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.

The only error discovered on the CMS system was in handling home health claims where the span of services covered a date range including the 10/1/15 deadline. These claims correctly included ICD10 codes, but were returned to the submitter. This issue will be corrected before the next end-to-end testing session in April. The volunteers for this testing session have already been selected and they are preparing for these tests.

The final round of “end-to-end” test are scheduled for the end of July. Applications to volunteer will be available on each MAC web site beginning 3/13 for this session. Earlier participants in testing are grandfathered in for future testing sessions so MEDTranDirect will be documenting both the April and July tests and providing results to any interested party through this blog. For the next round of testing, we hope to provide claim by claim comparisons of reimbursement for services submitted on both ICD9 (through the original claim and EOB) and through ICD10, through the test claim and test electronic remittance, converted to EOBs.

This should provide insight into the process for providers that may not be selected for these tests. Here is a slide show used by CMS during the call. It contains some useful information regarding the tests, results and pending testing.

By Kalon Mitchell – President, MEDTranDirect