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  • MIPS 2023—Quality: ICD-10 Turbulence and Changes in Clinical Guidelines

    This content is excerpted from EyeNet’s MIPS 2023: A Primer and Reference; also see the Academy’s MIPS hub page.

    During the course of the year, a quality measure may be impacted by “significant changes” to its clinical guide­lines, to its measure specifications, or to relevant codes (e.g., updates or deletions of ICD-10, CPT, or HCPCS codes). This can mean that continued adherence to the measure’s original specifications—as defined at the start of the performance year—could result in “patient harm” and/or “misleading results” on performance quality. In such cases, CMS may truncate the performance period for that measure or suppress the measure altogether, de­pending on when in the year the changes take place.

    Truncation or suppression? If a quality measure has been impacted by a significant change, are there nine consecutive months of performance data that are unaf­fected by that change? If so, CMS will as­sess clinician performance for that measure based on a truncated nine-month performance period. If not, CMS will suppress the measure altogether.

    Truncation example. Each year, on Oct. 1, CMS im­plements changes to the ICD-10 codes. These diagnosis codes are used to determine which patients are eligible for each quality measure. If the Oct. 1 changes to the ICD- 10 code set have significant repercussions for a measure’s performance rate, CMS can score you on that measure based on your performance from Jan. 1 to Sept. 30.

    What if a measure is suppressed? Clinicians aren’t scored on suppressed quality measures. If you submitted data on a quality measure before it was suppressed— because, for example, you reported it by claims—1) you wouldn’t score points for that measure, and 2) when CMS calculates your quality score it would reduce your de­nominator by 10 points (so you wouldn’t be penalized for reporting the suppressed measure).

    Which quality measures are affected? CMS will an­nounce on its website which measures are scored on a truncated performance period or suppressed altogether, and has said it will do so “as soon as technically feasible” but no later than Jan. 2, 2024.

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