Is health care ready for ICD-10? Results from CMS's end-to-end testing

CMS accepted 81% of claims sent during the testing period

CMS on Wednesday announced that it accepted 81% of claims sent during a week-long ICD-10 end-to-end testing period.

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.

What you need to do today to get ready for ICD-10

Details of testing period

The testing periods are designed for providers to determine whether ICD-10 codes submitted to Medicare will be accepted by the program. This testing round ran from Jan. 26 to Feb. 3, during which 661 participants—including billing companies, clearinghouses, providers, and suppliers—submitted about 15,000 claims.

Of all the claims that were submitted:

  • 56% were professional;
  • 38% were institutional; and
  • 6% were supplier claims.

Results

CMS said the most recent testing showed that the agency's systems are prepared to accept and process ICD-10 claims, adding that the results were an improvement over the previous testing round. In an ICD-10 acknowledgement test conducted in November 2014, CMS accepted 76% of claims.

According to the most recent results, few of the rejected claims were related to ICD-9 or ICD-10 errors. Specifically, the results showed that of all claims:

  • 3% were rejected due to invalid ICD-9 diagnosis or procedure code submissions;
  • 3% were rejected due to invalid ICD-10 diagnosis or procedure code submissions; and
  • 13% were rejected due to mistakes unrelated to ICD-10 codes, such as problems setting up test claims.

Reaction

In a blog post about the results, CMS Administrator Marilyn Tavenner said the testing revealed some confusion over understanding that ICD-9 codes must be used for services provided before Oct. 1, while ICD-10 must be used following that deadline.

Tavenner said, "This successful week of testing continues to put us on course for successful implementation of this important initiative that better reflects modern practice of medicine by Oct. 1," adding, "CMS is ready for ICD-10. And, thanks to our many partners ... the health care community at large will be ready for ICD-10."

However, Robert Tennant—senior policy adviser for the Medical Group Management Association—said it would be "catastrophic" if CMS experiences the same 19% failure rate on the Oct. 1 deadline as it did during this testing round. He added that if stakeholders are "experiencing issues, when they flip the switch, that 19% (failure) rate would increase."

Hospitals lobby against another ICD-10 delay

Meanwhile, Stanley Nachimson, a health IT consultant and ICD-10 specialist, said that while it's good CMS has "emphasized the need for testing," stakeholders "have a lot of work to do." He added that providers should get testing in now "so they don't run into these errors" on Oct. 1 (Slabodkin, Health Data Management, 2/26; Gruessner, EHR Intelligence, 2/25; Bowman, FierceHealthIT, 2/25; Conn, Modern Healthcare, 2/25 [subscription required]).

The takeaway: Although health care organizations appear to be more prepared for ICD-10 than they were in December, stakeholders say more work must be done to bring down the 19% failure rate.

You have a lot to do for ICD-10. We help you do it right.

Your ICD-10 preparations are most likely underway, but how do you know your plan is getting you where you need to be? Learn how Revenue Optimization Compass gives you visibility into your performance so you can effectively protect your revenue now and after the transition.

For more information about Revenue Optimization Compass, or to request a demonstration of the technology, please contact Erika Renson at rensone@advisory.com or 202-568-7932.


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