What Is MACRA?
MACRA stands for the Medicare Access and CHIP Reauthorization Act. It fundamentally changed how Medicare pays providers. Instead of the old fee-for-service model that paid strictly for volume, Medicare now adjusts your payments based on your clinical performance.
That’s where MIPS comes in.
What Is MIPS?
MIPS stands for the Merit-based Incentive Payment System. MIPS is the actual program that determines whether your Medicare payments receive a positive adjustment, a negative adjustment, or stay the same.
You’re scored across four distinct categories:
- Quality: Usually the largest chunk of your score, tracking how well you treat patients and follow evidence-based care.
- Cost: How efficiently you use Medicare resources.
- Improvement Activities: Steps taken to improve care processes, patient access, and safety.
- Interoperability: How well your Electronic Health Record (EHR) shares data with other systems and patients.
At a high level, you collect data during the patient visit, submit it to the Centers for Medicare & Medicaid Services (CMS), receive a score, and your future payments are adjusted accordingly.
How MIPS Works (In Plain Terms)
During the year, you see patients as usual. While doing that, you’re expected to document certain things tied to specific measures. These measures are rules set by Medicare, like tracking outcomes, documenting screenings, or following certain care guidelines.
Each time you meet the requirements for a measure, it counts toward your score—but only if it’s done in the exact way the system expects. That usually means it has to be documented in the right place, during the right type of visit, and sometimes confirmed with an extra step.
At the end of the year, all of that data is submitted to Medicare, often through a registry like Healthmonix or DataDerm.
CMS reviews the data and gives you a MIPS score.
That score determines whether your future Medicare payments go up, stay the same, or go down.
When looking at a list of dozens of quality measures, it’s easy to panic. Most practices assume they have to track everything on every patient. That’s not true.
Here’s what actually matters:
- You don’t need dozens of measures. Traditional MIPS requires you to submit six. If you’re using MVP, it’s only four.
- You don’t need to hit every patient. You only need 20 eligible cases per measure across your group.
- You don’t have to pick perfectly upfront. A better approach is to track seven to eight measures during the year, then choose your best six when it’s time to submit.
The part that causes problems is that doing the work isn’t enough. The system only recognizes it if it’s captured correctly.
That’s why practices often feel like they’re doing everything right but still not seeing it reflected in their reporting.
Why Dermatology Practices Struggle with MIPS
Most practices don’t struggle because they don’t understand medicine. They struggle because MIPS regulations don’t align seamlessly with their clinical workflow.
A common assumption is: "If we document it in the note, it automatically counts." Unfortunately, MIPS reporting depends entirely on how data is captured, not just whether it exists.
Our team regularly works with practices during onboarding and training, and we see the same issues consistently. Teams are doing the hard clinical work, but because they miss a specific checkbox, forget a confirmation step, or trigger a workflow outside of an E&M visit, they don't get the credit they deserve.
Where Most Practices Get It Wrong: Real Dermatology Scenarios
To understand why documentation isn't always enough, let's look at exactly how specific dermatology MIPS measures trigger—and where workflows tend to break down.
1. Measure 130: Documentation of Current Medications It is standard practice to ask a patient if their medications have changed. However, simply listing the supplements and prescriptions the patient takes is not enough. If your staff fails to actively document the dose, route, and frequency for those medications, you won't fully satisfy the measure and could be dinged in an audit.
2. Measure 410: Psoriasis Vulgaris Clinical Response You might have excellent clinical notes regarding a patient's psoriasis. But for this measure to trigger, documenting the Body Surface Area (BSA) alone isn't going to cut it. You must actively use your EHR's tracking tools (like scroll wheels) to document both the PASI and PGA scores. Miss those specific fields, and the visit won't count.
3. Measure 176: TB Screening for Biologics Timing and visit types trip up many practices here. First, the patient must be completely naive to biologics, meaning they cannot have been on a biologic in the past 15 months. Second, MIPS measures generally only trigger on actual, billable E&M visits—not virtual encounters or nurse visits. If you wait for the TB lab results to come back and then send the prescription during a virtual encounter, it won't count. The solution? Queue the prescription in your EHR during the actual E&M visit to trigger the measure, then officially order it once the labs clear.
4. Measure 374: Closing the Referral Loop Many practices assume this only applies to external specialists. However, referring a patient internally to your in-house Mohs surgeon counts perfectly. The catch is the workflow: you must officially use your EHR's task system (like sending a "to-do") to notify the surgeon, and you must receive a report or note back to officially close that loop.
5. Forgetting the Final Confirmation: Even if your EHR is smart enough to auto-populate a measure because you completed the right steps in the chart, CMS still requires human verification. If you see a measure checked off but you fail to hit the "Done" or "Confirm" button before signing the note, it will register as incomplete.
How to Approach MIPS Without Overcomplicating It
1. Standardize Your Triggers
Your team doesn’t need to memorize the CMS rulebook. They just need to know which specific actions in your EHR make a measure count, where to complete them, and when to click confirm. Standardize this workflow across all MAs and providers.
2. Build It Into the Visit
If MIPS documentation happens after the patient has left the building, it will never be consistent. It needs to happen during intake, active charting, and checkout. Once a provider signs off on a note, you generally cannot go back and trigger a measure that was missed.
3. Don’t Rely on End-of-Year Cleanup
If a measure doesn’t trigger correctly during the visit, trying to clean it up in November is a nightmare. You may need to recreate parts of the visit entirely or just accept that the case won't count. Track your progress quarterly so you know exactly where your reporting rates stand.
MIPS Measures Supported by Ezderm
We’ve built Ezderm to track the most critical traditional MIPS measures right inside your daily clinical workflow. Our dermatology-specific system supports:
General Dermatology & Preventive Care
- Measure 47: Advance Care Plan (High Priority)
- Measure 130: Documentation of Current Medications in the Medical Record (High Priority)
- Measure 226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
- Measure 317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
Psoriasis, Dermatitis & Biologics
- Measure 176: Tuberculosis Screening Prior to First Course of Biologic and/or Immune Response Modifier Therapy
- Measure 410: Psoriasis - Clinical Response to Oral Systemic or Biologic Medications (Outcome measure)
- Measure 485: Psoriasis – Improvement in Patient-Reported Itch Severity (High Priority)
- Measure 486: Dermatitis – Improvement in Patient-Reported Itch Severity (High Priority)
Surgical Dermatology & Mohs
- Measure 355: Unplanned Reoperation within the 30-Day Postoperative Period (High Priority & Outcome)
- Measure 357: Surgical Site Infection (SSI) (High Priority & Outcome)
- Measure 358: Patient-Centered Surgical Risk Assessment and Communication (High Priority)
- Measure 509: Melanoma: Tracking and Evaluation of Recurrence (High Priority)
Care Coordination
- Measure 374: Closing the Referral Loop: Receipt of Specialist Report (High Priority)
(Note: CMS officially removed Measure 487—Screening for Social Drivers of Health—in the 2026 reporting year, so your team no longer needs to worry about tracking it for MIPS compliance.)
Final Takeaway
MIPS isn’t just about reporting; it’s about whether your EHR and your daily workflow actually support your efforts. Most dermatology practices already collect the right clinical information. The issue is making sure the system recognizes it so that it actually counts.
If your team is constantly guessing what triggers a measure, or if you find yourself scrambling to fix charts at the end of the year, your current setup is putting your revenue at risk.
Request a demo to see how Ezderm tracks MIPS measures within your workflow so your team knows exactly what to do during the visit—not after.
