The Dermatology Practice Guide to MIPS

Every March, dermatology practices across the country scramble to figure out their MIPS submissions. Others don't realize they've been penalized until the adjustment shows up on their remittance. Some are still trying to work out whether they're required to participate at all.

MIPS doesn't have to be this hard. Whether you're a practice owner trying to understand the financial stakes, a biller managing the submission process, or an office manager responsible for keeping your team's documentation on track, this guide covers what you actually need to know: what MIPS is, how it's scored, which quality measures matter for dermatology, how to submit, and what to do right now to set up a strong year.

MIPS 101: The Basics Every Dermatology Practice Needs to Know

MIPS stands for the Merit-based Incentive Payment System. It's the primary quality payment track under MACRA, the Medicare Access and CHIP Reauthorization Act, signed into law in 2015 and active since 2017. The program moves Medicare reimbursement away from pure volume and toward quality, efficiency, and the use of health information technology.

Your MIPS performance during a given calendar year determines whether you receive a positive, negative, or neutral adjustment on your Medicare Part B reimbursements two years later. Your 2026 performance affects your 2028 payments.

Who Has to Participate?

Most clinicians billing Medicare Part B are subject to MIPS, with some exceptions. You're typically exempt if you:

• Are in your first year of Medicare participation
• Fall below the low-volume threshold (currently: $90,000 or less in Medicare Part B allowed charges, 200 or fewer Medicare Part B patients, or 200 or fewer covered professional services under the PFS in the performance period)
• Are a Qualifying APM Participant (QP) in an Advanced Alternative Payment Model

Check your eligibility using the lookup tool at qpp.cms.gov. If you are eligible, not participating isn't a neutral choice - it's a guaranteed penalty.

What's at Stake Financially?

For 2026, the performance threshold is 75 points. Here's how your final score maps to 2028 payment adjustments:

• Above 75 points: Positive payment adjustment
• At 75 points: No adjustment
• Below 75 points: Negative adjustment, up to a maximum of -9% for scores below 18.75 points

A -9% hit on a dermatology practice with significant Medicare volume is real money. On $500,000 in Medicare Part B revenue, that's $45,000 off the top. Getting MIPS right protects your bottom line.

Individual vs. Group Reporting

Practices report MIPS either as individuals (each eligible clinician separately) or as a group (all eligible clinicians under the same Tax Identification Number, pooled together). Group reporting combines patient data across providers, which makes it easier to hit the 20-case minimum per measure. The tradeoff is that every provider's performance rolls into the group score. Talk with your billing team or MIPS consultant about which approach makes sense for your practice.

The Four Performance Categories of MIPS

Your final MIPS score comes from four weighted categories. Here's what each one means and where your leverage actually is.

Quality (30%)

This is where dermatology practices have the most control. You report on six quality measures for the full 12-month performance period, and at least one must be an Outcome or High Priority measure. Your score in this category is benchmarked against national performance on each measure you select.

The 2026 data completeness threshold is 75%, meaning you must report on at least 75% of your eligible patients across all payers for each selected measure. Reporting Medicare patients only is no longer enough.

Cost (30%)

CMS calculates this entirely from Medicare administrative claims. You don't submit anything. CMS looks at your total per capita cost of care and compares it to a risk-adjusted benchmark for your patient population. Since this is claims-driven, your best lever is diagnosis coding accuracy. Incomplete coding can make your patients look healthier than they are, which makes your actual costs appear high against the benchmark.

Promoting Interoperability (25%)

This category measures how your practice uses certified EHR technology (CEHRT) to exchange health information. In 2026, you must report for a minimum of 180 continuous days - a change from prior years. You'll also need to attest that you completed a self-assessment using the SAFER Guides (specifically the High Priority Practices Guide). Skipping that attestation means a zero for the entire PI category, regardless of everything else you submitted.

Key 2026 requirements also include a Security Risk Analysis with documented risk management activities and evidence of health information exchange.

