Top 5 MIPS Workflow Mistakes Dermatology Practices Make

For many dermatology practices, MIPS challenges are not caused by poor patient care. More often, they stem from small workflow breakdowns, incomplete documentation, or missed system steps that prevent measures from being captured correctly.

Even experienced practices can lose points because a required field was skipped, a trigger was missed during the first visit, or staff assumed documentation saved automatically.

Based on real training sessions with dermatology practices, these are some of the most common MIPS workflow mistakes we continue to see — and how practices can avoid them.

1. Completing the Workflow — But Not Saving It

One of the most common MIPS issues has nothing to do with clinical care. It comes down to a simple workflow step: staff completing the process but failing to confirm the entry correctly.

In the MACRA wizard, measures are not fully captured unless users click “Done” to save the information. In many cases, staff accidentally click “Cancel” instead — especially when moving quickly between patients or assuming pre-filled information saves automatically.

This often happens when:

• Easy Check-In data automatically populates the measure
• Staff assume the measure has already been recorded
• Users exit the wizard too quickly without confirming the entry

The result?
Patients may appear as “Incomplete” in quality reports, even though the workflow itself was performed correctly.

Practices often discover this issue months later when reviewing reporting data and seeing measures showing “0 out of 6” or incomplete statuses for patients they believed were already addressed.

How to Avoid It

• Train staff to always confirm entries using “Done”
• Include MACRA wizard completion in workflow checklists
• Run regular quality reports to identify incomplete patients early

In many cases, the clinical work was done correctly — but the final confirmation step was missed.

2. Missing Required Documentation Details

Another common issue occurs when practices complete the required care activity but miss specific CMS documentation requirements.

A checkbox alone is often not enough for MIPS documentation.

Advanced Care Plans and Surrogate Documentation

For Advanced Care Plan measures, many practices document whether a patient has a living will but forget to document a surrogate decision-maker.

CMS requires:

• Documentation of the living will status
• Identification of a surrogate decision-maker or notation that none was identified

Practices frequently complete the first part while overlooking the second.

Medication Documentation Gaps

Medication documentation creates similar problems.

CMS requires a complete and accurate medication list, including:

• Medication name
• Dose
• Route
• Frequency

Practices sometimes document only medication names or assume structured medication fields automatically satisfy the requirement. However, important details may not pull into the progress note unless properly documented.

This becomes especially challenging when patients are unsure of their exact medication details during the visit.

How to Avoid It

• Use structured medication workflows whenever possible
• Verify required documentation fields are included in progress notes
• Train staff on CMS documentation expectations beyond simple checkboxes
• Review incomplete patients regularly for missing detail fields

The issue is rarely that the practice failed to provide care. More often, the documentation simply lacked the level of specificity required for reporting.

3. Missing the Trigger on the First Visit

Some MIPS measures must be initiated correctly during the patient’s first qualifying encounter. If the workflow is missed at that point, the measure may not trigger later — even if the patient returns for follow-up care.

This commonly affects dermatology-specific itch severity and psoriasis measures.

For certain measures:

• The itch severity scale must be documented during the initial visit
• The patient must meet the required score threshold
• The workflow must occur before the note is signed

If the trigger is missed during that first encounter, practices often cannot go back and repair the measure retroactively.

This creates frustration because providers may continue managing the condition appropriately across multiple visits while the measure itself never activates.

How to Avoid It

• Train clinical staff on first-visit trigger requirements
• Include intake prompts for qualifying diagnoses
• Review unsigned notes before finalization
• Use standardized workflows for psoriasis and dermatitis encounters

If the measure does not start correctly, it often cannot be fixed later.

4. Documenting MIPS Data on the Wrong Encounter Type

Another common misunderstanding involves encounter types and billing codes.

Practices sometimes assume that if information is documented anywhere in the chart, it will count toward MIPS reporting. However, many measures only trigger during qualifying billable office visits tied to appropriate E&M codes.

This becomes an issue when documentation occurs during:

• Nurse visits
• Virtual encounters
• Lab follow-ups
• Non-billable visit types

For example, practices managing biologic therapies may document TB screening information during a follow-up workflow that does not qualify for measure triggering.

The documentation exists — but the measure itself never activates because the encounter type does not meet CMS requirements.

One of the biggest workflow frustrations providers face is what many teams call the “Click Tax” — forcing clinicians to leave their normal charting workflow, open additional tabs, or search through multiple dropdown menus just to complete compliance requirements. When MIPS workflows feel disconnected from patient care, documentation becomes inconsistent and measures are more likely to be missed.

Effective MIPS workflows should feel integrated into the clinical encounter — not like a separate administrative task.

How to Avoid It

• Understand which encounter types qualify for measure triggering
• Align documentation workflows with billable E&M visits
• Train staff on measure-specific trigger requirements
• Queue appropriate workflows during qualifying office visits

Successful MIPS reporting depends not only on documentation, but also on when and where that documentation occurs.

5. Waiting Until the End of the Year to Review MIPS Data

Many practices unintentionally treat MIPS as a “Q4 problem,” waiting until the end of the year to review reporting data. This often leads to a stressful scramble in the fall, with staff manually auditing charts, chasing incomplete documentation, and trying to repair missed measures before submission deadlines.

Beyond the reporting risk, this creates significant operational strain for both providers and administrative staff.

At that point:

• Patients may no longer return before submission deadlines
• Staff may not remember missing details
• Providers may not recall conversations that were never documented
• Missed triggers can no longer be corrected

Small workflow issues that could have been addressed quickly in real time become major reporting gaps later.

The practices that perform best with MIPS typically treat reporting as an ongoing operational process — not a year-end cleanup project.

How to Avoid It

• Run MACRA Quality Reports monthly or quarterly
• Monitor incomplete patients throughout the year
• Audit documentation workflows regularly
• Address reporting gaps while patient information is still fresh

Regular review allows practices to identify trends early and correct workflow problems before they impact final scores.

Final Thoughts

Most dermatology MIPS issues are not caused by a lack of clinical quality. They are caused by small workflow breakdowns that prevent measures from being captured correctly.

The good news is that many of these problems are preventable with:

• consistent workflows
• staff training
• regular reporting reviews
• better understanding of measure triggers and documentation requirements

By identifying these workflow gaps early, practices can improve reporting accuracy, reduce incomplete measures, and avoid unnecessary performance penalties.

If your practice is preparing for MIPS reporting, now is the time to review your workflows — not at the end of the reporting year.

Simplify MIPS Reporting with Dermatology-Specific Workflows

MIPS reporting becomes much easier when your workflows, documentation tools, and reporting processes are built specifically for dermatology practices.

Ezderm helps practices streamline MIPS reporting with integrated workflows, specialty-specific documentation tools, real-time reporting visibility, and support designed around the way dermatology teams actually work.

Whether you're struggling with incomplete measures, missed triggers, or reporting accuracy, the right system can help reduce manual work and improve confidence heading into submission season.

Ready to see how Ezderm can support your MIPS workflows?

Book a personalized demo today to see how Ezderm helps dermatology practices simplify reporting, improve documentation accuracy, and stay ahead of MIPS requirements.