Due to a glitch with quality reporting measures based on a recent update to ICD-10 diagnosis and procedure codes, the Centers for Medicare & Medicaid Services (CMS) announced it will not apply the 2017 or 2018 PQRS adjustments to certain affected healthcare providers. Why? Because the CMS won’t be able to process data on the affected measures…yet.
Normally, under the PQRS program, penalties are 2% of the Medicare fee schedule. It is not clear when the ICD-10 code issue will be corrected.
Who does this affect?
- According to CMS, this affects any “eligible professional” or “group practice that fails to satisfactorily report for [calendar year] 2016, solely as a result of the impact of ICD-10 code updates on quality data reporting for the fourth quarter of [calendar year] 2016.” In other words, this will apply to providers reporting PQRS for 2016 who could not report on the affected codes.
- During PQRS 2016 reporting, relevant ACOs will get an additional chance to report for the PQRS 2015 program.
Get more information
- Review the ICD-10-CM FAQ fact sheet detailing measures, impacts, and how CMS will apply this consideration
- Read the January 9 CMS ICD-10 Update Announcement.
- For questions regarding the PQRS and/or ACO programs, contact the Qualitynet help desk via e-mail qnetsupport@hcqis.org phone at (866) 288-8912.
- For questions regarding the Value Modifier program contact the Physician Value help desk via e-mail at pvhelpdesk@cms.hhs.gov or phone at (888) 734-6433, option 3.