“Testing, testing. One, two, three. Is this thing on?” Okay, so CMS might not be testing sound levels to rock the mic—but they are testing to see whether your claims are ICD-10-ready. A group of 661 volunteers (including healthcare providers, billing agencies, and equipment suppliers) submitted test claims from January 26 to February 3, during Medicare’s first end-to-end ICD-10 testing week. And now, the results are in: “Of nearly 15,000 test claims received by the Centers for Medicare & Medicaid for the first round of end-to-end ICD-10 testing, 81 percent were accepted,” explained this FierceHealthIT article. According to CMS, that makes this round of testing a huge success, as it proves they’re ready to accept and process claims come October 1.
But what about the 19% of claims that didn’t pass the test? If you’re wondering what went wrong, here’s the CMS data that explains the denials:
- 3% of claims were rejected due to invalid ICD-9 diagnosis or procedure codes.
- 3% contained invalid ICD-10 diagnosis or procedure codes.
- 13% of the denials weren’t ICD-10 related, but were instead related to problems with the test claim setup (e.g., they contained incorrect or invalid NPIs, health insurance claim numbers, submitter IDs, dates of service, HCPCS codes, or places of service).
Beyond proving its ICD-10 readiness, CMS unearthed a couple common points of ICD-10 confusion among those in the healthcare industry. Specifically, things seem to get fuzzy when it comes to claims spanning the transition. In response, CMS clarified that:
- Claims for services provided before the October 1 deadline must include ICD-9 codes only (regardless of transmission date).
- Claims for all services provided on—or after—October 1 must include ICD-10 codes only.
- For claims with multiple dates of service falling both before and after the transition, split claims so ICD-9 and ICD-10 codes are never on the same claim.
Now that CMS has confirmed that they’re ready to handle ICD-10 codes, there’s never been a better time for providers to jump on the testing bandwagon. This blog post stresses how important it is for Medicare providers to participate in future testing opportunities: “Testing allows us to identify areas of improvement, and we will work with outside entities and stakeholders to improve those very small deficiencies identified. And we will continue to do testing, especially in those areas we identify as needing improvement.”
But remember, Medicare providers aren’t the only ones who need to make sure they’re in tip-top ICD-10 shape; ICD-10 affects all HIPAA-covered entities, and commercial payers across the country are conducting their own testing exercises. So stay on the lookout for other testing opportunities, and sign up to participate whenever you can.
With successful testing, training, and education, the healthcare community will be more than ready to rock the ICD-10 transition like a hurricane. After all, the best way to ensure a smooth show is to work out all the kinks during the rehearsal. With that in mind, how prepared are you?