81 percent of claims accepted as CMS completes "successful" week of ICD-10 testing

The Centers for Medicare & Medicaid Services (CMS) has completed what Administrator Marilyn Tavenner called a “successful” first week of end-to-end ICD claims testing.

According to CMS, of the 14,929 test claims (from 661 providers) received during the week ending Feb. 3, 12,149 (81 percent) were accepted. “This successful week of testing continues to put us on course for successful implementation of this important initiative that better reflects modern practice of medicine by Oct. 1, 2015,” Tavenner said in blog post discussing the testing results.

Some of the reasons why claims were rejected included:

• Invalid submission of ICD-9 diagnosis or procedure code (3 percent)
• Invalid submission of ICD-10 diagnosis or procedure code (3 percent)
• Non-ICD-10 related errors, including issues setting up the test claims (e.g., incorrect NPI, Health Insurance Claim Number, Submitter ID, dates of service outside the range valid for testing, invalid HCPCS codes, invalid place of service). (13 percent)

More than half (56 percent) of the claims received were professional, while 38 percent were institutional and 6 percent were supplier claims.

In her blog post, Tavenner said that CMS will work with outside entities and stakeholders to address those “small” deficiencies identified during the testing. She added that CMS has also learned there is some confusion within the healthcare community about the timeline for the transition from ICD-9 to ICD-10.

ICD-9 must be used for services provided before the Oct. 1 deadline, she reiterated, while ICD-10 should be used for services provided on or after that date.

“That means ICD-10 can be used only for test purposes before October 1,” she wrote. “And, only ICD-10 can be used for doctor’s visits and other services that happen on or after October 1. ICD-9 cannot be used to bill for services provided on or after October 1. This rule applies no matter when the claim is submitted, so claims submitted after October 1, 2015, for services provided before that date must use ICD-9 codes.”

Two more end-to-end testing periods are scheduled in April and July.