Improvement Activities (15%)

You attest that your practice completed specific clinical improvement activities for at least 90 continuous days. Large practices attest to two activities (20 points each). Small practices, 15 or fewer clinicians, only need one activity for full credit (40 points). At least 50% of clinicians in the group must complete the same activity during the required window.

Practical options for dermatology include formal quality improvement methods (IA_PSPA_19) and telehealth to expand access (IA_EPA_2). New for 2026: Patient Safety in the Use of Artificial Intelligence is now an eligible activity.

MIPS Quality Measures for Dermatology: A Complete Breakdown

Quality is where dermatology practices win or lose MIPS. The 2026 measure inventory has 187 measures in total. You report six, and at least one must be High Priority or Outcome. The practical strategy is to actively track eight to nine measures throughout the year, then submit your best six at year-end.

A Note on "Topped-Out" Measures

Topped-out measures are ones where national performance is so uniformly high that CMS caps the maximum score at 7 points instead of 10. If your entire six-measure set is topped-out, you're leaving points on the table before your performance is even evaluated. Build in at least one or two Outcome or High Priority measures.

MIPS 47 - Advance Care Plan

Type: Process | Age Restriction: 65 and older

Tracks whether patients 65 and older have an advance care directive documented in the medical record. There are two required components: confirming the patient has an active living will, and documenting who their healthcare surrogate or proxy decision-maker is.

The living will question can be collected during intake. The surrogate question requires someone to ask directly. Both need to be in the chart. If a patient doesn't have a surrogate or declines to name one, document that. "Patient declined to name a surrogate" counts.

Key thing to know: You get credit when the patient confirms they have a living will. The surrogate documentation is a required second step regardless, and skipping it creates audit exposure.

MIPS 130 - Documentation of Current Medications in the Medical Record

Type: Process / High Priority | Age Restriction: 18 and older

At every visit, you document the patient's full medication list with dose, route, and frequency. This includes prescriptions, over-the-counter medications, vitamins, and supplements. If a patient doesn't know the exact dose of something, document what they said and note that complete information wasn't available. The requirement is showing the effort was made.

EHRs with Surescripts integration can pull in current prescription data automatically, which cuts the documentation burden significantly.

Key thing to know: Practices have received audit warnings for not capturing dose, route, and frequency. That's the most commonly missing piece.

MIPS 176 - Tuberculosis Screening Prior to First Course of Biologic Therapy

Type: Process | Age Restriction: All ages

Patients starting a biologic for the first time, or after a 15-month gap without biologics, must have a TB test documented within the 12 months before the first dose. The measure is triggered by the prescribing of the biologic, not by the TB test itself.

The 15-month window matters. A patient off biologics for 16 months who is restarting qualifies. A patient who was on a biologic last month does not.

Key thing to know: The biologic must be prescribed within a valid E&M visit for this measure to trigger. Practices that send biologics via virtual encounters or nurse visits won't capture it there.

MIPS 226 - Tobacco Use: Screening and Cessation Intervention

Type: Process | Age Restriction: 12 and older

Patients are screened for tobacco use. Those who screen positive receive cessation counseling (at least three minutes) and/or pharmacotherapy. Brochures don't qualify. The conversation has to happen and be documented.

Intake questionnaires handle the screening. A brief provider note or structured treatment plan documents the counseling.

Key thing to know: When a patient reports no tobacco use, you still need to answer the measure question. Leaving it blank counts against your reporting rate.

MIPS 317 - Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Type: Process | Age Restriction: 18 and older

Applies to patients with a newly elevated blood pressure reading (130/90 or above) who don't have an existing hypertension diagnosis and aren't on antihypertensive medications. You document the reading and refer them to a PCP or appropriate provider.

Most dermatology practices don't routinely take blood pressure, which naturally limits how often this triggers. If your practice takes vitals for patients on systemic medications, it becomes more relevant.

