MIPS Improvement Activities: What They Are and How to Report Them in Elation

The Improvement Activities (IA) category is perhaps the most underappreciated component of MIPS. At 15% of the composite score, it represents a meaningful opportunity to boost your total — and for many primary care practices using Elation, the activities required are things you are already doing. The challenge is knowing what qualifies, how to document it, and how to attest to it at submission time. This post explains the IA category framework and gives Elation-specific guidance on the activities most relevant to primary care.

How the IA Category is Scored

CMS evaluates the IA category based on whether you have completed approved activities for at least 90 continuous days during the performance year. Activities are rated as medium or high weight. To earn full credit (40 points out of 40), you can complete either four medium-weight activities, two high-weight activities, or one combination. Certain practice types get automatic full credit: patient-centered medical home (PCMH) recognition, comparable specialty practice designation, or participation in a qualifying APM. If you are a PCMH, confirm that Elation has your recognition on file, because attestation is the mechanism by which CMS awards automatic full IA credit. For practices that are not PCMH-recognized, selecting the right combination of medium and high-weight activities is where the strategy lies.

Activities That Align Naturally with Elation Workflows

Several CMS-approved Improvement Activities map directly to features that Elation users are already likely to be using. Telehealth expansion activities credit you for providing care via video visits — Elation's integrated telehealth tool makes this straightforward. Care coordination activities credit you for using systematic approaches to ensure patients receive follow-up after hospitalizations or emergency visits — Elation's care team communication tools support this workflow. Patient engagement activities credit you for using your EHR patient portal to share health information and communicate with patients — again, something Elation supports natively. The practical advice for practice managers: audit your current clinical workflows against the CMS IA activity list and document the ones you are already performing. You may find that you can satisfy the IA requirement with minimal additional effort.

Documentation and Attestation

Improvement Activities are reported on an honor system — CMS does not audit IA submissions in the same way it validates Quality measure data. However, you must be prepared to demonstrate that you actually performed the activities if audited. This means maintaining records: dates the activity was in place, any protocols or workflows you used, and evidence that it operated for the required 90 continuous days. Practice managers should create a simple IA log — a spreadsheet noting the activity name, start date, end date, and brief description of how the practice performed it. This log should be completed during the year, not reconstructed from memory at submission time. When you submit your MIPS data through Elation or a third-party registry, the IA category will ask you to attest to these activities.

High-Value Activities for Primary Care

If you need to select activities from scratch, several consistently deliver the highest strategic value for primary care practices on Elation. Achieving PCMH certification (high weight) earns full IA credit with a single attestation. Implementing use of specialist reports in EHR (medium weight) credits you for documenting specialist communications in Elation. Care transition documentation (medium weight) credits you for using Elation to document hospital and ED discharges. Depression screening and follow-up (medium weight) is easy to satisfy if you are already reporting the CMS2 quality measure. Selecting activities that overlap with your Quality reporting and your daily clinical workflow is the most efficient approach. It ensures the activities are genuinely performed rather than added as administrative tasks on top of your existing workload.