CMS’ Second End-to-End Testing Week a Success

CMS’ Second End-to-End Testing Week a Success

The Centers for Medicare & Medicaid Services (CMS) held its second end-to-end testing week April 27 through May 1, with participation by all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. Participants included fee-for-service healthcare providers, clearinghouses, and billing agencies. CMS said the second round of testing has demonstrated that their systems are ready to accept ICD-10 claims.

There were approximately 875 participants with nearly 1,600 National Provider Identifiers (NPIs), including some that had participated in the first end-to-end testing in January of this year. Most were able to successfully submit ICD-10 test claims. The acceptance rate was higher than the January end-to-end testing, with an increase in the number of test claims submitted and a decrease in the error rate percentage related to both ICD-9-CM and ICD-10-CM codes.

Twenty thousand, three-hundred-six test claims of the 23,138 test claims submitted were accepted, a rate of 88 percent. The first end-to-end testing week had an 81 percent acceptance rate. Only 2 percent of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure codes, and fewer than 1 percent of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure codes. In the first end-to-end testing, ICD-9 and ICD-10 errors were 3 percent, each.

Other rejections for errors not related to ICD-10 included incorrect NPI numbers, Health Insurance Claim Numbers, and Submitter IDs; invalid HCPCS codes; dates of service outside the date range valid for testing; and invalid places of service. These constituted 9 percent in the second testing week. These are the same types of errors that were found in the January end-to-end testing with 13 percent.

Fifty percent of the claims submitted were professional in nature, 43 percent were institutional, and 7 percent were suppliers. No issues were identified and no rejections were due to front-end CMS systems issues.

One issue related to system edits on the inpatient claims was identified, in which some claims were inappropriately processed due to a systems issue with codes exempt from Present on Admission reporting. CMS said this issue will be resolved prior to the final end-to-end testing offering in July of this year. At that point, testers may resubmit the test claims.

The home health testing issue found in the first end-to-end testing week was resolved by CMS prior to this testing week. The January testers that had submitted these claims resubmitted them during this testing week and the claims were processed correctly.

CMS said this testing demonstrates they are ready to accept ICD-10 claims. This good information should bring comfort to those preparing for the transition. Keep moving forward with your implementation efforts and be ready to go October 1, 2015.

2017-code-book-bundles-728x90-01

Rhonda Buckholtz

Rhonda Buckholtz

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC,has more than 20 years of experience in healthcare, working in the reimbursement, billing, and coding sectors, in addition to being an instructor. She is responsible for all ICD-10 training and curriculum at AAPC. She has authored many articles for health care publications and has spoken at conferences across the country. She is co-chair for the WEDI ICD-10 Implementation Workgroup and has provided testimony ongoing for ICD-10 and standardization of data for NCVHS. She also sits on the Provider Outreach and Education committee for Novitas Solutions (formerly Highmark Medicare Services).
Rhonda Buckholtz

Latest posts by Rhonda Buckholtz (see all)

About Has 33 Posts

Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, has more than 20 years of experience in healthcare, working in the reimbursement, billing, and coding sectors, in addition to being an instructor. She is responsible for all ICD-10 training and curriculum at AAPC. She has authored many articles for health care publications and has spoken at conferences across the country. She is co-chair for the WEDI ICD-10 Implementation Workgroup and has provided testimony ongoing for ICD-10 and standardization of data for NCVHS. She also sits on the Provider Outreach and Education committee for Novitas Solutions (formerly Highmark Medicare Services).

Leave a Reply

Your email address will not be published. Required fields are marked *