The MIPS 2026 Quality performance category remains the largest contributor to your final MIPS score, making it one of the most important areas for small practices to understand and optimize. CMS continues to refine measure specifications, scoring policies, and reporting mechanisms, which means practices must stay current to avoid preventable performance losses.

One of the most misunderstood aspects of the Quality category is the concept of “collection types.” Selecting the appropriate collection method can directly impact scoring potential, administrative burden, and reporting accuracy.

What Is a Quality Collection Type?

A collection type refers to the method used to collect and submit data for a specific quality measure. Although a quality measure may appear similar across reporting pathways, each collection type has distinct technical specifications. Reporting a measure under the wrong specification can result in data rejection or scoring penalties.

For the 2026 performance year, clinicians participating in Traditional MIPS or MIPS Value Pathways (MVPs) may report quality measures using the following collection types:

• Electronic Clinical Quality Measures (eCQMs)
• MIPS Clinical Quality Measures (MIPS CQMs)
• Qualified Clinical Data Registry (QCDR) Measures
• Medicare Part B Claims Measures
• CAHPS for MIPS Survey
• Administrative Claims Measures

Each option carries unique operational implications.

Electronic Clinical Quality Measures (eCQMs)

eCQMs require the use of Certified Electronic Health Record Technology (CEHRT). For 2026, practices must ensure:

• CEHRT meets ONC certification requirements
• The EHR is updated with 2026 measure specifications
• A valid CMS EHR Certification ID (CHPL ID) is submitted
• Data is aggregated if multiple EHR systems are used

eCQMs rely heavily on structured data fields within the EHR. Practices with strong documentation workflows may benefit from automation, but technical misalignment between EHR build and measure specifications can create reporting errors.

MIPS Clinical Quality Measures (MIPS CQMs)

MIPS CQMs are often submitted via a Qualified Registry or QCDR. Unlike eCQMs, these measures may allow more manual abstraction and reporting flexibility.

Specialty practices often prefer MIPS CQMs because they may align more closely with clinical documentation patterns. However, registry reporting requires coordination with approved vendors and timely data submission.

Qualified Clinical Data Registry (QCDR) Measures

QCDRs are CMS-approved entities authorized to develop specialty-specific quality measures. For clinicians struggling to find relevant measures in the standard inventory, QCDR measures may provide better clinical alignment.

These measures must be reported through the QCDR that owns them. Practices should verify registry approval status annually, as approval is tied to CMS review cycles.

Medicare Part B Claims Measures

Claims-based reporting is available only to small practices (15 or fewer clinicians). This method uses billing data submitted under the rendering NPI.

While operationally simpler, claims-based reporting limits measure selection and requires strict coding accuracy. Incorrect coding can negatively affect performance rates.

CAHPS for MIPS Survey

The CAHPS survey measures patient experience. Groups wishing to administer CAHPS must register during CMS’s designated window and use a CMS-approved survey vendor.

This option is particularly relevant for primary care practices focused on patient engagement and satisfaction metrics.

Administrative Claims Measures

Administrative claims measures are calculated entirely by CMS and require no data submission. These include population-based measures such as hospital readmissions.

Although no submission is required, performance still contributes to the final Quality score.

2026 Quality Measure Updates

For 2026, CMS added five new quality measures, removed ten, and substantively modified thirty measures. The data completeness threshold remains at 75%, providing continuity through 2028.

Practices must verify that previously reported measures have not been retired or revised significantly. Substantial measure changes may eliminate historical benchmarks, affecting scoring predictability.

Small Practice Scoring Protections

Small practices receive important scoring advantages:

• 3-point floor for measures without a benchmark
• 3 points for measures not meeting case minimum or completeness requirements
• 6 bonus points for submitting at least one quality measure

These protections create meaningful insulation against negative payment adjustments.

Strategic Recommendations

Successful Quality reporting requires:

• Early measure selection
• Workflow alignment
• Quarterly performance monitoring
• Verification of benchmark availability
• Proper documentation and abstraction

Quality reporting is no longer just about compliance; it is about strategic positioning within MIPS.

Conclusion

The MIPS 2026 Quality performance category rewards preparation, alignment, and proactive performance monitoring. Selecting the correct collection type and understanding scoring nuances can dramatically impact your final MIPS score and Medicare revenue.

At TriumpHealth, we help practices evaluate reporting pathways and optimize quality performance for maximum financial gain. To learn more or schedule a consultation, please call us at (888) 747-3836  or email us at [email protected].