The Merit-based Incentive Payment System (MIPS) has been around since 2017, but that doesn't mean the program has gotten easier to navigate.

Holly Black, project manager for regulatory affairs and compliance at Sightview Software — and often referred to as a "MIPS Geek Guru" — walks through the most consequential changes for 2026, including the removal of the three-point scoring floor for large practices and new documentation requirements for security risk assessments.

She explains why MIPS performance is never really one person's job, what practices should be doing quarterly to avoid a scramble at year-end, and how electronic health record (EHR) documentation habits show up directly in performance scores. Black also covers the shift toward MIPS value pathways (MVPs), what the transition means for specialists and sub-specialists, and how time-strapped practices can focus their limited hours on the changes that will have the biggest impact on their score.

Music Credits:
Swinging Lounge Bar by NC MUSIC - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:18 | Cold open Black previews the episode's central theme: MIPS is a team sport, not a one-person job.

0:18 – 0:59 | Introduction Austin Littrell introduces the episode and previews the conversation with Black.

0:59 – 3:40 | What's changed in MIPS for 2026 Black breaks down the biggest updates by category: the removal of the three-point scoring floor for large practices, new documentation requirements for security risk assessments under the promoting interoperability category, and the updated 2025 SAFER guide that practices need to be using.

3:40 – 5:58 | What practices can still do right now Black's top recommendations for mid-year course correction: build a MIPS team, run reports at least quarterly, and know your key deadlines — including the September 30 registry mapping deadline and the March 31 MIPS attestation window for 2025.

5:58 – 8:36 | MIPS value pathways: what they mean for specialists Black explains how MVPs work in 2026, why practices can opt in now and let CMS take the higher of the two scores, and what the shift to four quality measures instead of six means for specialty practices. She flags where sub-specialties may run into trouble finding applicable measures.

8:36 – 10:14 | Lessons from ophthalmology Drawing on Sightview's eye care client base, Black reports that practices opting into MVPs are scoring roughly the same as traditional MIPS — and says the takeaway for all specialties is to start looking at MVPs now and focus on measures specific to your patient demographics.

10:14 – 11:02 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

11:02 – 14:08 | Compliance mistakes that are still costing practices Black walks through the most common and avoidable errors: missed registry mapping deadlines, EHR switching mid-year without updating the registry, failing to validate data throughout the year, and leaving all MIPS responsibility on the practice administrator.

14:08 – 15:44 | How EHR documentation affects your MIPS score Since CMS eliminated manual data submissions last year, EHR use is now essential for meaningful MIPS reporting. Black explains why structured fields, automated workflows and patient portal engagement all feed directly into performance scores.

15:44 – 17:07 | Protecting Medicare revenue without adding administrative burden Black's practical advice for small and mid-size practices: use the EHR to its full capability, understand your category weights, and double-check registry data rather than assuming it's pulling correctly. Quality and cost categories each carry 30% of the total score.

17:07 – 19:00 | MIPS priorities for time-strapped practices For practices with only a few hours a month to dedicate to MIPS, Black says focus on tracking the right measures and reviewing workflows with the team — drawing on her own experience spending five hours a month as a MIPS coordinator at a medical practice.

19:00 – 20:38 | Final advice and outro Black closes with a reminder to check qpp.cms.gov regularly and never assume last year's approach still applies — especially for improvement activities, where documentation requirements can shift quietly from year to year. Littrell thanks listeners and wraps the episode.

S1 Ep134: MIPS update, with 'MIPS Geek Guru' Holly Black of Sightview

Off the Chart: A Business of Medicine Podcast

S1 Ep134: MIPS update, with 'MIPS Geek Guru' Holly Black of Sightview