ICD-10 Testing Results

March 6th, 2015
ICD-10, Testing Week

“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?


Testing, Testing: Results from the November ICD-10 Acknowledgement Testing Week

January 6th, 2015
ICD-10, Preparation, Testing Week

November wasn’t a great month for turkeys, but it was a great month for the Centers for Medicare & Medicaid Services (CMS). More than 500 participants—including small and large physician practices, small and large hospitals, labs, ambulatory surgical centers, dialysis facilities, home health providers, ambulance providers, and several other physician specialties—submitted almost 13,700 test claims during a successful week (November 17–21) of acknowledgement testing.

CMS held this testing week to ensure the organization is able to accurately receive, process, and reimburse claims containing ICD-10 codes. The trial run also allowed participants to practice documentation and billing practices to ensure their workflows suit the new diagnosis codes.

CMS made certain that each test claim submitted during the week included all of the information required for processing, including:

  • Valid diagnosis code
  • Matching dates of service
  • Valid National Provider Identifier (NPI)
  • ICD-10 companion qualifier code

CMS rejected some claims due to both intentional errors—that is, those part of the “negative testing” process, which ensures erroneous claims aren’t accepted—as well as unintentional errors, including:

  • Invalid NPI
  • Future dates of service (CMS requires that all test claims use current dates of service)
  • Missing ICD-10 companion qualifier codes

Overall, testing went well. The system experienced no issues, and CMS accepted 76% of the submitted test claims, with the daily acceptance rate improving steadily over the course of the week to a high of 87% on Friday.

If you missed this particular testing week, don’t worry. CMS is offering two more testing weeks this year: March 2–6, 2015, and June 1–5, 2015. That being said, providers, suppliers, billing companies, and clearinghouses aren’t limited to testing claims just during these weeks; they can submit test claims anytime before ICD-10 officially goes into effect on October 1, 2015.

For more information on the testing process or to learn how to participate, contact your Medicare Administrative Contractor.


End-to-End Testing Volunteer Applications Due January 21

December 30th, 2014
ICD-10, Preparation, Testing Week

Despite recent buzz about yet another ICD-10 delay, as of now, the implementation of the new diagnosis code set will go forward as planned on October 1, 2015. To prepare for the transition, Medicare will conduct a second round of end-to-end testing with a new sample group of providers this April. As with the previous end-to-end testing exercise, this effort will verify that:

  • Providers and other claim handlers are able to submit Medicare claims containing ICD-10 codes
  • Medicare’s software can correctly process claims containing ICD-10 codes
  • Claim submission results in accurate remittance advices

CMS will select approximately 850 test participants from its pool of volunteers. This sample will represent a wide variety of geographic locations, provider types, and claim submission processes. Want to get in on the action? Here’s how to throw your hat in the volunteer ring:

  1. Visit your local MAC website to get a volunteer form.
  2. Complete the form and turn it in by January 21.
  3. Keep your eyes peeled for a selection notification from CMS.
  4. Receive further testing setup instructions from CMS by January 30 (if you’re selected).

Please note that all volunteers must be able to submit future-dated claims as well as provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers (HICNs). If you are selected for testing and are unable to provide this information to your MAC by February 20, 2015, CMS will eliminate you from the test group.

CMS has an additional end-to-end testing period planned for July 20–24, just a hair over two months before the go-live date. As a side note, those who volunteer to participate in the April testing exercise don’t need to reapply for the July test.

CMS will use the data it collects during the testing week to address any lingering ICD-10 issues and develop appropriate educational materials, thus ensuring a smooth transition come October 1.

For more information, check out the MLN Matters fact sheets found here and here.


CMS Sets ICD-10 Transition Date, Releases Testing Information

August 5th, 2014
ICD-10, Testing Week, Transition

It’s official: October 1, 2015, is the new ICD-10 transition deadline. While that gives providers ample time to prepare for the switch, it’s imperative that those affected by the change stay on top of their prep work to ensure a timely and seamless transition when that day finally arrives.

To that end, CMS recently revealed its testing plan for the months leading up to the ICD-10 implementation date. According to this MLN Matters article, CMS is taking “a comprehensive four-pronged approach to preparedness and testing” in an effort to ensure everyone in the healthcare community has enough practice with submitting the new codes before it becomes a requirement. The four pieces of the testing plan are:

  • Internal testing of CMS’s claims processing systems
  • Release of downloadable beta testing tools
  • Acknowledgement testing
  • End-to-end testing

As you may recall, CMS successfully conducted acknowledgement testing this past March. To build on that round of testing, CMS has invited all providers, suppliers, billing companies, and clearinghouses to submit acknowledgement test claims any time before October 1, 2015. Additionally, CMS has scheduled special acknowledgement testing weeks in November 2014 and March and June 2015. During these testing periods, participants will have access to real-time desk support. You do not need to sign up to participate in these testing activities. If you’re interested, simply contact your Medicare Administrative Contractor (MAC) for more information.

