Thursday, June 5, 2014

ICD-10 Medical Code Tests Yield Successful Results for CMS

The Centers for Medicare and Medicaid Services’ claims acceptance rates approached the average for normal claims, and participants were able to test the impact of errors in claim reports during the process.

The Centers for Medicare and Medicaid Services’ initial testing of updated medical diagnosis codes that will be required at health care payers and providers next year proved to be successful, according to Niall Brennan, the acting director of CMS Offices of Enterprise Management.
The updated codes, ICD-10, replace ICD-9 to bring the U.S. up to speed with other industrialized countries and allow for more specific patient diagnoses.
After several delays, the implementation of ICD-10 will be required by Oct. 1, 2015.
All entities covered by the Health Insurance Portability and Accountability Act must implement the new codes to create consistency between the health care system in the United States and other industrialized countries.
Brennan, in a CMS blog post, said testers submitted more than 127,000 claims with ICD-10 codes to the Medicare Fee-for-service (FFS) claims systems and received electronic acknowledgments confirming their claims were accepted.
There were approximately 2,600 participating providers, suppliers, billing companies and clearinghouses during the week of testing, according to Brennan.
The largest testing group was from clearinghouses, which submit claims on behalf of health care providers, Brennan said. They submitted 50 percent of all the test claims.
In the U.S., CMS accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent, according to Brennan. Medicare FFS claims system did not present any issues during the testing process. Normal claims acceptance rates average between 95 and 98 percent.
“This testing week allowed an opportunity for testers and CMS alike to learn valuable lessons about ICD-10 claims processing,” Brennan said. “In many cases, testers intentionally included such errors in their claims to make sure that the claim would be rejected, a process often referred to as negative testing.”
In the near future, the Department of Health and Human Services expects to release an interim final rule that will include a new compliance date requiring the use of ICD-10 beginning Oct. 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9- through Sept. 30, 2015.
CMS will be releasing details about plans to conduct end-to-end testing in 2015, according to Brennan.

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