Yes, You Still Have to Report PQRS in 2016!

Last night, a very surprising article was promoted, "CMS waves Physician Quality Reporting System penalties for 2017, 2018 after massive ICD-10 update clogs system." This post makes it seem as if only the Value-Based Modifier (VM) program penalties and incentives would still be in effect based on PQRS reporting done in 2015 and 2016. This is a dangerous misconception.

This news, if true, would be a very big deal. Not all eligible professionals who reported PQRS are also eligible for the VM, so potentially time and money would have been wasted by providers in 2015 and those who have already reported in 2016. Luckily, upon further investigation, I was able to determine that this news false.

What happened?

ICD-10 was introduced last year, and the transition went pretty smoothly. However, there were a few hiccups that resulted in some coding updates. In a bulletin sent via email last night (available to the right), CMS communicated that they understood this could have had an impact on quality reporting. After careful consideration of the impact of the changed ICD-10 codes, CMS determined that there could be a detrimental effect to certain eligible professionals participating in PQRS.

CMS has announced that as a result, if an eligible professional or group did not successfully report PQRS a reason relevant to the alteration of ICD-10 codes, they will not be subject to the negative payment adjustment of PQRS or the VM. However, if they have unsuccessfully reported for any other reason, then they will still be subject to program penalties.

What happens next?

CMS is planning on issuing an addendum updating the ICD-10 codes for measures being used in the Merit-Based Incentive Payment System (MIPS) later this month. For now, continue reporting PQRS as previously planned, and get ready to participate in MACRA next year. If you are not sure where to get started, we recommend attending a free PQRS webinar hosted by PQRSPRO.