While at a trade show in the late fall of 2014, I heard a rumor that the implementation of ICD-10 might yet be delayed again.  It turned out to be just a rumor. There are always hints around the internet that some congressperson may still try to sneak a postponement in on a new bill. 

With no way to know, responsible healthcare administrators should be continuing on the path to implementing ICD-10 diagnosis coding as scheduled on October 1, 2015.

CMS is forging ahead and has continued with its scheduled claims acknowledgement testing.

In March of 2014, CMS received over 127,000 claims for ICD-10 processing evaluation.  Clearinghouses were responsible for approximately 50% of the claims. The total amount of participants was almost 2,600 which consisted of providers, suppliers, billing companies and those clearinghouses.

 

 

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The national acceptance rate for the test claims was 89%.  This compares to regular claim acceptance rate of 95-98%.  As part of the testing protocol, errors were included on test claims.  That contributed to some of the 11% of rejected claims. 

Errors can be caused if the claims do not meet these minimum standards:

• diagnosis code that matches the date of service is checked for validity
• the national provider identifier must be valid
• accurate companion qualifier codes were required to distinguish ICD-10 charges from the ICD-9 charges

 

Repeat of the testing occurred in November 2014.  With a smaller sampling, there were a little over 500 participants and about 13,700 claims.  The acceptance rate of this batch of test claims was lower at 76%.  Again, some claims were deliberately sent with errors.  The largest amount of rejected professional claims based on invalid NPI.  Claims containing future dates of service were also rejected.

CMS has planned two more testing periods: March 2-6, 2015 and June 1-5, 2015.   All billing entities should take advantage of opportunities for testing prior to the implementation deadline of October 1, 2015.  Healthcare providers should inquire with their contracted clearinghouse or software vendor to ensure they are ready for this big change coming soon.

 

If you want more information on testing and ICD-10 implementation, contact your Medicare Administrative Contractor.