MIPS 355 - Unplanned Reoperation Within 30 Days of a Surgical Procedure

Type: Outcome (Inverse) | Specific CPT Codes Required

An inverse measure - lower is better. You don't want patients coming back for unplanned reoperations within 30 days. This only applies to specific CPT codes covering soft tissue excisions and certain surgical procedures. If your practice doesn't use those codes, this measure won't trigger.

Key thing to know: You can answer "no reoperation" at the time of surgery and update the answer if the patient does return. Or wait 30 days, then work through your incomplete patient list.

MIPS 357 - Surgical Site Infection

Type: Outcome (Inverse) | Specific CPT Codes Required

Tracks whether patients developed a surgical site infection within 30 days of a procedure. Same inverse logic as Measure 355, same CPT code requirements. Most applicable to practices performing excisions, Mohs, or reconstructive procedures.

MIPS 358 - Patient-Centered Surgical Risk Assessment and Communication

Type: Process | Specific CPT Codes Required

Before surgery, you use a validated risk calculator to assess patient risk, then communicate those risks and benefits to the patient. You don't need to document the calculator output itself. Attesting that a risk calculator was used and the discussion happened is sufficient.

CMS doesn't specify which calculator to use. One that includes dermatology-specific CPT codes is the Surgical Outcomes and Risk Tool (SORT). This measure applies to the same specific CPT codes as Measures 355 and 357.

MIPS 374 - Closing the Referral Loop: Receipt of Specialist Report

Type: Process / High Priority | Age Restriction: All ages

Tracks whether a referral loop was closed - you referred a patient, and you got confirmation the specialist saw them and returned a report. For practices with in-house Mohs or internal surgeons on the same EHR, this can be handled through internal to-do messages that confirm the referral was completed.

This triggers on virtually any E&M visit where a referral occurs. Because it applies broadly, it's one of the easier measures to accumulate cases for and always carries High Priority status.

Key thing to know: You don't need to have made a referral to answer this question. You need to answer it, or it sits in your incomplete queue and pulls your reporting rate down.

MIPS 397 - Melanoma Reporting

Type: Process | Topped-Out

Tracks whether melanoma diagnoses were reported to a cancer registry or clinical data repository. Nationally, performance rates are high enough that this measure is topped out at a maximum of 7 points. You can still report it, but it shouldn't anchor your scoring strategy.

MIPS 410 - Psoriasis: Clinical Response to Systemic Medications

Type: Outcome / High Priority | Diagnosis: Psoriasis Vulgaris only

One of the highest-value measures for dermatology. You document three scores at each psoriasis visit: Body Surface Area (BSA), PASI (Psoriasis Area and Severity Index), and PGA (Physician Global Assessment). All three must be captured for the measure to register.

The diagnosis must be specifically psoriasis vulgaris (ICD-10 L40.0), not other subtypes. Many practices document PGA scores in notes already, but if those scores aren't entered through the designated tool in your EHR's body map, they won't trigger the measure.

Key thing to know: This is a high-priority outcome measure. Make it a non-negotiable step in the clinical workflow for every psoriasis vulgaris patient on systemic medication.

MIPS 431 - Unhealthy Alcohol Use: Screening and Brief Counseling

Type: Process | Age Restriction: 18 and older

Screen patients for unhealthy alcohol use and provide brief counseling when the screen is positive. Most applicable at comprehensive new patient evaluations. The screening can be embedded in your intake questionnaire.

MIPS 440 - Skin Cancer: Biopsy Reporting Time - Pathologist to Clinician

Type: Process | Topped-Out

Tracks turnaround time for pathology results after a skin biopsy. Topped out nationally, so the ceiling is 7 points. Worth reporting if your practice has strong turnaround times, but not a primary scoring driver.

