CMS has finished the third and final round of end-to-end testing for claims containing ICD10 codes. The tests results included an 87% acceptance rate of the claims submitted. Only 1.8% of the claims were rejected because of the new codes, 2.6% were rejected because of invalid ICD9 codes. These rejection rates are about normal for the current production claims processing environment.
The minor problems discovered by CMS in their system after round two of tests in April appear to be corrected. On the surface it would appear that the industry, or at least CMS, is ready to process these claims, however, these statistics are deceiving.
First, the participants in these tests were all volunteers. Presumably, these are provider organizations who feel they were prepared for the transition and used this opportunity to confirm this. Only a few of the volunteers were selected by the Medicare Contractors (MACs), leaving many organizations who wished to participate, out of the loop. There were about 1200 total providers selected in each round of tests. Many of these were repeat testers who had tested in prior periods. In the final testing period, 500 of the 1200 participants had tested previously. In addition, some vendor systems, like our own, participated in testing with multiple MACs and multiple periods. My guess is the number of unique entities participating in these three testing periods is less than 2000.
What will be the impact to Medicare claims processing when all the systems that are not ready or not yet tested begin to participate? If you did not have the opportunity to participate in these tests because you were not selected or your vendor was not yet ready, there are still opportunities to test your ability to send valid transactions.
CMS is supporting testing of any batch of claims through the production system all the way up to the 10/1/15 deadline. This is done through a process called “acknowledgement testing” because you simply mark a batch as “Test” that includes the ICD10 codes. When it is processed, you get back the 999 acknowledgement file showing if the batch was accepted. The only difference in this process and the end-to-end tests is that you do not get back a remittance. Also, the acknowledgement testing claims cannot be submitted with future dates. However, the validity of the batches will be verified.
You can also test your ability to send valid transactions with many of the Medicaid agencies. Each Medicaid has their own method of testing and their own requirements. Most of them are simple and they just need you to change the status of a batch to test and include the new codes. To get more information, contact the EDI department for your Medicaid organization. Even if you have participated in Medicare testing, this is not a bad idea since your procedures may be altered for the processing of the ICD10 claims after the deadline.
Most major clearinghouses, such as Emdeon and Availity also provide testing opportunities. Make sure you test with them as well as his is an excellent “Plan B” option if direct transmission to any payer fails at the deadline due to payer issues. The clearinghouses can represent your interests with the payers and resolve these issues without your participation, assuming they are related to issues with the payer systems only.