Health Information Management

Tip: Prepare for ICD-10 testing by assessing payers

APCs Insider, October 24, 2014

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In order to prepare testing for ICD-10 implementation, facilities should assess the readiness of their payers. Start by identifying the top payers, then create a list of those with the largest number of denials in order to prioritize. Ask when their ICD-10 testing will be available.
Collaboration between hospitals and payers is important because health plans cannot precisely forecast how providers will code claims, and providers cannot predict how payers will process and reimburse claims.
As a result of the ICD-10 delay, CMS has announced several additional rounds of testing. Providers, suppliers, billing companies, and clearinghouses are able to submit acknowledgement test claims at any time up to October 1, 2015. Test claims will not be adjudicated, but MACs will confirm whether they accepted or rejected submitted claims.
CMS will highlight the testing in November 2014, March 2015, and June 2015 with scheduled acknowledgment testing weeks. MACs and DME MAC Common Electronic Data Interchange contractors will have staff ready to handle increased call volume during those weeks to help providers.
This tip is adapted from “Collaboration with physicians and payers key to ICD-10-CM readiness” in the October issue of Briefings on APCs.

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