In 2017 and 2018, few family physicians will get a pass from CMS (Centers for Medicare & Medicaid Services) when it comes to the application of penalties related to a failure to meet Physician Quality Reporting System (PQRS) requirements in the year of 2016.
The agency is conducting the unusual action due to the incomplete updates related to the nation's implementation of the ICD-10 code sets on the day of Oct. 1, 2015, according to a message from CMS (www.cms.gov).
"CMS has analyzed impact to quality measures and has evaluated that the ICD-10 code updates will affect the ability of CMS to process data reported on few quality measures," for the fourth quarter of 2016, stated the agency.
Hence, the 2017 or 2018 PQRS payment adjustments will be waived by CMS to physicians or groups that fail to satisfactorily report for 2016 solely as an outcome of the affect of ICD-10 code updates on quality data reported for the fourth quarter of 2016 year.
A certified professional in health care quality, Sandy Pogones, M.P.A., described further in an interview.
"CMS is claiming that while considerable work was done to incorporate ICD-10 modifications into the measure specifications, there are yet some issues and that work is yet incomplete."
The ICD-10 updates are closely related to PQRS quality reporting because several of the measures have specifications that involve ICD-10 codes, Pogones explained.
Pogones said, "Those codes have to be completely accounted for in the specifications and documented in the medical record for a physician to precisely report quality data.”
She further added, "So CMS is saying if you fail to meet the reporting’s requirements due to the ICD-10 issue, they are not going to penalize you.”
Although, "If a physician fails to meet the requirements of reporting for other reasons -- say a physician just opts not to report, or a group fails to meet the reporting threshold -- then the penalty waiver does not apply."
CMS' decision will come as a relief to several family physicians, Pogones said
"There has been much concern on the part of our members about how all of these modifications in the implementation of ICD-10 would affect their quality reporting. And now CMS is stating, 'Do not worry about it. If ICD-10 affects your reporting, you’ll not be hit with a negative payment adjustment.'"