CMS: Latest End-to-End ICD-10 Testing Results Show Progress

February 26, 2015 in News

On Wednesday, CMS announced that it accepted 81% of claims sent during a week-long ICD-10 end-to-end testing period, Health Data Management reports (Slabodkin, Health Data Management, 2/26).

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 by Oct. 1.

Details of Testing Period

The testing periods are designed for providers to determine whether ICD-10 codes submitted to Medicare will be accepted by the program (iHealthBeat, 12/23/14).

This testing round ran from Jan. 26 to Feb. 3, during which 661 participants — including billing companies, clearinghouses, providers and suppliers — submitted about 15,000 claims (Gruessner, EHR Intelligence, 2/25).

Of all the claims that were submitted:

  • 56% were professional;
  • 38% were institutional; and
  • 6% were supplier claims (Bowman, FierceHealthIT, 2/25).

Results

CMS said the most recent testing showed that the agency’s systems are prepared to accept and process ICD-10 claims, adding that the results were an improvement over the previous testing round (Conn, Modern Healthcare, 2/25). In an ICD-10 acknowledgement test conducted in November 2014, CMS accepted 76% of claims (iHealthBeat, 12/23/14).

According to the most recent results, few of the rejected claims were related to ICD-9 or ICD-10 errors (EHR Intelligence, 2/25). Specifically, the results showed that of all claims:

  • 3% were rejected due to invalid ICD-9 diagnosis or procedure code submissions;
  • 3% were rejected due to invalid ICD-10 diagnosis or procedure code submissions; and
  • 13% were rejected due to mistakes unrelated to ICD-10 codes, such as problems setting up test claims.

Reaction

In a blog post about the results, CMS Administrator Marilyn Tavenner said the testing revealed some confusion over understanding that ICD-9 codes must be used for services provided before Oct. 1, while ICD-10 must be used following that deadline (FierceHealthIT, 2/25).

Tavenner said, “This successful week of testing continues to put us on course for successful implementation of this important initiative that better reflects modern practice of medicine by Oct. 1,” adding, “CMS is ready for ICD-10. And, thanks to our many partners … the health care community at large will be ready for ICD-10″ (Health Data Management, 2/26).

However, Robert Tennant — senior policy adviser for the Medical Group Management Association — said it would be “catastrophic” if CMS experiences the same 19% failure rate on the Oct. 1 deadline as it did during this testing round. He added that if stakeholders are “experiencing issues, when they flip the switch, that 19% (failure) rate would increase.”

Meanwhile, Stanley Nachimson, a health IT consultant and ICD-10 specialist, said that while it’s good CMS has “emphasized the need for testing,” stakeholders “have a lot of work to do.” He added that providers should get testing in now “so they don’t run into these errors” on Oct. 1 (Modern Healthcare, 2/25).

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