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February 14, 2018

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Providers Not to Be Penalized for Quality Measures Affected by ICD-10 Update

January 25, 2017:

In December 2016, the Centers for Medicare and Medicaid Services (CMS) announced that it would not apply the 2017 or 2018 payment adjustments based on the Physician Quality Reporting System if the sole reason data were inadequately reported was the ICD-10 update effective October 1, 2016. Payment to EPs and group practices will still be adjusted for those who do not report the measures for reasons other than the code update.

Note that the Quality Payment Program replaced the PQRS beginning January 2017. Because the data reported in any given year affects Medicare payment adjustments two years down the road, the data reported under PQRS through 2016 will continue to affect payment adjustments through 2018.

The coding changes that CMS is anticipating most affect the diabetes, diabetic retinopathy, cardiovascular prevention, oncology, and cataracts measures groups under the PQRS. Providers should still report 2016 PQRS measures even if they think they were adversely affected by the code changes. CMS will determine whether the measures were compromised by analyzing submissions after the close of the 2016 reporting period. The agency will remove the practices and EPs negatively affected by the code updates from the payment adjustment before it releases feedback reports. These reports inform EPs and group practices whether they satisfactorily reported data and whether they are subject to any payment adjustments. The Value Modifiers for these practices and EPs also will not be adjusted downward.

The Quality Payment Program, which replaced PQRS, consists of two tracks: alternative payment models (APMs) and the Merit-based Incentive Payment System (MIPS). CMS is easing providers into the new program by allowing them some flexibility in participation level in the first year. For more information, the provider site for the QPP is at https://qpp.cms.gov/ .


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