CMS suspends negative adjustments to 2017 and 2018 PQRS and Value-based Modifier payments

On Dec. 13, 2016, the Centers for Medicare and Medicaid Services (CMS) announced that it will not apply negative 2017 or 2018 payment adjustments to any eligible professional or group practice that was unable to satisfactorily report certain quality data to the Physician Quality Reporting System (PQRS) for the fourth quarter of this year due to the impact of recent updates to the ICD-10 codes.

The addition of more than 5,000 new ICD-10 codes will greatly affect CMS’ ability to process quality measure data filed for the period of Oct. 1 thru Dec. 31, 2016. Therefore, CMS will not enforce Medicare payment adjustments for PQRS participants who fail to satisfactorily report because of IDC-10 coding updates. The Value-based Modifier program will also consider eligible professionals (EPs) as successful if they met PQRS reporting requirements.

The Oct. 1, 2016, enactment of ICD-10 was the first major change to the system since its implementation in 2015. While coding updates generally occur every year, CMS postponed the addition of new codes in the years prior to ICD-10 implementation in order to ensure a smooth transition for providers. As a result, CMS anticipates data processing challenges at the end of 2016 for certain quality measures, which will impact PQRS and Value Modifier payment adjustments.

CMS also acknowledged that the same data processing challenges exist for eligible professionals who were included in a Medicare Shared Savings Program accountable care organization (ACO) participant Taxpayer Identification Number in 2015 and are reporting apart from their ACO for the special secondary reporting period. Therefore, CMS will not apply a penalty to these EPs or group practices if their fourth quarter 2016 PQRS measure specifications were affected by the ICD-10 update.

For the 2017 quality measure specifications affected by the ICD-10 update, CMS announced its plans to issue an addendum, which will include the pertinent ICD-10 codes. In the announcement, CMS stressed that the expected addendum will only concern the electronic Clinical Quality Measures (eCQM) value sets, and that the Health Quality Measure Format (HQMF) specifications, the value set object identifiers (OIDs), and the measure version numbers for 2017 eCQM reporting will not change. The addendum will get rid of expired codes and will add in relevant replacement codes. Eligible hospitals, clinicians and providers should wait until the reported January 2017 release date for the eCQM value sets addendum.

2016-12-21T00:00:00+00:00 December 21st, 2016|Clinical Resources|