MIPS 485 - Psoriasis: Improvement in Patient-Reported Itch Severity

Type: Outcome / High Priority | Age Restriction: 8 and older | Diagnosis: Psoriasis

A two-visit measure. On the first qualifying visit, document a patient-reported itch severity score of 4 or higher using a validated itch severity scale. On any subsequent visit, document the score again. If it's dropped by 3 or more points, the measure is met.

The itch severity scale must be used at the first visit for it to activate on follow-up visits. If a patient comes in with a 6 in March and a 3 in June, the measure is met.

Key thing to know: Use the itch severity scale on every qualifying patient at their first visit, every time. Once a note is signed, there's no way to retroactively trigger this measure on that encounter without recreating it.

MIPS 486 - Dermatitis: Improvement in Patient-Reported Itch Severity

Type: Outcome / High Priority | Age Restriction: 8 and older | Diagnosis: Atopic Dermatitis

Same logic as Measure 485, applied to atopic dermatitis patients. Score 4 or above at Visit 1, reduce by 3 or more points at a subsequent visit.

MIPS 487 - Screening for Social Drivers of Health

Type: Process | Note: Removed for the 2026 performance year

Available in 2025, discontinued for 2026. Don't include it in your measure selection this year.

MIPS 493 - Adult Immunization Status

Type: Process | Age Restriction: 18 and older

Tracks whether adult patients are up to date on recommended vaccinations. Most dermatology practices aren't administering vaccines, but practices that screen and refer for immunizations may find this applicable.

MIPS 498 - Connection to Community Service Provider

Type: Process

Tracks whether patients with identified social needs were connected to a community service provider. With Measure 487 removed for 2026, the practical relevance for most dermatology practices is limited.

MIPS 503 - Gains in Patient Activation Measure (PAM) Scores at 12 Months

Type: Outcome / High Priority | Age Restriction: 18 and older

Tracks improvements in patient engagement in their own care over 12 months using the validated PAM survey, administered at two time points. For dermatology practices managing chronic conditions like psoriasis, atopic dermatitis, or melanoma follow-up, this can be a useful addition to the measure set.

MIPS 509 - Melanoma: Tracking and Evaluation of Recurrence

Type: Process / High Priority | Age Restriction: 18 and older

Applies to patients who had a melanoma or melanoma in situ excised within the past five years and are being followed up by the excising provider. It's an inverse measure - lower scores reflect better outcomes (fewer recurrences). The goal is to document follow-up evaluations for post-excision patients.

This measure is tied to the excising provider specifically. If a patient's excision was performed by one clinician and follow-up is with another, the measure is attributed to the excising clinician. That's an important workflow detail for practices with multiple providers or internal referrals.

The 20-Case Rule and Why It Matters

Each measure you report needs at least 20 eligible patient cases to count toward your final score. Fall short of 20 and the measure generally won't qualify.

This is one of the places where group reporting pays off. A three-provider practice where each dermatologist sees 7 to 10 qualifying psoriasis patients can collectively hit 20 cases for Measure 410, even though no single provider gets there alone.

Once you've hit 20 cases, keep answering the measure for every qualifying patient. Your reporting rate - the percentage of eligible patients for whom you answered the measure question - needs to stay at or above 75%. Stopping at 20 and ignoring the rest pulls that rate down and lowers your score.

Finding Your Gap Patients

Most EHRs with MIPS tracking let you see which eligible patients have incomplete measure responses. Use this throughout the year, not only in December. An incomplete patient report pulled in October that shows 40 unanswered cases for Measure 374 is fixable. The same report pulled in February, after the submission window has closed, is not.

How to Submit MIPS Data: Your Reporting Options

After tracking your measures throughout the year, you submit the data to CMS. The right method depends on your practice's size, technology, and resources.

Direct Submission via Your EHR

If your EHR has a direct integration with the CMS Quality Payment Program API, it can generate and transmit quality data to CMS automatically. This is the cleanest path if your EHR supports it.

