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CMS Revises ICD-10 Testing Plan Leading Up to 2015 Deadline

August 4, 2014
by Rajiv Leventhal
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In a follow up to its announcement that finalized October 1, 2015 as the new ICD-10 deadline, the Centers for Medicare & Medicaid Services (CMS) has updated its recommendations for providers as they again prepare for the transition.

The agency says that it is taking a comprehensive four-pronged approach to preparedness and testing for ICD-10 to ensure that CMS as well as the fee-for-service (FFS) provider community is ready.

The four-pronged approach includes:

• CMS internal testing of its claims processing systems

• Provider-initiated beta testing tools

• Acknowledgement testing

• End-to-end testing

In 2015, CMS says it plans to offer three separate end-to-end testing opportunities. Each opportunity will be open to a limited number of providers that volunteer for this testing; as planned, approximately 2,550 volunteer submitters will have the opportunity to participate over the course of the three testing periods.

End-to-end testing includes the submission of test claims to Medicare with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims. The goal of this testing is to demonstrate that:

• Providers or submitters are able to successfully submit claims containing ICD-10 codes to the Medicare FFS claims systems

• CMS software changes made to support ICD-10 result in appropriately adjudicated claims (based on the pricing data used for testing purposes)

• Accurate RAs are produced

CMS says that the sample will be selected from providers, suppliers, and other submitters who volunteer to participate and that information about the volunteer registration will be available shortly. The sample group of participants will be selected to represent a broad cross-section of provider types, claims types, and submitter types, the agency says.

In February, when the ICD-10 transition deadline was still in 2014, CMS announced that it was going to conduct end-to-end testing for a small sample group of providers, reversing course from its original stance. Many organizations, such as the American Medical Association (AMA) and the Medical Group Management Association (MGMA), pleaded with CMS to initiate end-to-end testing. The main reason was to ensure that vendors’ software would be ready for the Oct. 1, 2014 compliance date.

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