ICD-10 Glitch Causes CMS To Relax Payment Penalties

Massive ICD-10 code update is responsible for clogging system and leading to reporting problems.

ICD-10 has hit yet another snag after massive code updates resulted in a clogged system and reporting problems for the Physical Quality Reporting system. As a result, CMS has decided to waive the penalties for 2017 and 2018. All eligible professionals will submit eCQM data according to the 2015 specifications for their 2016 fourth quarter reporting, according to Healthcare Finance.

According to the CMS website, “CMS has examined the 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 fourth quarter of CY 2016. Therefore, CMS will not apply the 2017 or 2018 PQRS payment adjustments, as applicable, to any EP 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 fourth quarter of 2016.”

According to CMS, “The Value Modifier program will consider solo practitioners and groups who do meet reporting requirements, either as a group or by having at least 50 percent of the individual eligible professionals in the taxpayer identification number avoid the PQRS adjustment, to be ‘Category 1.’” This means they won’t get hit with the automatic downward adjustment under the program.

CMS stated it will publish an addendum later this year that includes the ICD-10 value set updates for eCQMs under MIPS. The agency has also released frequently asked questions (FAQs) about the ICD-10-CM code updates that impact PQRS quality reporting.

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Photo courtesy of: Health IT Outcomes

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