Just-released guidance from the Centers for Medicare and Medicaid Services walks providers, clearinghouses, suppliers and billing firms through preparing claims for ICD-10 end-to-end testing with Medicare.
The agency reminds stakeholders that while acknowledgement testingconfirming claims sent to Medicare are accepted or rejectedis open to all electronic submitters, end-to-end testing is limited to a smaller subset of participants who volunteer and are accepted. Those doing end-to-end testing with their Medicare Administrative Contractor can submit up to 50 claims.
Before testing, an organization must submit to the contractor data that includes up to two submitter identifiers, up to five national provider identifiers or provider transaction access numbers, and up to 10 health insurance claim numbers (HICNs). These data may be used in any combination on the 50 test claims. The HICNs must be real beneficiaries who are not deceased.
Once selected for end-to-end testing, such as in the January 2015 round, an organization need not reapply for later rounds; they are automatically registered. An organization can submit the same data to the contractor as previously sent in the first round of testing, or send a new set.
Medicare also requires specific dates on the ICD-10 coded claims being tested. Professional claims must have a date of service on or after Oct. 1, 2015, with inpatient claims having a discharge date on or after Oct. 1, 2015. Supplier claims must have a date of service between Oct. 1, 2015 and Oct. 15, 2015. Professional and institutional claims may have dates up to Dec. 31, 2015. ICD-9 and ICD-10 codes cannot be submitted on the same claim.
The guidance covers additional testing scenarios such as Returned to Provider claims (they count toward the 50 limit and cant be resubmitted), and specific data submissions for supplier, home health, hospice, inpatient rehabilitation facility and skilled nursing facility claims. The guidance is available here.
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