CMS Report Card on ICD10 End-to-End Testing

Medicare held a conference call yesterday (2/26/15) regarding the status of testing between Medicare provider systems, clearinghouses, and the CMS adjudication systems that will be used for processing claims with ICD10 codes in October.

Medicare has been ready for ICD10 for several years. Each quarter, they have updated their systems to prepare for the transition. Early this year, they ran their first live test that involved the processing of test claims submitted by volunteers through the entire adjudication process, including providing remittances.


This is referred to by CMS as “end-to-end” testing. This process allows the providers to test their processes including coding with ICD10, the validity of their claim files, and the payments and adjustments returned for the services. It also allows CMS to fine tune their systems to make sure they are ready in October.

There were 661 participating submitters that represented about 1400 NPIs. The tests were performed from 1/26 – 2/3. 14,929 claims were processed and about 81% were accepted. 6% had errors related to ICD9 or ICD10 codes, 13% had other errors not related to ICD10. Of these claims, 56% were professional, 38% institutional and the others suppliers, like DME. Continue reading

HIPAA Transaction Adoption Rates

CAQH (Council for Affordable Quality Healthcare) conducts an annual study of the adoption rates for commonly used HIPAA transactions in the healthcare industry.  A copy of this study can be obtained through this link:

This data is for the 2013 calendar year.  Based on the comments provided in the report, it is apparent that they feel that there has been significant progress in the implementation of these transactions.  As a vendor that provides systems that use them in revenue cycle management, the growth seems painfully slow. Continue reading

CMS Contractor End-to-End testing and MEDTranDirect

As we approach the deadline for implementation of ICD10, opportunities present themselves to examine our preparedness as software vendors and providers for the processing of claims containing these new codes. CMS has been ready to implement ICD10 in their claims adjudication systems since 2011. Since then, as the deadline was extended, they have made changes to their systems quarterly to fine tune them prior to October.

CMS has implemented a testing strategy beginning late last year that allows any provider to submit test claim files with ICD10 codes and review the 999 and 277CA response files returned. If you submit your claims directly to Medicare, CMS encourages you to participate in these tests. If you submit your Medicare claims through a clearinghouse, they will need to conduct these tests instead of you.

The details of CMS ICD10 testing policies are provided in this MLN Matters announcement.


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Moving from ICD9 to ICD10 – Dealing with the Transition and Learning from the Past

As the healthcare industry prepares for the October transition from ICD9 to ICD10, many organizations are dealing with the obvious issues.  Computer systems are being upgraded to handle the new codes, health plans are developing new business rules for reimbursement, coders and physicians are being retrained.  These are all necessary steps in the adoption of these codes, but some of the most difficult issues will not be in dealing with the new codes, but transitioning to them as these systems are implemented.

One of the strategies in dealing with these types of transitions is to look toward similar situations in the past.  How did this impact you last time?  What issues came up that you did not anticipate?  These transitions are never smooth, but they have to be dealt with.  Experience is the best teacher.

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