CMS also plans to facilitate end-to-end testing in January, April, and July of 2015. Approximately 2,550 volunteers representing a variety of regions and provider types will be selected to participate in these testing events, which involve submission of test claims with ICD-10 codes to Medicare as well as the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims. According to the above-cited MLN Matters article, CMS will soon release information on the volunteer registration process.

For more information on these testing initiatives, as well as links to various testing resources and tools, please refer to the MLN Matters article.


CMS’s ICD-10 Testing was a Success

June 5th, 2014
ICD-10, Preparation, Testing Week

You may remember the ICD-10 testing week that the Centers for Medicare and Medicaid Services (CMS) conducted in March of this year. Well, the results are in, and it was a success. Participants submitted more than 127,000 claims containing ICD-10 codes to Medicare “and received electronic acknowledgements confirming that their claims were accepted,” writes Niall Brennan, acting director of the CMS Offices of Enterprise Management, in the May 30, 2014, CMS ICD-10 News Update (which the Mississippi Hospital Association republished here).

About 26,000 providers, suppliers, billing companies, and clearinghouses (representing approximately 5% of the total submitting population) participated in the testing program, with clearinghouses making up the largest portion of participants and submitting half of all test claims. On the national level, CMS accepted 89% of test claims (the normal acceptance rate is 95–98%). However, some regions reported acceptance rates close to 99%.

According to Brennan, the “testing did not identify any issues with the Medicare [fee-for-service] FFS claims system”—which is great news—but the program did afford testers and CMS the opportunity to learn. “To be processed correctly, all claims must have a valid diagnosis code that matches the date of service and a valid national provider identifier,” writes Brennan. “Additionally, the claims using ICD-10 had to have an ICD-10 companion qualifier code…” Claims lacking any of the above were rejected. Brennan reports that many program participants intentionally submitted errored claims to ensure the rejection process was working correctly—a process known as “negative testing.”

The Department of Health and Human Services (HHS) plans to release an interim final rule that will include October 1, 2015, as the new mandatory ICD-10 compliance date. Under this proposed rule, HIPAA-covered entities will need to continue using ICD-9 through September 30, 2015. However, “providers, suppliers, billing companies, and clearinghouses are welcome to submit acknowledgement test claims anytime up the anticipated October 1, 2015, implementation date.” However, Brennan cautions, you may want to wait to do so until after October 6, 2014, when Medicare will complete its system updates. If you’re interested in conducting acknowledgement testing, please contact your local Medicare Administrative Contractor (MAC) for more information.

CMS will soon release details about another round of end-to-end testing slated for next year. We’ll pass along that info as soon as we receive it.

For more ICD-10 news, visit the CMS ICD-10 website, sign up for ICD-10 email updates, or follow CMS on Twitter. Also, check back here often.


New Research Finds Less than 10% of Physician Practices Ready for ICD-10

March 20th, 2014
ICD-10, Preparation, Testing Week

The Medical Group Management Association (MGMA) published the findings from their most recent ICD-10 readiness survey and the results are, well, scary. According to Jeff Wood in this ICD-10 Hub blog post summarizing the findings, the researchers found that “less than 10% of physician practices have made significant progress toward preparing for the upcoming conversion to ICD-10.” While this demonstrates an improvement from MGMA’s June 2013 survey, it’s not much.

For physicians, one of the issues may very well be their EHR. The survey found that:

  1. Most (almost 87%) need to—or already had to—upgrade or replace their EHR software to use the new codes. Almost 37% have/had to cover the cost—$12,885 per full-time physician.
  2. Only about 8% have started internal ICD-10 testing with their EHR vendor.

It’s not just MDs who are less than raring to go. Wood writes that “almost 60% of the 570 medical groups polled had not heard from their payers about when end-to-end testing would begin” and “nearly 50% [of respondents] had not received a testing date from their clearinghouse.” Despite the results of this readiness survey, there’s been no news about another transition date delay—although I’m sure many providers and payers were hoping that would be the case.

So what does this mean for PTs, OTs, and SLPs? We’ll, it means it’s a great time to be a therapist. Although the transition to ICD-10 may not be a total picnic, you’ve got a lot less to worry about than your physician counterparts. For starters, your EMR implementation costs are a fraction of that frightening figure above. And you don’t have to demonstrate meaningful use this year in addition to making the transition to the new super specific coding set. And that means you and your team can focus solely on learning—and implementing—the new codes. And if you’re a WebPT Member—or plan to become one—you have an EMR that will ensure everything is working smoothly well before the transition deadline. Plus, all of our billing software partners are ready (or almost ready), too. Some—like Therabill and Medisoft—are already accepting ICD-10 codes (along with their ICD-9 counterparts) and most—including CollaborateMD, AdvancedMD, and Kareo—participated in Medicare’s ICD-10 Testing Week to verify their own ICD-10 readiness.

