Amid Pressure, CMS To Conduct End-to-End Testing for ICD-10 Codes

February 20, 2014 in News

On Wednesday, CMS announced its contractors will conduct “end-to-end” testing of Medicare claims using new ICD-10 diagnostic and procedure code sets prior to their Oct. 1 implementation, Modern Healthcare reports (Conn, Modern Healthcare, 2/19).

Background

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch from ICD-9 to ICD-10 code sets means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes.

In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date from Oct. 1, 2013, to Oct. 1, 2014, partially to look at the incremental changes needed in reforming health care.

CMS was scheduled to conduct only front-end testing on the new code sets during the week of March 3.

However, on Tuesday four Republican senators sent a letter to CMS Administrator Marilyn Tavenner warning that inadequate testing of ICD-10 code sets could result in “system-wide errors and delay” similar to those that hampered the launch of HealthCare.gov. The senators raised concerns about the “brevity and limited scope” of the front-end testing and called on CMS to “establish clear metrics and perform system-wide tests to certify its readiness” (iHealthBeat, 2/19).

Details on End-to-End Testing

CMS said that a small group of providers representing “a broad cross-section of provider types, claims types and submitter types” would participate in the testing (Pittman, MedPage Today, 2/19).

The agency said the planned end-to-end testing will:

  • Enable claims from participating providers and suppliers to be tested with ICD-10 codes; and
  • Ensure that providers and suppliers can obtain remittance advice about how the claims were processed.
  • CMS said the tests will ensure that:
  • Claims submitters can successfully send ICD-10 code claims to CMS’ systems;
  • CMS’ software is up-to-date prior to the ICD-10 switch and can handle claims; and
  • Correct remittance advice is sent back to submitters (Modern Healthcare, 2/19).

According to the agency, additional details about the testing initiative will be released at a later date (MedPage Today, 2/19).

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