CMS: 88% of Claims Approved in Latest ICD-10 End-to-End Testing

June 2, 2015 in News

On Monday, CMS released the results of its second week-long ICD-10 end-to-end testing period, EHR Intelligence reports (Gruessner, EHR Intelligence, 6/2).

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.

The testing periods are designed for providers to determine whether ICD-10 codes submitted to Medicare will be accepted by the program (iHealthBeat, 2/26).

Details of Second Testing Period

This testing round ran from April 27 to May 1 and involved 875 participants including:

  • Billing agencies;
  • Clearinghouses; and
  • Payers (EHR Intelligence, 6/2).

Of all the claims that were submitted:

  • 50% were professional;
  • 43% were institutional; and
  • 7% were supplier claims (CMS results, 6/2).

CMS said that most participants were able to send ICD-10 claims effectively and that Medicare’s billing systems were able to process such claims without significant issues (EHR Intelligence, 6/2).

The results showed that the acceptance rate in April — 88% of claims — was higher than during the previous round of end-to-end testing, which took place in January (CMS results, 6/2).

Further, fewer errors in the most-recent round were related to diagnosis codes, according to CMS.

The final week of end-to-end testing will run from July 20 to July 24. Voluntary testing for this period has closed, though those who participated in the January or April testing are able to participate in the July testing and may test their system an additional time, according to EHR Intelligence.

CMS is encouraging providers who would like to participate in ICD-10 testing with the federal agency to do acknowledgment testing. This testing can be done at any point ahead of the Oct. 1 switchover date (EHR Intelligence, 6/2).

House Committee Lists ICD-10 Transition Recommendations

In related news, members of the House Ways and Means Committee on Monday sent a letter to CMS, outlining six ways to help make a smooth transition to ICD-10, Politico‘s “Morning eHealth” reports (Pittman et al., “Morning eHealth,” Politico, 6/2).

In the letter, the lawmakers recommended that CMS:

  • Expand voluntary end-to-end testing to include more than the current 2,500 providers;
  • Make any contingency plan public;
  • Provide public descriptions about how ICD-10 codes will be applied to incentive programs and incorporated into anti-fraud, waste and abuse efforts;
  • State whether claims need to include the ICD-10 code the with highest specificity on Oct. 1;
  • Teach providers about resources for avoiding claims processing disruption; and
  • Work with non-Medicare payers on these measures as much as possible (House Ways and Means Committee letter, 6/1).
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