No PQRS, VM Penalties for Physicians Affected by ICD-10 Update

We have some good news to report on the 2016 fourth-quarter ICD-10 code updates, which had the potential to negatively affect some physicians who participate in quality reporting for the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. It turns out CMS will not apply payment penalties to physicians and groups who fail to meet reporting requirements solely as a result of those code updates.

Because the code updates, which occurred on Oct. 1, 2016, included a large number of new codes added or removed from the ICD-10 code set and because of its impact on quality measures, CMS has determined that it will not have the ability to process data reported on certain quality measures for the fourth quarter of 2016. That means physicians and groups will not incur payment penalties or "negative payment adjustments" to Medicare Part B payments in 2018, and for a few in 2017, under the PQRS and VM programs. 

CMS still expects physicians and groups to report quality data for the 2016 PQRS program year, even if they believe they were affected by the ICD-10 code changes. For an in-depth description of the issue, refer to the ICD-10 Section on the CMS PQRS website, and read the ICD-10-CM FAQ.

Remember: You have from January to March 2017 to report quality measure data for the 2016 PQRS program year. The specific deadline is dependent upon the submission method you use to report data to CMS. For specific dates, visit TMA's Deadlines for Doctors

For guidance on quality reporting, visit the TMA PQRS and VM Resource Center. For ICD-10 help, visit the TMA ICD-10 Resource Center. For questions, contact the CMS QualityNet Help Desk, Monday through Friday, 7 am to 7 pm CT, by phone, (866) 288-8912, or by email.

Action, Jan. 17, 2017

Last Updated On

March 04, 2019

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