Submission via a Data Registry (Qualified Registry or QCDR)

Many practices use a third-party intermediary: a Qualified Registry or a QCDR. Both handle data collection and submission on your behalf. The next section covers the difference between them.

Claims-Based Submission

Small practices without registry access or a capable EHR can submit certain quality measures by appending codes directly to Medicare claims. It's the most limited method in terms of measure selection and generally the most time-intensive.

Web Interface

Groups with 25 or more clinicians can use the CMS Web Interface, though CMS has been scaling this pathway back as EHR and registry submissions have matured.

Understanding QCDRs and Qualified Registries

If your practice uses a third-party vendor for MIPS submission, you're working with either a Qualified Registry or a QCDR. Here's how they differ and why it matters.

What is a Qualified Registry?

A Qualified Registry collects MIPS data from eligible clinicians and submits it to CMS on their behalf. Practices work directly with the registry to compile and transmit data on selected measures and improvement activities. CMS approves Qualified Registries and sets data security and transmission standards they must meet.

What is a QCDR?

A Qualified Clinical Data Registry (QCDR) goes further than data collection and submission. CMS defines a QCDR as an intermediary that demonstrates clinical expertise in medicine and quality measurement development. QCDRs collect medical or clinical data on behalf of MIPS eligible clinicians to track patients and diseases, with the purpose of improving care quality.

A QCDR can take several forms:

• An intermediary with clinical staff on board who lend their expertise to the organization's work as a QCDR
• An intermediary with independent quality measurement development experience
• An intermediary that collects clinical data for patient and disease tracking on behalf of clinicians
• An intermediary using an external organization for data collection, calculation, or transmission, provided a signed written agreement is in place detailing the relationship and responsibilities (this agreement must exist prior to September 1 of the year before the MIPS performance year)

One key distinction: QCDRs can offer and submit QCDR measures, which are measures developed and validated by the QCDR itself, outside the standard CMS measure inventory. This expands the available measure set for practices that want options beyond traditional MIPS quality measures.

Choosing the Right Submission Partner

When evaluating a registry or QCDR, ask:

• Does it support the specific measures you're planning to report?
• Does it integrate with your EHR, or will you be uploading data manually?
• What reporting and monitoring tools does it offer during the year, not just at submission time?
• What's its track record for on-time submission to CMS?
• What does it cost relative to the payment adjustment at stake?

Healthmonix is widely used among dermatology practices, particularly those on Ezderm. The American Academy of Dermatology also offers a registry platform called DataDerm, and there are a range of specialty-agnostic options approved by CMS.

MIPS Value Pathways (MVPs): The Future of Dermatology Reporting

CMS is transitioning away from Traditional MIPS toward MIPS Value Pathways (MVPs) - a model that groups together clinically relevant measures and activities for specific specialties rather than asking every clinician to report from the same broad inventory.

The Dermatological Care MVP (M1421)

The Dermatological Care MVP is available for 2026 and is built around the treatment and management of dermatologic conditions. Compared to Traditional MIPS, the reporting requirements are narrower:

• Quality: Select 4 measures from the MVP's curated list (at least one must be an Outcome or High Priority measure)
• Improvement Activities: Select 1 activity from the MVP list
• Cost: No submission required - CMS calculates the Melanoma Resection cost measure automatically from claims
• Promoting Interoperability: Full PI reporting still applies
• Foundational Layer: CMS calculates a population health measure from claims data

For practices that find Traditional MIPS hard to manage, the Dermatological Care MVP may offer a more straightforward path to 75 points.

Registration Requirements

MVP participation isn't automatic. Register between April 1 and November 30, 2026. If you want to include the CAHPS for MIPS patient experience survey as a quality measure, the registration deadline is June 30, 2026. Miss the window and you default to Traditional MIPS for the year.

