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Experience. Integrity. Advocacy.

CMS ICD-10 End-to-End Testing a Success; Some Still Holding Out for Another ICD-10 Delay

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The successful results of a second ICD-10 end-to-end testing week support the Centers for Medicare and Medicaid Services’ (CMS) claim that they are ready for ICD-10.

From April 27 through May 1, 2015, Medicare health care providers, clearinghouses, and billing agencies participated in the second testing week with all Medicare Administrative Contractors (MAC) and the Durable Medical Equipment MAC Common Electronic Data Interchange contractor. Volunteer participants represented a broad cross-section of provider, claim, and submitter types.

Approximately 875 providers and billing companies participated, and testers submitted over 23,000 test claims in the April end-to-end testing week. Overall, most were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems.

  • The acceptance rate for April’s testing week was 88 percent, an increase from January’s 81 percent.
  • The number of test claims submitted in April also increased from January by 55 percent.
  • Only 2 percent of errors in April’s test were related to invalid submissions of ICD-10 codes; that rate was 3 percent in January.
  • The majority of claim rejections for both testing weeks were due to errors unrelated to ICD-10.

The final end-to-end testing week will be conducted July 20-24, 2015. The opportunity to volunteer for this testing week has closed; however, testers who participated in the January and April end-to-end testing weeks are automatically eligible to test again in July. Also, providers can participate in acknowledgement testing at any time.

Meanwhile, members of Congress continue to bat around ideas and propose legislation to further delay the ICD-10 implementation date or mitigate its effects on provider revenue and cashflow. With Rep. Diane Black’s (Tennessee) H.R. 2247, “Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act)” and Rep. Ted Poe’s (Texas) H.R. 2126, “Cutting Costly Codes Act” still pending in the House of Representatives, last week Rep. Gary Palmer (Alabama), along with thirty-five co-sponsors, introduced H.R. 2652, “Protecting Patients and Physicians Against Coding Act of 2015.” This latest proposed legislation would give healthcare providers a little more leeway when submitting claims using the new ICD-10 classification. As such, providers would not be “penalized for errors, mistakes and malfunctions relating to the transition to such a code set.”

Other voices of dissent also are calling CMS to do something to help physicians during the ICD-10 transition. At their annual meeting in Chicago last week, the American Medical Association called for a similar two-year transition period for ICD-10, proposing to “aggressively promote this new implementation compromise to Congress and CMS since it will allow implementation of ICD-10 as planned, and at the same time protect patients’ access to care and physicians’ practices.” And the Alabama State Senate passed a Joint Resolutionlast week urging Congress “to delay the mandated implementation of ICD-10 on Oct. 1 and lessen the burden on Alabama’s medical practices.”

Though not introduced as legislation, a letter to acting CMS Administrator Andy Slavitt written by Rep. Kevin Brady (Texas), chair of the Ways and Means Subcommittee on Health, and signed by twelve other lawmakers, asks CMS to “take steps to instill confidence … that the October 1, 2015 diagnosis code implementation will not cause widespread disruption.” The letter goes on to provide several suggestions for avoiding a “debacle,” including making contingency plans public, offering a period when less granular ICD-10 codes will be accepted, and expanding the end-to-end testing.

Meanwhile, other industry experts are urging the healthcare community not to get side-tracked with each new headline about an ICD-10 delay. In her ICD-10 Monitor article, “Headlines Generate False Hope,” Holly Louie, president-elect of the Healthcare Billing and Management Association and chair of their ICD-10 committee, said, “For those physicians, practices, and entities that aren’t ready, the continuing barrage of questions regarding whether there may be another delay is counterproductive.”

Instead of worrying about another delay, Louie exhorts providers to move ahead in their preparation. “Without a last-minute surprise, ICD-10 will happen on Oct. 1, 2015,” Louie wrote. “This industry needs to focus on the facts and the whole story. Talk of these phantom additional delays gives false hope, which will cause far more problems for our providers.”

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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