December 28, 2016
CMS Updates PQRS Payment Adjustments Policy for 2017, 2018
By: Deanna Rasch, Technical Communication Specialist
On December 21, 2016, the Centers for Medicare and Medicaid Services (CMS) announced that it will not apply negative 2017 or 2018 payment adjustments to eligible individual healthcare professionals (EPs) or group practices that were unable to report quality data under the Physician Quality Reporting System (PQRS) for fourth quarter 2016. Over 7000 new and modified ICD-10 diagnosis and procedure code sets went into effect on October 1, 2016, impacting CMS’ ability to process quality measure data filed for fourth quarter 2016. Although code set updates occur each year, CMS has to this point postponed adding new codes in an effort to ensure an easier transition from ICD-9 to ICD-10 for healthcare providers. As a result, the October 1, 2016, update is the first major code set update since the last completed update on October 1, 2013. With the addition of so many new codes, CMS anticipates data processing challenges at year-end 2016 for certain quality measures, which will impact PQRS and Value Modifier Payment Adjustments. Also affected by these data challenges are eligible EPs in a Medicare Shared Savings Program Accountable Care Organization (ACO) who shared a participant Taxpayer ID Number in 2015 and are reporting outside of their ACO for the secondary reporting period. CMS will not apply the payment adjustment penalty to these groups if their ACO failed to properly report on their behalf for the 2015 PQRS performance period. For the 2017 performance period, CMS will publish an addendum later this year with relevant ICD-10 updates for electronic clinical quality measures (eCQMs) in the Merit-based Incentive Payment System Program (MIPS).