EPs in Pain Groups May Avoid PQRS Payment Adjustments

While it’s not the blanket “get out of jail free card” many of you would like to have, this does apply to some.  Among abeo clients and followers, pain practices are the most likely Eligible Providers (EPs) to avoid PQRS payment adjustments.

First, second and third quarters seem to have gone on without a hitch, but in the fourth quarter new coding updates impacted quality measures and CMS’ ability to process the data. As a result, EPs or Groups that reported on certain quality measures may avoid the -2% PQRS payment adjustment if their failure can be traced back to the ICD-10 update issue.

CMS states they, ”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 4th quarter of CY 2016.”

Most of the anesthesia measures do not have ICD-10 eligibility requirements, however some measures reported by many pain practices could be affected. EPs or Groups this applies to may avoid penalties for two years. The impact of ICD-CM (Clinical Modification) and ICD-PCS (Procedural Coding System) changes from October 1, 206 are cited as the cause by CMS.

The specific PQRS measures that are impacted are not yet clear. abeo is hopeful during the next vendor call with CMS this topic will be discussed in more detail. Details will be forthcoming as we learn more.

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