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Wednesday May 13, 2015

Testing, testing – check your ICD-10 readiness

Physicians who still would like to participate in the final scheduled test of whether they are ready to use ICD-10 codes ahead of this fall’s deadline are getting another opportunity.

The Centers for Medicare & Medicaid Services (CMS) is accepting additional volunteers for the ICD-10 end-to-end testing scheduled for the week of July 20-24. Volunteers will be able to apply from May 11-22. This appears to be the last chance to test coding systems with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) prior to the Oct. 1 implementation date.

CMS will select approximately 850 volunteer submitters to participate in the July end-to-end testing. The selected volunteers will represent a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Testers who participated in the January and April end-to-end testing weeks are able to test again in July without re-applying.

Volunteer forms are available on your MAC website(www.cms.gov), and you will need to complete your form by May 22 to volunteer as a testing submitter. CMS will review applications and select additional July testers, after which the MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing by June 12.

If you are selected, you must be able to submit future-dated claims. You must also be able to provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers that will be used for test claims. This information will be needed by your MAC for set-up purposes by the deadline on your acceptance notice. Testers will be dropped if information is not provided by the deadline.

For more information on end-to-end testing, look at these MLN Matters articles:
•    “ICD-10 Limited End-to-End Testing with Submitters for 2015”(www.cms.gov)
•    “FAQs – ICD-10 End-to-End Testing”(www.cms.gov)
•    “Medicare FFS ICD-10 Testing Approach”(www.cms.gov)

Whether or not you are selected for end-to-end testing, you can still participate in acknowledgement testing with the MACs and the Durable Medical Equipment (DME) MAC CEDI contractor anytime before Oct. 1. Additionally, CMS has scheduled a dedicated ICD-10 acknowledgement testing week June 1-5, during which submitters will have access to real-time help desk support. This is the final dedicated acknowledgement testing week.

MLN Matters Special Edition Article SE1501(www.cms.gov) explains the differences between acknowledgement and end-to-end testing with Medicare. For acknowledgement testing, all electronic submitters are encouraged to participate, even if you submit claims through a clearinghouse. You can also find more information in the MLN Matters article “ICD-10 Testing - Acknowledgement Testing with Providers.”(www.cms.gov)

Information on how to participate in acknowledgement testing is available on your MAC website(www.cms.gov) or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically can participate in acknowledgement testing.

Here’s what you can expect during acknowledgement testing:
•    Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system.
•    Test claims will be subject to all current front-end edits, including edits for valid NPIs, PTANs, and codes, including Healthcare Common Procedure Coding System and place of service codes.
•    Testing will not confirm claim payment or produce a Remittance Advice (RA).
•    MACs and CEDI will be staffed to handle increased call volume during this week.

When doing acknowledgement testing, make sure test files have the "T" in the ISA15 field to indicate the file is a test file, and send ICD-10 coded test claims that closely resemble the claims that you currently submit. Also, use valid submitter identification, NPI, and PTAN combinations plus current dates of service on test claims. Do not use future dates of service, or your claim will be rejected.

For more information about ICD-10, please visit the ICD-10(www.cms.gov) and Medicare fee-for-service provider resources(www.cms.gov) web pages on the CMS web site, and for help preparing for ICD-10 implementation, please visit the coding web page on the AAFP web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted at 12:17PM May 13, 2015 by David Twiddy

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

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