CMS Releases Findings from Initial ICD-10 Testing

CMS logoCMS has released early findings from its review of the claims that were submitted with ICD-10 codes during their ICD-10 testing week in March 2014. This testing was "acknowlegement testing" indicating only whether the Medicare contractor received the electronic claims submission and acknowledges back to the provider or vendor that the claims were received. During the testing week, CMS received more than 127,000 claims and responded with electronic acknowledgements that the claims were accepted.  However, only about 2,600 providers submitted claims, about 5 percent of all testers. Clearinghouses were the largest group of testers - submitting nearly half of all test claims submitted. Nationally, CMS accepted 89 percent of the these test claims. Since normal Medicare claims acceptance rates average 95-98 percent, there were clearly some claim issues found in this round of testing. CMS reported no major issues were found in the testing, but states that they learned some lessons in ICD-10 claims processing that can be used in tightening up their system before the next implementation date. CMS will continue to accept “acknowledgement testing” as they did during the testing week but asks submitters to delay such testing until after October 6, 2014, when Medicare updates their system. CMS had originally planned for "spot" end-to-end testing this July. End-to-end testing follows the claim all the way through the process including payment or denials back to the providers. This testing was cancelled after the ICD-10 deadline was pushed back. It is unclear whether CMS will be conduct end-to-end testing in 2015. CMS had planned the end-to-end testing after providers raised concerns that the lack of such testing  could cause claim adjudication issues and ultimately payment delays.

The Department of Health and Human Services has stated that it expects to release an interim final rule in the coming weeks that would require the use of ICD-10 diagnosis codes on claims beginning on October 1, 2015 and will require providers to continue to use ICD-9 codes on claims through September 30, 2015.