Successful End-to-End Testing, CMS Ready for ICD-10

CMSCMS has released the results from its second round of Medicare fee-for-service ICD-10 end-to-end testing week. Testing demonstrated that CMS is ready to accept ICD-10 claims. Below are some of the key highlights from the testing period.

  • 875 participants
  • 1,600 NPI registered to test
  • 23,138 test claims received
  • 20,306 test claims accepted
  • 88% acceptance rate
  • 2% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code
  • Less than 1% of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code

It is important to note that majority of the errors that did occur were unrelated to ICD-9 or ICD-10 coding issues (e.g., incorrect National Provider Identifier, Health Insurance Claim Number, or Submitter ID; dates of service outside the range valid for testing; invalid HCPCS codes; and invalid place of service).

50% of the claims submitted were professional. CMS reported no issues and zero rejects due to front-end CMS system issues. For institutional claims submitted, one issue was identified related to system edits. Certain inpatient hospital test claims were inappropriately processed due to a systems issue with codes that are exempt from Present on Admission reporting. CMS indicated that this issue will be resolved prior to the July end-to-end testing week, and testers will have an opportunity to re-submit these test claims. The home health issue discovered during the January end-to-end testing week was resolved prior to the April testing. January testers had the opportunity to re-submit these test claims, and they were processed correctly.

With four months remaining to correct issues discovered during testing, the testing results are a positive step toward ICD-10 readiness for October 1, 2015. There has been significant progress since the January end-to-end testing with the overall rejection rate dropping from 19% to 12% and ICD-10 rejections dropping from 3% to 2%.

The last ICD-10 end-to-end testing week with CMS will take place on July 20 to July 24, 2015.

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