CMS will waive penalties related to ICD-10 update

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Physicians won't face penalties for quality reporting problems that relate to ICD-10 updates.

Some physicians won’t see any downward payment adjustments in 2017 and 2018 for failing to meet Physician Quality Reporting System (PQRS) requirements in 2016.

The Centers for Medicare & Medicaid Services (CMS) announced that it will not penalize physicians or group practices that fail to satisfactorily report on certain quality measures because of the impact of incomplete updates related to the implementation of ICD-10 code sets.

The agency says it "has examined impact to quality measures and has determined that the ICD-10 code updates will impact CMS’ ability to process data reported on certain quality measures for the fourth quarter of calendar year 2016."

The ICD-10 updates and PQRS quality reporting are linked because many of the quality measures have specifications that include those codes, said Sandy Pogones, senior strategist for healthcare quality for the American Academy of Family Physicians (AAFP).

"So CMS is saying if you fail to meet the requirements of reporting because of the ICD-10 problem, they're not going to penalize you," Pogones told AAFP News.

However, if physicians fail to meet reporting requirements for reasons other than ICD-10 issues, the penalty will still apply.

Find more information under CMS’ frequently asked questions related to the code updates.