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CMS waves Physician Quality Reporting System penalties for 2017, 2018 after massive ICD-10 update clogs system

Eligible professionals will submit eCQM data according to the 2015 specifications for their 2016 fourth quarter reporting.

Beth Jones Sanborn, Managing Editor

Providers who fail to meet the standards of the Physician Quality Reporting System in 2016 will get a pass from CMS in 2017 and 2018, the agency has announced. CMS said it will not penalize providers for not meeting the program's requirements because of the ICD-10 update's impact on the agency's ability to process data on certain quality measures reported for the fourth quarter of CY 2016.

Previously, code updates were made annually, but during the immediate years before the ICD-9 to ICD-10 transition, a freeze on updates was in effect to help smooth the transition. As a result, the FY 2017 updates included several years worth of updates at one shot, since the last update had been made in October of 2013, the agency said.

[Also: ICD-10's first year was easy, but specificity has providers bracing for denials]

"CMS has examined impact to quality measures and has determined that the ICD-10 code updates will impact CMS's ability to process data reported on certain quality measures for the 4th quarter of CY 2016.  Therefore, CMS will not apply the 2017 or 2018 PQRS payment adjustments, as applicable, to any eligible provider or group practice that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the 4th quarter of CY 2016," the agency said in a statement.

The Value Modifier program will consider solo practitioners and groups who do meet reporting requirements, either as a group or by having at least 50% of the individual eligible professionals in the taxpayer identification number avoid the PQRS adjustment, to be "Category 1." This means they won't get hit with the automatic downward adjustment under the program.

[Also: Tech firm launches contest to find the best ICD-10 coders]

Instead, "eligible professionals" will submit eCQM data according to the 2015 specifications for their 2016 fourth quarter reporting, CMS said. The agency will publish an addendum later this year with ICD-10 value sets updates for eCQMs under MIPS.

Twitter: @BethJSanborn

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