Subgroup Reporting for Multispecialty Practices

Starting in 2026, multispecialty groups can no longer register as a single group under an MVP. Practices with multiple specialties that want to participate in the Dermatological Care MVP must register as a subgroup, as individuals, or as an APM Entity. Small practices with 15 or fewer clinicians are exempt from this rule and can still register as a multispecialty group.

Should Your Practice Consider MVPs?

If you've found Traditional MIPS reporting time-consuming or hard to optimize for a strong outcome score, the Dermatological Care MVP is worth evaluating. The reduced measure set and automatic cost calculation free up staff time while still offering a solid path to a competitive score.

Common Mistakes Dermatology Practices Make with MIPS

These are the issues that show up most often in practices that struggle with their MIPS scores.

• Skipping the surrogate question on Measure 47. The living will is usually captured on intake forms, but the surrogate is a separate step that requires someone to ask the patient. That step gets missed constantly. Without it, the measure is incomplete.

• Not capturing dose, route, and frequency on Measure 130. A medication list without those three fields doesn't satisfy the measure. This is the most commonly audited component of Measure 130.

• Pulling the incomplete patient report only in December. By then, notes are signed, encounters are closed, and most of the window to fix things is gone. Monthly is better. Quarterly, at minimum.

• Not using the itch severity scale at the first visit for Measures 485 and 486. These measures can only be triggered retrospectively if the tool was used at the initial qualifying visit. Once a note is signed, that encounter can't be retroactively linked to the measure without recreating the visit from scratch.

• Triggering measures on non-E&M visits. Quality measures only track on E&M coded visits - standard office visit codes in the 99201-99215 range. Procedure-only visits and nurse visits without an E&M code won't trigger anything. This is the first thing to check when staff say a measure "isn't showing up."

• Clicking Cancel instead of Done in the MACRA wizard. In EHRs that use a confirmation step (including Ezderm), answering the measure questions isn't enough. You have to hit Done to save the responses. Clicking Cancel - even after filling in every answer - leaves the session showing zero captured measures.

• Waiting until February to start the submission process. Registry queues fill up near the deadline. Getting in early, ideally by December or January, means faster processing and more time to catch and fix any issues before the CMS deadline.

• Building a measure set entirely out of topped-out measures. Measures 397 and 440 are both capped at 7 points. A six-measure set made up only of topped-out measures limits your Quality score ceiling from the start. Add at least one or two Outcome or High Priority measures.

• Using last year's CEHRT ID. The CEHRT ID changes annually. Using the wrong one causes submission errors. Confirm the current year's ID with your EHR vendor each January.

Planning for MIPS Success Year-Round

MIPS is a 12-month performance program. Practices that do well treat it that way.

January: Set Up and Orient

• Confirm eligibility for the new performance year at qpp.cms.gov
• Decide individual vs. group reporting
• Select target measures (aim for 8 to 9; submit your best 6)
• Note the April 1 MVP registration window if applicable
• Confirm your CEHRT ID with your EHR vendor
• Brief clinical and front office staff on which measures you're targeting and what each requires

February through September: Capture and Track

• Run a quality report monthly to check case counts per measure
• Review the incomplete patient list at least quarterly
• Confirm that staff workflows include the right documentation steps for qualifying visits - the itch severity scale, the surrogate question, the BSA/PASI/PGA scores
• If using a QCDR or registry, check mid-year that your data is coming through correctly

October through November: Gap Review

• Pull a full incomplete patient report and close out open measure responses
• Confirm you've hit 20 cases for each target measure
• Review reporting rate and performance rate per measure
• Verify MVP registration if applicable
• Start the year-end bridging process with your registry or QCDR

December through March: Submission

• Submit before the CMS deadline (typically March 31)
• Get written confirmation of submission from your registry or QCDR
• Retain supporting documentation for 10 years in case of audit

Assign a MIPS Champion

Practices that consistently score well tend to have one thing in common: one person owns MIPS. Whether that's the office manager, the biller, or a quality coordinator, a single point of accountability makes a real difference. They run the monthly reports, flag documentation gaps, escalate questions to the registry, and keep the practice out of end-of-year crisis mode.

