Monday, June 9, 2014

CMS ICD-10 Testing Successful

Dianne De La Mare 

This past March, CMS conducted a successful ICD-10 testing week, with approximately 2,600 testers (providers, suppliers, billing companies and clearinghouse organizations) submitting more than 127,000 claims with ICD-10 codes to the Medicare Fee-For Service (FFS) claims system. The testing week allowed an opportunity for both the Centers for Medicare & Medicaid Services (CMS) and testers to learn valuable lessons about ICD-10 processing. In many cases, testers intentionally included errors in their claims to make sure that the claim would be rejected (i.e., a process known as negative testing).

For proper processing, all claims had to have a valid diagnosis code matching the date of service and a valid national provider identifier. Further, the claims using ICD-10 had to have an ICD-10 companion qualifier code and the claims using ICD-9 had to use the ICD-9 qualifier code. Claims that did not meet those requirements were rejected. Nationally, CMS accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent. The normal FFS Medicare claims acceptance rates average between 95 beginning percent.

The US Department of Health and Human Services (HHS) expects to release an interim final rule in the near future that will include the new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule also would require the Health Insurance Portability and Accountability Act (HIPAA) covered entities to use ICD-9 through September 30, 2015. Providers, suppliers, billing companies and clearinghouses are welcome to submit acknowledgement test claims anytime up to October 1, 2015. Submitters should contact their local Medicare Administrative Contractor (MAC) for more information about acknowledgment testing.

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