CMS Defers PQRS Penalties for Two Years Due to Quality Measures Error

Due to the high volume of new ICD-10 procedure and diagnosis codes released on October 1, 2016, the Centers for Medicare and Medicaid Services (CMS) was unable to update all of the Physician Quality Reporting System (PQRS) measures. As a result, CMS will not penalize eligible providers or group practices that fail “to satisfactorily report for CY [calendar year] 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the 4th quarter of CY 2016,” according to the CMS website.

Typically, under the PQRS program, penalties are two percent of the Medicare fee schedule for reporters who fail to meet PQRS quality measures.

According to CMS, the majority of ICD-10-CM coding changes that impacted 2016 PQRS measures were related to diabetes, pregnancy, cardiovascular, oncology, mental health, and eye disease diagnosis.

“So, for example, a medical record with one of the new diabetes codes might not seem to meet the diabetes quality measures, since the code isn’t included in the measure specifications,” said Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance, at AHIMA. “I’m sure CMS is updating the quality measures as fast as they can. But in the meantime, they have said they won’t penalize physicians who didn’t meet a quality measure simply because the measure hadn’t been updated to reflect the new codes.”

According to a CMS FAQ document about the quality measure reporting, “All changes to the eCQM value sets will be available through the National Library of Medicine’s Value Set Authority Center starting in early to mid-January 2017.” Additionally, it will provide a follow-up communication announcing the availability of the addendum and educational materials.

Click here to read the FAQ document.

Mary Butler is the associate editor at The Journal of AHIMA.


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