ICD-10 Medicare FFS End-to-End Testing Results: 87% Accepted
By - The Centers for Medicare and Medicaid (CMS) has announced results regarding the the ICD-10 Medicare Fee-For-Service (FFS) End-to-End Testing conducted from July 20 through July 24. CMS systems are ready to accept claims with nearly 9 of 10 claims confirmed as being accepted. This announcement, as RevCycleIntelligence.com reported, follows similar announcements from CMS regarding “successful” testing weeks where most claims rejections were supposedly merely caused by errors unrelated to ICD-9 or ICD-10.
CMS defines this third week of testing as a focused process within a specific region, utilizing innovative or updated applicable products, operating rules, or transactions. The testing week's objective, says CMS, is to quantify predictability and preparation levels. Healthcare providers, clearinghouses, and billing agencies participated with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) in what CMS claims was another successful testing week.
According to CMS, “Overall, participants in the July end-to-end testing week were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems. In some cases, testers may have intentionally included errors in their claims to make sure that the claim would be rejected, a process often referred to as ‘negative testing.’” CMS additionally confirms although July’s acceptance rate matched January and April’s rates, the number of testers and test claims submitted increased.
Regarding matters of volume, CMS confirms 1,200 were selected to participate in end-to-end testing, including nearly 500 repeat testers from those testing weeks conducted last April and January. Nearly 1,400 National Provider Identifiers (NPIs) were registered to test, 12 percent of which – 174 – being repeat NPIs from earlier testing weeks. Says CMS, “This indicates that many clearinghouses that participated in previous weeks chose different providers for July.”
Over 29,000 test claims were received. Over 25,600 test claims were accepted. CMS confirms the acceptance rate was 87 percent. “1.8% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code,” states CMS. “2.6% of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code.”
“Additional rejections were from non-ICD-10 related errors, including 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 service,” CMS states. “These types of errors also occurred in the January and April end-to-end testing weeks. 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 describes the types of claims received – over 52 percent were professional, over 40 percent were institutional, and nearly 6.5 percent were supplier.
“Testing demonstrated that CMS systems are ready to accept ICD-10 claims,” CMS says. There were no new ICD-10 related issues identified in any Medicare fee-for-service claims processing systems, CMS confirms. Additionally, there were “zero rejects due to front-end CMS systems issues.” Any issues identified during previous testing weeks were resolved before July testing began, CMS adds, confirming July end-to-end testing participants received Remittance Advices (RAs) and a specific report about their test claims disposition.
CMS confirms in today’s announcement: “Through its robust system release testing, CMS has ensured that the Medicare FFS claims processing systems changes for ICD-10 implementation have been thoroughly tested and validated.” CMS reminds the healthcare industry Medicare claims with a date of service on or after October 1, 2015 will be rejected if they contain an invalid ICD-10 code. Medicare claims processing systems lack the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims with both ICD-9 and ICD-10 codes.
