CMS to Waive PQRS Payment Penalties Related to ICD-10 Update Glitch


Providers who fail to meet the standards of the Physician Quality Reporting System (PQRS) 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.

"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.

Physicians and group practices must still report on 2016 PQRS measures, regardless of whether they believe they will be unable to satisfactorily report due to the ICD-10-CM code updates. CMS will determine after the data is submitted whether the clinician or group practice was among those impacted. The affected practices will be removed from the PQRS penalty prior to the release of the 2016 feedback reports.

CMS is anticipating that the following measure groups may be affected by the ICD- 10 code updates:

  • Diabetes
  • Cataracts
  • Oncology
  • Cardiovascular Prevention
  • Diabetic Retinopathy