CMS to Waive PQRS Penalties Related to ICD-10 Update Issues

January 09, 2017 04:02 pm Sheri Porter

Some family physicians will get a pass from CMS in 2017 and 2018 when it comes to the application of penalties related to a failure to meet Physician Quality Reporting System (PQRS) requirements in 2016.

According to a message from CMS,( the agency is taking the unusual action because of incomplete updates related to the nation's implementation of the ICD-10 code sets on Oct. 1, 2015.

"CMS has examined impact to quality measures and has determined that the ICD-10 code updates will impact CMS' ability to process data reported on certain quality measures," for the fourth quarter of 2016, said the agency.

Therefore, CMS will waive the 2017 or 2018 PQRS payment adjustments to physicians or groups that fail to satisfactorily report for 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the fourth quarter of 2016.

Sandy Pogones, M.P.A., a certified professional in health care quality and the AAFP's senior strategist for health care quality, explained further in an interview with AAFP News.

"CMS is saying that while considerable work was done to incorporate ICD-10 changes into the measure specifications, there are still some problems and that work is still incomplete."

Pogones explained that the ICD-10 updates are closely related to PQRS quality reporting because many of the measures have specifications that include ICD-10 codes.

"Those codes have to be fully accounted for in the specifications and documented in the medical record for a physician to accurately report quality data," said Pogones.

"So CMS is saying if you fail to meet the requirements of reporting because of the ICD-10 problem, they're not going to penalize you," she added.

However, "If a physician fails to meet reporting requirements for other reasons -- say a physician just chooses not to report, or a group fails to meet the reporting threshold -- then the penalty waiver doesn't apply."

Pogones said CMS' decision will come as a relief to many family physicians.

"There has been a lot of concern on the part of our members about how all of these changes in the implementation of ICD-10 would impact their quality reporting. And now CMS is saying, 'Don't worry about it. If ICD-10 impacts your reporting, you will not be hit with a negative payment adjustment.'"

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