As the Oct. 1 compliance deadline nears, a question on the minds of many industry observers is whether Medicare billing systems will in fact be able to successfully process ICD-10 claims starting next month.
The Centers for Medicare and Medicaid Services says yes, but some critics are still skeptical. CMS Acting Administrator Andy Slavitt says Medicare systems have been completely converted from ICD-9 to ICD-10 and are fully ready to process claims using the new codes come Oct. 1.
“With proper preparation, this transition can be highly successful,” Slavitt said last week during a Medicare Learning Network National Provider Call on ICD-10. “Our role is to be ready just like yours. On our end, CMS has been doing exactly that—prepare, prepare, prepare—or as the surgeons like to say: ‘measure twice, not once.’”
It’s an opinion shared by the Government Accountability Office, which conducted its own independent assessment of CMS’s preparations for the code switchover. In a January 2015 report, GAO gave Medicare fee-for-service (FFS) claims processing systems a clean bill of health in the form of an ICD-10 audit.
Also See: GAO Gives CMS ICD-10 Readiness Thumbs Up
Based on CMS documentation, GAO reported that the agency completed all ICD-10-related changes to its Medicare FFS claims processing systems as of October 1, 2014, and that the systems had been updated in response to the results of internal testing. Yet, auditors did include one caveat—reporting that “it is not yet known whether updates may be needed based upon the results of external testing.”
It should be noted that since the GAO report was issued earlier this year, CMS has conducted three separate weeks of external end-to-end ICD-10 testing in January, April, and July. In publicly released test results for the third and final week of end-to-end testing conducted July 20-24, the agency stated that it “demonstrated that CMS systems are ready to accept ICD-10 claims.”
In addition, the CMS report found that:
*No new ICD-10 related issues were identified in any of the Medicare FFS claims processing systems;
*There were zero rejects due to front-end CMS systems issues, and;
*Issues identified during previous testing weeks were resolved prior to July testing.
Nonetheless, some critics of the agency are not convinced about the readiness of CMS systems for ICD-10, including Rep. Michael Burgess (R-Tex.), M.D., a member of the House Energy and Commerce Subcommittee on Health. Though Burgess has “a great deal of faith” in claims processing by Medicare contractors and health insurers, he has said on the record that CMS appears to be the “weak link in the chain.”
Noting well-publicized problems with CMS’s implementations of the Healthcare.gov and Open Payments websites, Burgess argues that “anytime CMS flips a switch and it involves the processing of data their systems fail.” He has recommended that the agency put contingency plans in place to ensure that providers will be reimbursed in a timely manner if Medicare FFS claims processing systems are unable to accept and correctly process ICD-10 claims starting next month.
But, Slavitt insists that Medicare claims with a date of service on or after October 1, 2015 will only be accepted by their systems if they contain a valid ICD-10 code. “CMS, like many other payers, will not be able to accept ICD-9 codes for dates of service after Sept. 30, 2015, nor will we be able to accept claims with both ICD-9 and ICD-10 codes,” he emphasized.
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