CMS ICD-10 ‘Acknowledgement’ Test Done, Now Comes the Hard Part

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Medicare ICD-10 “acknowledgement” testing March 3-7 “went well” for RelayHealth, the connectivity and transactions processing unit of McKesson Corp., says Josh Berman, the unit’s director of business analytics and ICD-10 But acknowledgements are easy and a tougher road lies ahead, Berman says.

The vendor, who operates a major claims clearinghouse, was one of many technology companies and providers that sent claims coded in ICD-10 to Medicare contractors to confirm they were accepted.

In an interview with Health Data Management, Berman warns that acknowledgement testing should not be seen as indicative of payer readiness for the new coding set. All payers can do acknowledgements, he explains. But the testing gives some comfort to providers and practice for coders, so it’s a good idea to do the tests with other payers.

The real concern, he adds, remains whether insurers will be able to process the claims. He was pleased when CMS announced it will conduct limited end-to-end testing this summer as other insurers often follow the government’s lead, and he hopes that CMS will involve hundreds of providers, maybe 500.

That’s important, because it puts pressure on other insurers, many of whom are not testing with more than 10 to 20 providers and CMS testing with hundreds could compel others to do so. It’s also important because while most providers were not ready for end-to-end testing three or four months ago, large numbers are quickly getting there and Berman expects end-to-end test requests to ramp up in April and May.

It won’t take much for chaos to ensue when the compliance date comes if insufficient end-to-end testing is done, Berman predicts. “On Oct. 1, all it will take is a small number of payers to put the industry in a mess.”

Consequently, providers need to be ready in October to code for ICD-9 and 10 for an indefinite period, Berman advises. “At this point, there is a high probability that your payers won’t be ready and the only thing they can do is revert back to ICD-9. The disruption could be great.”

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