ICD-10 Acknowledgement Test Shows 87 Percent Acceptance Rate
The latest CMS ICD-10 acknowledgement test of 13,700 claims found an 87 percent acceptance rate of ICD-10 codes.
- It may seem as though the switch to ICD-10 is in a constant state of delay. While the current deadline to implement the inpatient hospital procedure coding is October 1, 2015, many organizations are already using it. The Centers for Medicare and Medicaid Services (CMS) has been encouraging the entire healthcare community to get on board early to avoid any hiccups when the switch is finally switched.
One way that CMS is helping to push the issue is through the use of periodic Acknowledgement testing. During these week long practice sessions, healthcare service providers are able to submit Medicare fee-for-service claims and receive electronic communication as to whether or not the claims were accepted. This allows both CMS and the providers to gauge how well prepared they are for ICD-10 and identify and correct any potential trouble areas.
According to a new report from CMS, the latest ICD-10 Acknowledgement testing from November showed an acceptance rate of 87 percent. Nationally, the organization accepted 76 percent of the total test claims. In total, more than 500 providers, suppliers, billing companies and clearinghouses participated by submitting nearly 13,700 claims. This includes practices, hospitals, labs, ambulatory surgical centers, home health providers and other healthcare organizations of all sizes.
To examine claims, CMS verified that each claim had a valid diagnosis code that matched the service data, a valid submitter National Provider Identifier (NPI) and the ICD-10 companion qualified code. Claims missing any of there or containing incorrect information were rejected.
The test wasn’t just to ensure that claims are meeting the new coding requirements but also to ensure that it denied claims that failed to do so. This happened through a process known as “negative testing.” While it is important for the system to acknowledge the changes, it is just as important that it denies older and incorrect codes that will not communicate with updated systems.
“In many cases, testers intentionally included errors in their claims to make sure that the claim would be rejected,” the report from CMS reads. “The majority of rejections on professional claims were common rejects related to an invalid NPI. Some claims were rejected because they were submitted with future dates.”
The next rounds of weekly testing will be held on March 2-6, 2015 and June 1-5, 2015. Organizations will also be able to submit acknowledgement test claims at any point before the October deadline. On top of that, during the week of April 26 through May 1, 2015, an additional ICD-10 test will be held. This one will be an end-to-end tested with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor. It will call for 850 volunteers to submit claims for a full scale examination.
