Corporate Compliance

CMS Completes Successful First Round of End-to-End Testing

Medicare Insider, March 3, 2015

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The main concern of some Congress members regarding ICD-10 implementation during the recent House subcommittee hearing was CMS' ability to handle the switch, after well-publicized technical issues with launching Healthcare.gov.
 
However, if the results of the first round of end-to-end testing are indicative of CMS' readiness, and that of the industry at large, concerns about the technical aspects of implementation may be overblown.
 
During the testing, 661 volunteers submitted nearly 15,000 test claims, with an 81% acceptance rate. The reasons for the rejected claims were:
  • 3%, invalid submission of ICD-9 diagnosis or procedure code
  • 3%, Invalid submission of ICD-10 diagnosis or procedure code
  • 13%, non-ICD-10 related errors, including issues setting up the test claims (e.g., incorrect NPI, Health Insurance Claim Number, submitter ID, dates of service outside the range valid for testing, invalid HCPCS codes, invalid place of service)
The main problem CMS identified during testing involved confusion surrounding claims submitted on or around the October 1 implementation date. CMS has reiterated that all services provided before the October 1 deadline should be submitted with ICD-9 codes, while all claims for services on or after that date should be submitted with ICD-10 codes.
 
The only problem CMS identified regarding its systems involved fewer than 10 test claims for home health services. CMS says the issue will be resolved before the next testing week, and providers will be able to resubmit those claims to ensure the problem has been fixed.
 
Another round of end-to-end testing, which previous volunteers are automatically eligible for, will take place April 27-May 1, and providers are encouraged to participate in upcoming acknowledgment testing weeks March 2-6 and June 1-5. Acknowledgement testing provides limited feedback because claims do not go through the adjudication process and the MAC does not produce remittance advice. However, submitters will find out whether they can submit a claim correctly and whether the MAC’s system can accept the claim.
 
Did you facility take part in in the first round of ICD-10 end-to-end testing, or are you signed up for future testing weeks? If so, and you'd like to share your experience, please email Steven Andrews at sandrews@hcpro.com and you may be included in a future story.
 
This article was written by Steven Andrews for APCs Insider. To subscribe to APCs Insider, click here.



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