Not every healthcare professional is automatically enrolled in MIPS. Criteria such as patient volume and Medicare billing influence eligibility. Participating in MIPS not only enhances a clinician’s reputation but also opens doors to additional incentives. Improvement activities are a key component of MIPS Reporting Services, providing clinicians with opportunities to enhance their performance. Selecting activities aligned with specific practice goals ensures a tailored approach to improvement. Balancing quality and cost is a delicate dance in healthcare, and the cost performance category in MIPS is a reflection of this. Clinicians must find the equilibrium that optimizes both quality and cost outcomes.  n the era of digital transformation, the Aqua Registry stands out as a valuable tool for clinicians. By simplifying data collection and streamlining reporting processes, it becomes an indispensable ally in the quest for high MIPS scores.