Claims acceptance rate rises in latest ICD-10 end-to-end test

With less than four months to go before the transition to ICD-10 coding, the Centers for Medicare & Medicaid Services (CMS) is continuing to make sure the system is ready.

Its latest round of end-to-end testing showed the percentage of failed claims narrowing, most of which it said were caused by technical problems not connected to the new ICD-10 codes.

Between April 27 and May 1, around 875 physicians, other health care providers, and billing companies volunteered to send test claims. Unlike ICD-10 acknowledgement testing, which simply determines if the tester’s claim is accepted or rejected, the end-to-end tests process the claims through all Medicare system edits and provide an Electronic Remittance Advice.

CMS said it accepted 88 percent of the 23,138 test claims submitted, which was an increase from the 81 percent accepted during the end-to-end test conducted earlier this year. It said 2 percent of the claims failed for using an invalid ICD-10 diagnosis or procedure code and less than 1 percent failed for using an ICD-9 code.

Other claims were denied for technical problems, such as using an incorrect National Provider Identifier (NPI), Health Insurance Claim Number, Submitted ID, or HCPCS code, using a date of service outside the valid range for testing, or using an invalid place of service.

CMS said it identified a coding issue involving inpatient hospital claims, which it will fix, and test filers will be allowed to resubmit those claims. An issue with home health claims identified in the January test has been fixed, CMS said.

The final end-to-end testing will be conducted July 20-24.

Posted on Jun 04, 2015 by David Twiddy