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CMS Reports Successful ICD-10 Testing Week

June 11, 2014
by Rajiv Leventhal
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The Centers for Medicare & Medicaid Services (CMS) has reported an 89 percent acceptance rate on test ICD-10 claims submitted to the agency during ICD-10 testing week in March, according to a recent blog post from Niall Brennan, acting director, CMS Offices of Enterprise Management.

More than 127,000 claims with ICD-10 codes were submitted to the Medicare fee-for-service (FFS) claims systems and received electronic acknowledgements confirming that their claims were accepted.

Approximately 2,600 participating providers, suppliers, billing companies and clearinghouses participated in the testing week, representing about five percent of all submitters. Clearinghouses, which submit claims on behalf of providers, were the largest group of testers, submitting 50 percent of all test claims. Other testers included large and small physician practices, small and large hospitals, labs, ambulatory surgical centers, dialysis facilities, home health providers, and ambulance providers.

Nationally, CMS accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent. The normal FFS Medicare claims acceptance rates average 95-98 percent. Testing did not identify any issues with the Medicare FFS claims systems, according to Brennan’s post.

In many cases, testers intentionally included such errors in their claims to make sure that the claim would be rejected, a process often referred to as negative testing. To be processed correctly, all claims must have a valid diagnosis code that matches the date of service and a valid national provider identifier. Additionally, the claims using ICD-10 had to have an ICD-10 companion qualifier code and the claims using ICD-9 had to use the ICD-9 qualifier code.  Claims that did not meet these requirements were rejected.  

Brennan wrote that the Department of Health and Human Services (HHS) expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015.

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