Want to learn more about WebPT and our integrated billing partners? If you’re already a member, head to the Community section of WebPT by clicking the people icon in the top-right corner of any screen within the application. If you’re not yet a member, call us at 866-221-1870, option 1.

What do you think about the survey findings? Tell us your perspective in the comments section below.


Sign Up by March 24 to Participate in End-to-End ICD-10 Testing

March 14th, 2014
ICD-10, Preparation, Testing Week

Note: Congress has passed legislation to delay ICD-10 implementation until October 1, 2015. Read the full story here.

In preparation for the October 1, 2014, transition to ICD-10, Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) will conduct end-to-end testing of the new code set during the week of July 21–25. This testing week will ensure that:

  • Providers and claim submitters can successfully submit ICD-10 codes to the Medicare Fee-For-Service (FFS) claim systems.
  • Medicare’s software can properly process claims containing ICD-10 codes.
  • Remittance Advices accurately reflect 2014 payment rates.

CMS will select more than 500 volunteers to participate in its end-to-end testing week. These volunteers will represent a variety of regions and provider, claim, and submitter types, including clearinghouses (which represent many different providers).

If you would like to volunteer to participate in this testing week, you must fill out the volunteer form on your local MAC website by March 24, 2014. After CMS reviews the volunteer applications and selects its final test group, the MACs and CEDI will notify all participants by April 14 and provide them with all the information they need to successfully complete their testing.

In an effort to ensure complete readiness prior to the transition date, CMS will use the data collected during the testing week to address any lingering ICD-10 issues and develop appropriate educational materials.

For more information, check out the MLN Matters fact sheets found here and here.


Medicare’s ICD-10 Testing Week is March 3–7: Want to Participate?

January 30th, 2014
ICD-10, Testing Week

Note: Congress has passed legislation to delay ICD-10 implementation until October 1, 2015. Read the full story here.

The switch to ICD-10 isn’t happening until October 1, 2014, but healthcare industry leaders have tirelessly touted the importance of early preparation. To that end, the Centers for Medicare and Medicaid Services will allow Medicare providers—including physical therapists, occupational therapists, and speech language pathologists—to submit ICD-10 codes in a testing environment during the week of March 3–7.

During the Medicare testing week, you can include ICD-10 codes for fake patients on Medicare claim forms with dates of service ranging from October 1, 2013, to March 3, 2014. This will allow you to see whether your Medicare administrative contractor (MAC) can receive and process such claims. Following the testing week, practitioners who submitted test claims will receive electronic notification of the status of those claims. However, per Common Electric Data Interchange, “testing will not confirm claim payment or produce remittance advice.” We want to emphasize that during testing week, you are to only use fake patients as none of these test claims will receive acceptance or reimbursement.

This is an opportunity for you to assess your ICD-10 readiness in a practice environment. Plus, according to CMS, local MACs will beef up their support resources—including real-time desktop support from at least 9:00 AM to 4:00 PM every day during the testing week—to accommodate the anticipated spike in phone calls.

If you wish to participate, you’ll need to visit your local MAC’s website. From there, look for the ICD-10 icon and click it. That will take you to a blurb about testing week with a link to register. Please note that while WebPT will not release its full-scale ICD-10 functionality prior to the testing week, we will have an ICD-10 testing module available to any Member interested in participating. However, most of our integrated billing services will be conducting testing independently of WebPT, so while all WebPT Members will be able to test in WebPT, they won’t be able to complete the testing process by carrying their test claims through the billing process. For this reason, we recommend that only those WebPT Members who submit their own claims to Medicare or those Members who use the WebPT Billing Service or AdvancedMD participate in Medicare testing week.

As we obtain details from these billing services—as well as further instructions about testing within WebPT—we’ll share them here on ICD10forPT.com, on the WebPT blog, and via email. We’ll also keep you posted about ICD-10 and Medicare developments as well as details regarding the launch of our full ICD-10 solution.

So, to recap, if you want to test ICD-10 codes in your clinic during Medicare testing week:

  1. Determine how you will submit test claims to Medicare (either directly to Medicare independently or through the WebPT Billing Service or AdvancedMD if you’re a customer).
  2. Visit your MAC website, click the ICD-10 icon, and follow their instructions on how to register.
  3. Keep your eyes peeled for an email explaining WebPT’s ICD-10 testing module, which we’ll release later this month.
  4. Check out ICD10forPT.com, peruse the WebPT blog, and sign up for our electronic newsletters to stay on top of all things ICD-10.