Anesthesia Coding Alert

CMS says test claim submissions are going well.

It appears that ICD-10 really will be implemented this year, with a recent Congressional hearing confirming that the government doesn’t plan to push back the new diagnosis coding system any further than it already has been—and with those plans full steam ahead, CMS revealed that its recent end-to-end testing period returned positive results. 

The agency processed 14,929 test claims during the Jan. 26 to Feb. 3 testing period, from 661 participating providers. An overwhelming majority of claims—81 percent—were accepted through the system, and the remaining claims were rejected for three main reasons, as follows, according to the most recent statistics released by CMS:

• Invalid submission of ICD-9 codes (seen in three percent of rejected claims)
• Invalid submission of ICD-10 codes (as demonstrated by another three percent of claims that didn’t pass through the system)
• Errors unrelated to ICD-10, such as using an incorrect NPI, an invalid date, the wrong place of service or an incorrect HCPCS code (seen in 13 percent of rejected claims).

Don’t Begin Using ICD-10 Too Soon

The date of service errors led CMS to discover that some providers are confused about when they can submit claims with ICD-10 codes in both the testing arena and the real, “non-testing” world, said CMS Administrator Marilyn Tavenner in a Feb. 25 blog post on the topic.

“ICD-10 can be used only for test purposes before October 1,” said Tavenner, who will be leaving her CMS post at the end of this month. “Only ICD-10 can be used for doctor’s visits and other services that happen on or after October 1. ICD-9 cannot be used to bill for services provided on or after October 1. This rule applies no matter when the claim is submitted, so claims submitted after October 1, 2015, for services provided before that date must use ICD-9 codes.”

Overall, the testing results indicate that the majority of health care providers are poised to succeed under the ICD-10 system—and those who aren’t should step up their training to be ready in time for the Oct. 1 deadline.

To read Tavenner’s statistics on the end-to-end testing, visit http://blog.cms.gov/2015/02/25/successful-icd-10-testing-shows-industry-ready-to-take-next-step-to-modernize-health-care.

Some Specialty Associations Still Voice Concerns

You may be furiously prepping for the ICD-10 conversion, but many specialty societies are still looking for answers to their burning questions.

The American Medical Association was among 100 medical groups that wrote to CMS on March 4 seeking answers about ICD-10 that they believe have not been appropriately addressed.

Although the groups didn’t go so far as to request a delay to the Oct. 1 implementation date, they did express strong concerns about the transition in the seven-page letter to Acting CMS Administrator Andrew Slavitt.

Chief among the issues were the results of CMS’s end-to-end testing periods, which revealed claim acceptance rates in the 76 to 89 percent range. This range clashes significantly with the current standard Medicare acceptance rate of 95 to 98 percent, the letter stated. Because only a small number of practices participated in the testing, the groups worry that when all Medicare practices start submitting claims, that percentage rate will extrapolate out to the community at large, triggering massive denials.

“The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex health care system each day represents an intolerable and unnecessary disruption to physician practices,” said AMA President Robert M. Wah, MD, in a March 4 statement. “Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious health care dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care.”