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

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  • June 10, 2015
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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.

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Rhonda Buckholtz

About Has 38 Posts

Rhonda Buckholtz, CPC, CPMA, CRC, CDEO, CMPE, CHC, COPC, AAPC Approved Instructor, is owner of Coding and Reimbursement Experts. She spends her time helping physician practices achieve operational excellence, compliance, education, and Lean Six Sigma through her consulting. Buckholtz has more than 30 years of experience in healthcare management, compliance, and reimbursement/coding sectors. She was responsible for all ICD-10 training and curriculum at AAPC during the transition from ICD-9. Buckholtz has authored numerous articles for healthcare publications and she has spoken at numerous national conferences for AAPC and others. She is past co-chair for the WEDI ICD-10 Implementation Workgroup, Advanced Payment Models Workgroup, and she provided testimony for ICD-10 and standardization of data for National Committee on Vital and Health Statistics. Buckholtz is on AAPC’s National Advisory Board.

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