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March 25, 2015

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Medical Coding News


CMS Deems First End-to-End Test of ICD-10 in 2015 a Success

March 25, 2015

The Centers for Medicare and Medicaid Services (CMS) reported promising results from its first successful ICD-10 end-to-end testing week from January 26 through February 3, 2015. Of the 14,929 test claims received, 81 percent were accepted, and only 3 percent of claims were rejected because of incorrect ICD-10 codes.

Of the remaining rejected claims, about 450 contained incorrect ICD-9-CM codes, and nearly 2,000 were rejected for reasons not related to ICD-10, such as an invalid national provider identifier, incorrect dates of service, or invalid HCPCS code. Of the coding errors, CMS notes that many of the errors could have been avoided had submitters understood that ICD-9-CM codes should be used for all services provided before October 1, 2015, and ICD-10 codes for services provided after that date.

The test involved 661 Medicare fee-for-service providers, clearinghouses, and billing agencies registered under 1,400 national provider identifiers (NPI). They submitted claims for processing to all Medicare administrative contractors and the durable medical equipment MAC Common Electronic Data Interchange (CEDI) contractor.

In November, CMS conducted a week-long acknowledgment test involving more than 500 providers, suppliers, billing companies, and clearinghouses. They submitted approximately 13,700 claims with an overall acceptance rate of 76 percent. Although the overall acceptance rate seems low, the rate over the course of the week slowly increased as problems were solved. By Friday, 87 percent of claims were being accepted.

The testing of claims processing success before this fall’s ICD-10 implementation has four parts:

  • CMS internal testing of its claims processing systems
  • Provision of Beta testing tools to providers
  • Acknowledgment testing
  • End-to-end testing

All of CMS’s internal testing since October 2013 has indicated that all Medicare fee-for-service claims processing systems are ready for the new coding system. To encourage providers to assess their own readiness, CMS provides Beta testing software on its website that includes ICD-10, national coverage determination, and local coverage determination crosswalks.

Acknowledgment testing is open to everyone—providers, suppliers, billers, and clearinghouses. Until October 1, 2015, anyone can submit claims anytime to their MACs to see if they are accepted as valid. Note that none of these claims will be paid; MACs will merely return an acknowledgment that the claim was received. During two particular weeks in March and June, real-time support will be available to answer submitters’ questions. MACs will identify on their websites the specific weeks support will be available.

End-to-end testing is where the rubber meets the road. Just 2,550 randomly selected volunteers create and submit claims, which are then processed all the way through the system as if they were real claims. With the first week of testing now over, there are two more weeks of testing before October: one from April 27 to May 1, and one July 20 through July 24. Those who want to participate can go to their MACs’ websites to check the eligibility requirements and to enroll. Each MAC will randomly choose 50 participants per jurisdiction, making sure that five are clearinghouses.

Those who are chosen for end-to-end testing can submit 50 claims containing ICD-10 codes within the designated week. The MAC will review the claims as if they were for payment; unlike acknowledgment claims, they will be subject to NCDs and LCDs. After reviewing the claims, the MAC will return a remittance advice to the submitter explaining the adjudication decision.



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