Results from a week of ICD-10 acknowledgement testing in November with Medicare fee-for-service contractors indicates some providers may have more work ahead to master a relatively easy task.
The Centers for Medicare and Medicaid Services in a report on results gave itself a top grade, saying: Testing did not identify any issues with the Medicare FFS claims systems. Yet, the agency also said the tests were an opportunity for testers and CMS each to learn lessons about processing ICD-10 claims.
CMS tested with more than 500 providers, billers, suppliers and clearinghouses, and during the week accepted 76 percent of nearly 13,700 submitted claims. The acceptance rate increased throughout the week, topping out at 87 percent on Friday.
Acknowledgement testing confirms that payer information systems can receive ICD-10 coded claims. In contrast, the more complicated end-to-end testing involves full adjudication of a claim, including generating an electronic remittance advice and sending it back to the provider. During acknowledgement testing, CMS contractors verify that claims have a valid diagnosis code matching the date of service, an appropriate National Provider Identifier and a companion qualifier code.
An undisclosed but sizable amount of rejected claims submissions were done intentionally by providers, such as purposely putting an error in a claim to see if the claim is rejected as it should be. The most common non-intentional rejection was because of an invalid NPI. Other leading reasons included claims submitted with future dates and claims that did not have an ICD-10 companion qualifier code, according to CMS.
While providers can submit Medicare acknowledgement test claims anytime, CMS has scheduled two formal acknowledgement testing weeks in the first half of 2015: March 2-6 and June 1-5.
CMS also has scheduled three end-to-end testing weeks: Jan. 26-30, April 27-May 1 and July 20-24. To access new guidance on ICD-10 end-to-end testing with Medicare, click here.
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