Part B Insider (Multispecialty) Coding Alert

Published on Fri Feb 21, 2014 PDF

The agency intends to select participants by April.

You are already aware of the ICD-10 testing period that will launch in just a few weeks, but CMS has even more in-depth system up its sleeve that will ensure that claims will process appropriately once the new diagnosis coding system goes into effect.

The newly-announced “end-to-end testing” was just one of the many ICD-10 topics that CMS discussed during its Feb. 20 ICD-10 Readiness Webinar.

No Change in Date

First and foremost, CMS reps reiterated yet again that there won’t be a delay in the ICD-10 compliance date, which many callers to the forum questioned. “The ICD-10 date is firm,” said CMS’s Robert Tagalicod during the presentation.

“I am pleased to let you know that CMS has been working very closely with numerous stakeholders – medical societies, payers, vendors, and clearinghouses – to ensure a smooth transition to ICD-10,” Tagalicod said. “We recently launched the ICD-10 success initiative as part of a collaboration to share guidance and insights.”

And even though the testing periods for these claims haven’t started yet, CMS has performed its own tests to ensure that the software systems are ready to process ICD-10 claims. “To date, CMS has completed over 60,000 hours of analysis, programming, and testing related to ICD-10,” said CMS’s John Evangelist during the call.  In addition, independent contractors have begun to implement edits to ensure that the claims process correctly, he added.

Prep Now for Upcoming Testing

As most Part B practices are aware, CMS has committed to offering a week for the provider community to perform ICD-10 testing with the MACs, said CMS’s Stacey Shagena during the call. From March 3 through March 7, you’ll be able to submit your ICD-10 claims to your MAC so you can ensure that your claims are accepted. Over 2,500 submitters have already registered for this testing, Shagena added, but if you aren’t ready to test yet, the MACs will also announce additional testing weeks in the future. To register for the March testing, visit your MAC’s website.

In addition, many MACs have agreed to allow practices to perform private testing sessions outside of the formal ICD-10 testing weeks. This will be up to discretion of the MACs, but if you’d like to participate in a private testing period, contact your MAC directly, she said.

Keep in mind that you won’t have to wait until the testing week is over before you get an acceptance or rejection on your claim. “You would get a rejection in a similar timeframe that you’d get a rejection in a production environment,” Shagena said.

Keep in mind, however, that you will not be able to report both ICD-9 and ICD-10 codes on the same claim during the testing period, because these sample claims should look exactly like the actual ICD-10 claims you’ll be submitting as of Oct. 1.

The test claims won’t be subject to date of service edits, either. Although ICD-10 codes won’t be accepted until Oct. 1, you don’t need to put an Oct. 2 date on your test claims. Instead, you can submit your claims with current dates of service, Shagena added.

Look for New ‘End-to-End’ Testing

CMS also intends to launch an end-to-end ICD-10 testing period in July, which will differ from the March tests, said CMS’s Larry Young during the presentation. “This is testing where providers will submit ICD-10 code claims to their MACs and will receive a remittance advice and adjudication—we call it submit to remit,” he says. “With respect to the scope and the scale, we will have more detail about that, but we’ll have a statistically significant sample of providers including physicians, hospitals, clearing houses, billing agents, and they’ll be available to test at all 16 MACs across the country.”

Certain entities will be selected to participate in the end-to-end testing this April. “The testing will be using fiscal year 2014 pricing files, so there will be a full submit to remit, with an adjudication and remittance advice, but you wouldn’t be receiving the fiscal 2015 pricing amounts since they won’t be available,” Young added.

This testing will be more in-depth than the test claims processed during the March 3 testing week, because the end-to-end testing will allow practices to ensure not only that claims are accepted, but also that they are adjudicated properly.