How Ezderm Makes MIPS Reporting Easier

If your practice uses Ezderm, MIPS tracking and submission are built into the platform rather than layered on top of it. Here's how the system supports the full MIPS workflow, from daily documentation to year-end bridging.

The MIPS Measures Ezderm Supports

Ezderm tracks the following MIPS quality measures within the clinical workflow:

• 47 - Advance Care Plan
• 130 - Documentation of Current Medications
• 176 - TB Screening Prior to First Course of Biologic Therapy
• 226 - Tobacco Use: Screening and Cessation Intervention
• 317 - Screening for High Blood Pressure
• 355 - Unplanned Reoperation Within 30 Days
• 357 - Surgical Site Infection
• 358 - Patient-Centered Surgical Risk Assessment
• 374 - Closing the Referral Loop
• 410 - Psoriasis: Clinical Response to Systemic Medications
• 485 - Psoriasis: Improvement in Patient-Reported Itch Severity
• 486 - Dermatitis: Improvement in Patient-Reported Itch Severity
• 509 - Melanoma: Tracking and Evaluation of Recurrence

These measures surface at the point of care rather than requiring a separate documentation session after the visit.

How Measures Trigger in Ezderm

Measures are activated through the MACRA Measures wizard, shown as a red "M" icon in the patient's progress note. It lights up when a qualifying encounter is open, signaling that there are measure questions to answer before closing the visit.

Measures only trigger on E&M coded visits. Procedure-only visits and nurse visits without an E&M component won't activate the MACRA wizard. When staff report a measure "isn't showing up," check the visit coding first.

Always click "Done," not "Cancel." Opening the MACRA wizard and answering the questions is not enough. You must click "Done" to save the responses. Clicking "Cancel" - even after filling in every answer - clears the session. The measure will still show as incomplete. This is one of the most common sources of zero-count measures at year-end.

How Specific Measures Work in Ezderm

Measure 47 (Advance Care Plan): The living will question comes through EasyCHECK-IN and auto-populates in the History section under "Advanced Health Care Directive." The surrogate question must be asked by staff at the visit. To document it, go to History, scroll to the bottom, find "Advanced Health Care Directive," and click the black text field to enter the surrogate's name or note that the patient declined. Then confirm the measure in the MACRA wizard and click "Done."

Measure 130 (Current Medications): Ezderm's Surescripts integration, accessed through the "Dispense Medication" field, pulls in current prescription data with dose, route, and frequency automatically. Add anything not captured by Surescripts (supplements, OTC medications) manually with the same fields. Ezderm includes a public treatment plan called "Review of Current Medications - MACRA Measure 130" that, when attached to the encounter, adds a note confirming the medication review was completed.

Measure 176 (TB Screening for Biologics): The trigger is prescribing the biologic within the encounter, not ordering the TB test. If a patient needs the TB test before the biologic is dispensed, queue the prescription in the Rx section (move it to the "Prescribed" tab without ordering it). That queued prescription triggers the measure. Add TB test documentation using the public treatment plan "TB Screening - MACRA Measure 176." When results return, the medication can be ordered through a follow-up encounter.

Measure 374 (Closing the Referral Loop): For internal referrals within Ezderm's shared record, send a to-do message to the receiving provider indicating the referral. The receiving provider sends one back confirming the visit was completed and documentation is in the chart. That exchange satisfies the referral loop requirement without faxes or external letters.

Measure 410 (Psoriasis Clinical Response): BSA, PASI, and PGA must be entered through Ezderm's body map controls, not typed into a free-text field. Clicking the BSA score cycles to PASI; clicking again cycles to PGA. Long-press on PASI or PGA to open the input wheel. The PASI score must be set to 1 or higher. All three entries through the body map are required for the measure to register.

