CMS Announces a Third Round of Successful ICD-10 Testing, Says They Won't Deny Claims for One Year | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

CMS Announces a Third Round of Successful ICD-10 Testing, Says They Won't Deny Claims for One Year

July 6, 2015
by Rajiv Leventhal
| Reprints

Nationally, the Centers for Medicare & Medicaid Services (CMS) accepted 90 percent of claims from the more than 1,200 submitters who participated during CMS’ third round of ICD-10 end-to-end testing.

This round of testing took place between June 1-5. During the first ICD-10 end-to-end testing week, which took place from January 26 until February 3, 81 percent of claims were accepted; on June 2, the agency announced that 88 percent of submitted claims were accepted in t he second round of testing,  which took place from April 27-May 1.

No Medicare fee-for-service claims systems issues were identified during this testing week or the previous acknowledgement testing weeks, CMS said. In the June test, as in previous acknowledgement testing weeks, CMS found that most rejects resulted from improperly developed test claims unrelated to ICD-10. The agency said, “Most rejects were the result of provider submission errors in the testing environment that would not occur when actual claims are submitted for processing. CMS will continue to conduct extensive outreach to testers on setup of test claims to avoid these issues for providers who plan to acknowledgement test.”

After CMS announced the first round of testing results, nearly 100 physician groups representing state and specialty medical societies wrote a letter to the agency expressing their remaining ICD-10 concerns as well as voicing displeasure with the first round of results, despite CMS’ praise.

Additionally, CMS has announced a joint effort with the American Medical Association (AMA) to help physicians get ready ahead of the Oct. 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will aim to allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.

In that guidance includes:

  • While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015. It is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons. 
  • CMS will have an ICD-10 Ombudsman to help receive and triage physician and provider issues. The Ombudsman will work closely with representatives in CMS’s regional offices to address physicians’ concerns.

Get the latest information on Health IT and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

Learn More

Topics

News

ONC Roundup: Senior Leadership Changes Spark Questions

The Office of the National Coordinator for Health IT (ONC) has continued to experience changes within its upper leadership, leading some folks to again ponder what the health IT agency’s role will be moving forward.

Media Report: Walmart Hires Former Humana Executive to Run Health Unit

Reigniting speculation that Walmart and insurer Humana are exploring ways to forge a closer partnership, Walmart Inc. has hired a Humana veteran to run its health care business, according to a report from Bloomberg.

Value-Based Care Shift Has Halted, Study Finds

A new study of 451 physicians and health plan executives suggests that progress toward value-based care has stalled. In fact, it may have even taken a step backward over the past year, the research revealed.

Study: EHRs Tied with Lower Hospital Mortality, But Only After Systems Have Matured

Over the past decade, there has been significant national investment in electronic health record (EHR) systems at U.S. hospitals, which was expected to result in improved quality and efficiency of care. However, evidence linking EHR adoption to better care is mixed, according to medical researchers.

Nursing Notes Can Help Predict ICU Survival, Study Finds

Researchers at the University of Waterloo in Ontario have found that sentiments in healthcare providers’ nursing notes can be good indicators of whether intensive care unit (ICU) patients will survive.

Health Catalyst Completes Acquisition of HIE Technology Company Medicity

Salt Lake City-based Health Catalyst, a data analytics company, has completed its acquisition of Medicity, a developer of health information exchange (HIE) technology, and the deal adds data exchange capabilities to Health Catalyst’s data, analytics and decision support solutions.