Claims acceptance rate dips slightly in final ICD-10 test

The Centers for Medicare & Medicaid Services (CMS) finished its series of end-to-end testing ahead of the Oct. 1 transition to ICD-10 coding with an acceptance rate nearing 90 percent.

During July 20-24, around 1,200 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, end-to-end testing processes the claims through all Medicare system edits and provides an Electronic Remittance Advice.

CMS called the test “successful” and said it accepted 87 percent of the 29,286 test claims submitted. That is down slightly from the 88 percent accepted in April but above the 81 percent accepted in January.

The agency noted that some of the rejected claims were submitted incorrectly on purpose to make sure the Medicare system caught the errors, although it didn’t indicate how many. In any event, the percent of test claims rejected in the July period for having an invalid ICD-10 diagnosis or procedure code remained steady compared with the April results at around 2 percent, while the percentage of invalid ICD-9 diagnosis or procedure codes jumped from less than 1 percent in April to almost 3 percent in July.

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 that most of these rejected claims represented provider submission errors in the testing environment that wouldn’t be duplicated with actual claims.

While this was the final end-to-end test, CMS encouraged physicians to continue acknowledgement testing by themselves ahead of the Oct. 1 deadline.