CMS says ICD-10 testing successful: Are you prepared?

The Centers for Medicare and Medicaid Services is reporting that it successfully completed the first week of end-to-end testing of the soon-to-be-implemented ICD-10 coding.

The testing, which took place between Jan. 26 and Feb. 3, included 661 participants with about 1,400 National Provider Identifiers registered. They were split equally between direct submitters and clearing houses/billing agencies. Nearly 15,000 test claims were submitted. Of those, 81 percent were accepted, according to CMS.

CMS cited the following reasons for the rejected claims:

  • Three percent due to an invalid submission of an ICD-9 diagnosis or procedure code
  • Three percent due to an invalid submission of an ICD-10 diagnosis or procedure code
  • Thirteen percent due to non-ICD-10 related errors, including issues setting up the test claims

The normal acceptance rates are around 97 percent, so despite CMS’ claim of success, physicians are concerned that the problems may continue after ICD-10’s implementation on Oct. 1.

CMS’s outgoing administrator Marilyn Tavenner stated in a blog post that the testing is designed to help identify areas of improvement and that CMS will work with outside entities and stakeholders “to improve those very small deficiencies identified.” She added that CMS “will continue to do testing, especially in those areas we identify as needing improvement.”

CMS said it identified one area that has caused confusion and reiterated that everyone must use ICD-9 for services provided before the Oct. 1 deadline and ICD-10 for services provided on or after Oct. 1. This means that ICD-10 can only be used for test purposes prior to the deadline, and ICD-9 cannot be used to bill for services provided on or after the Oct. 1 deadline.

“This rule applies no matter when the claim is submitted, so claims submitted after Oct. 1 for services provided before that date must use ICD-9 codes,” Tavenner noted.

CMS reiterated that the rules for ICD-10 apply not just to those who accept Medicare and Medicaid, but also to all healthcare providers.

Is your practice/healthcare company prepared for ICD-10? The Health Law Offices of Anthony C. Vitale can assist you. Give us a call.

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