Inpatient Facility Coding & Compliance Alert

Win the battle by setting right the invalid NPI’s and ICD-10 qualifier codes.

If your facility participated in the CMS ICD-10 acknowledgement testing in November, here’s great news for you: CMS declared the results on Dec. 22, and the test was an overall success.

Specifics: In the November testing week, CMS gave the providers an opportunity to submit claims with ICD-10 codes to the Medicare Fee-For-service (FFS) claims systems and receive electronic acknowledgements confirming that their claims were accepted. CMS reported submission of almost 13,700 claims.

Participants: More than 500 testers took part, including small and large physician practices, small and large hospitals, labs, ambulatory surgical centers, dialysis facilities, home health providers, ambulance providers, and several other physician specialties.

CMS verified the test claims to include:

• A valid diagnosis code that matched the date of service,
• A National Provider Identifier (NPI) that was valid for the submitter ID used for testing
• An ICD-10 companion qualifier code to allow for processing of claims.

Results: Acceptance rates improved throughout the week, with Friday’s acceptance rate for test claims at 87 percent. Nationally, CMS accepted 76 percent of total test claims. Testing did not identify any issues with the Medicare FFS claims systems. Claims with the following scenarios were rejected:

• The majority of rejections on professional claims were common rejections related to an invalid NPI.
• Some claims were rejected because they were submitted with future dates. Acknowledgement testing cannot accept claims for future dates.
• Some claims did not have an ICD-10 companion qualifier code.
• In many cases, testers intentionally included errors in their claims, a process often referred to as “negative testing.”

Heads up: “The NPI correlation is definitely the biggest issue,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. This fundamental mistake may not even figure in your to-do list. Therefore, “All healthcare providers need to review their NPI information to make certain it is up-to-date and accurate,” he says.

Missed This Test? Catch the Next One

There is no better way to learn than to submit live claims with ICD-10 codes, and get feedback from the experts. So go ahead, internalize, implement and emulate these results and register for the upcoming acknowledgement testing weeks on March 2-6, 2015, and June 1-5, 2015. CMS encourages providers to submit acknowledgement test claims anytime up to the October 1, 2015.