Measures 485 and 486 (Itch Severity): Use the pruritus/itch severity scale icon in the body map at the first qualifying visit and document a score of 4 or higher. The scale must be on the encounter for the measure to activate on future visits. On a later visit, if the score has dropped by 3 or more points, the measure is met. Re-enter the scale on each follow-up for tracking to carry through.

Measure 509 (Melanoma Recurrence): Surfaces automatically for patients with a melanoma or melanoma in situ excision in the past five years, followed up by the excising provider. Confirm the measure in the MACRA wizard at each eligible follow-up visit.

Running Your Quality Report in Ezderm

Navigate to Settings > My Profile > MACRA/Quality. Hit the "+" button, enter the provider name (or group), set the date range to the current calendar year, and click "Done."

Wait for the report to finish generating before clicking into it - opening it mid-generation can trigger an error.

Once loaded, each measure shows:

• Denominator: Total eligible patients the measure triggered for
• Performance Met: Patients who met the measure
• Performance Rate: Percentage who met it (target: above 75%)
• Reporting Rate: Percentage of eligible patients for whom the question was answered (target: 75 to 100%)

Finding and Closing Incomplete Patients

Inside any measure, click "Eligible Patients" to see the breakdown: met, not met, excluded, and incomplete. The incomplete list shows every patient where the measure triggered but the MACRA question was never confirmed.

Click on the patient, open the related visit, navigate to the MACRA wizard, answer the outstanding questions, and click "Done." That patient shifts from incomplete to either met or not met. This is how you clean up your reporting rate at any point in the year.

Bridging to Healthmonix

Ezderm integrates with Healthmonix for MIPS submission. The bridge - the data transfer from Ezderm to Healthmonix - should be requested well before year-end. Do not wait until February.

Steps to prepare:

1. Log in to Healthmonix and go to the Quality section
2. Under "My Measures," add all the measures you're tracking, even ones you may not submit. You pick your best six at the end
3. Confirm the CEHRT ID is current. It updates annually. Using last year's ID causes a submission error. Request the current ID from Ezderm support if needed
4. Request the bridge through Ezderm's team or your Healthmonix account. Once complete, Healthmonix receives your full year's data from Ezderm and calculates your projected scores

After the bridge, review your performance across selected measures in Healthmonix, choose the six to submit, and submit before the CMS deadline - typically March 31.

Tips for MIPS Reporting in Ezderm

Use the public treatment plans. Ezderm has built-in plans for Measures 130, 176, and others. When attached to an encounter's body map, they add supporting documentation to the chart and help confirm the measure was addressed. Easy to overlook, worth building into your workflows for qualifying patients.

Answer the measure for every eligible patient, not just the first 20. Your reporting rate is calculated across all eligible patients. Stopping at 20 drags that rate down.

Track 8 to 9 measures, submit 6. Extra active measures give you flexibility if one underperforms.

Drill the "Done button" rule with every staff member who touches notes. That single step is behind a significant share of incomplete measures across practices.

Request the Healthmonix bridge in November or December. The queue grows near the deadline. Requesting early means faster turnaround and more time to spot issues before submission.

Make high-priority measures explicit in staff training. Measures 374, 410, 485, 486, and 509 move the needle on your score more than most. They deserve dedicated attention in your clinical workflows and staff onboarding.

Ready to Take the Stress Out of MIPS?

MIPS reporting doesn't have to be a year-end scramble. With the right system and the right support, it becomes a manageable part of your practice's rhythm - not a fire drill.

Ezderm is built to make MIPS tracking straightforward, with measures embedded directly in your clinical workflow, a quality reporting dashboard you can pull at any time, and a seamless bridge to Healthmonix at year-end.

See how Ezderm supports your practice through every step of MIPS.

This guide reflects 2026 MIPS performance year requirements. MIPS rules are updated annually by CMS. Verify current-year requirements at qpp.cms.gov or with your registry partner before finalizing your reporting strategy.