The Centers for Medicare and Medicaid Services has announced that providers, clearinghouses, and billing agencies have successfully participated in the second ICD-10 end-to-end testing week, held April 27 through May 1.
Overall, participants in the week-long testing were able to successfully submit 88 percent of ICD-10 claims23,138 test claims were received and 20,306 were accepted. The results are a step in the right direction. CMS reported that the acceptance rate for April was higher than Januarys 81 percent acceptance rate, with an increase in test claims submitted and a decrease in the percentage of errors related to diagnosis codes.
The latest testing included approximately 875 providers and billing companies, with 1,600 National Provider Identifiers (NPIs) registered to test, representing what CMS called a broad cross-section of provider, claim, and submitter types. According to the agency, the testing demonstrated that CMS systems are ready to accept ICD-10 claims, emphasizing most of the claim rejections that occurred were unrelated to ICD-9 or ICD-10.
Reasons for rejected claims included: invalid submission of ICD-9 diagnosis or procedure code (1 percent) and invalid submission of ICD-10 diagnosis or procedure code (2 percent), incorrect NPI, Health Insurance Claim Number, or Submitter ID; dates of service outside the range valid for testing; invalid HCPCS codes; and invalid place of serviceerrors that CMS said also occurred in the January end-to-end testing week.
As far as professional and supplier claims submitted during the April testing, there were no issues identified and zero rejects due to front-end CMS systems issues, reports the agency. However, in the area of institutional claims, there was one issue identified related to system edits: certain inpatient hospital test claims were inappropriately processed due to a systems issue with codes that are exempt from Present on Admission reporting. CMS states that the issue will be resolved prior to the July end-to-end testing week, and testers will have an opportunity to re-submit these test claims.
In a statement issued by the Coalition for ICD-10, the organization congratulated CMS on the success of its April end-to-end testing which it said demonstrated that the agencys systems are ready to accept ICD-10 claims. Specifically, it referenced the fact that there were zero claims rejected due to front-end CMS system issues for professional and supplier claims. Further, the Coalition for ICD-10 noted that of the 23,138 test claims received, half were professional claims.
With four months remaining to correct issues discovered during testing, the high rate of successful submission of ICD-10 codes is especially encouraging for physician offices since half the claims submitted for end-to-testing were professional claims, according to the organization. These results indicate that significant progress has been made since the January end-to-end testing with the overall rejection rate dropping from 19 to 12 percent and ICD-10 rejections dropping from 3 to 2 percent.
Though the organization acknowledged that 12 percent of claims submitted for end-to-end testing were rejected, it pointed out that only two percent of the rejections were due to invalid submission of an ICD-10 diagnosis or procedure code and that the remaining rejections were for non-ICD-10 related errors that have no bearing on ICD-10 implementation and would be rejected under ICD-9.
According to CMS, a final ICD-10 end-to-end testing week will be held July 20-24. However, the agency said it is no longer accepting volunteers for this testing. CMS did emphasize that those who participated in the January and April end-to-end testing weeks are automatically eligible to test again in July.
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