estimates that this change will take place between 2027 and 2030. Taking the time now to understand the differences between MVPs and traditional MIPS reporting will help ensure better performance when MVP reporting becomes mandatory in the future.
A: Determine eligibility status and form a MIPS team: Check the MIPS eligibility for your practice to determine both group and individual-level status. Form your MIPS team and designate a lead who understands regulations, oversees the process, and ensures timely reporting. Remember that MIPS is a performance-based program; therefore, consistent effort, ongoing evaluation, and continuous improvement are essential to achieving higher scores.
A: Review your Quality measures: Identify the measures that your practice reports on and understand the data requirements for each. Review your performance on your dashboard to make sure that measures are being mapped correctly. If any mapping issues are discovered, open tickets with your registry or EHR to request remapping. There is often a deadline to make these requests, and you don’t want to find out after the deadline that you are performing workflows per the measure requirements, but the dashboard is not reflecting performance correctly.
Achieving a high MIPS score increases your reimbursements and demonstrates your commitment to quality care. However, navigating MIPS can be a full-time job. Between staying up to date with policy changes, tracking performance, and managing reporting, it can overwhelm your team.
That’s where Sightview’s MIPS Consulting Services come in. With over 80 years of collective experience in MIPS for ophthalmology, our team offers the support you need to navigate the process, boost your score, and maximize your reimbursements.
“The MIPS service has made my life so much less stressful by not needing to worry about our clinic meeting our MIPS goal. I know I have the most knowledgeable team on our side to help.”
—Andrea, Clinic Manager
Interested in seeing how we can support your ophthalmology practice? Schedule a consultation with our MIPS team today.