News Feature | December 22, 2014

ICD-10 Issues Highlighted By CMS Testing Week

By Megan Williams, contributing writer

CMS Reports ICD-10 End-To-End Testing Results

The second of four ICD-10 acknowledgement testing weeks is complete, and while CMS has announced that, overall, it was happy with the results, other issues have come to light.

Lingering Issues

CMS Provider Billing Group Director, Diane Kovach is quoted as saying that “the testing went really well” according to ICD10Monitor, but the testing week highlighted two issues:

  • Provider ability to submit claims with ICD-10 codes to CMS
  • CMS’ ability to accept those codes

While that may sound sarcastic, the claims at this stage in the testing process (the first was held in March) were not intended to be fully adjudicated. “These claims are not fully adjudicated in this testing,” Kovach said. “It’s really just what we like to call ‘getting the claim in the door.’”

A Drop In Participation

CMS saw a small drop in participation in this round of testing, but believes that this is due to the recent ICD-10 delay (which of course killed some of the sense of urgency), and the agency publicly highlighting its ability test providers at any time — a move Kovach believes has left many providers ignoring the designated testing weeks, and putting off their own testing initiatives.

Results

Official results were scheduled to be released the middle of this month, and preliminary results are pending, but the agency is reporting that about 7,800 ICD-10 claims were submitted, with about 73 percent “getting in the door.”

That’s a drop from the March testing week, with institutional claims having better rates than non-institutional, or supplier claims. Kovach believes this is for three reasons:

  • an invalid ICD-10 code being submitted
  • providers using future dates to submit claims
  • national provider identifier (NPI) issues

“We know last time that providers did do negative testing, where they purposely submitted an ICD-9 code, for instance, just to make sure that it was actually rejected,” Kovach explained. They will be working with providers to resolve these, and any other issues before CMS’s full-on testing week, Jan 26-30, 2015.

“Test claims submitted during that week will go through full adjudication, all the way to remittance advice. Results of that testing will be made available around the end of February.”