Third ICD-10 test shows 87-percent success rate

CMS’ third ICD-10 testing shows 87 percent success rate

Health professionals across the industry have been training for the transition from the ICD-9 to the ICD-10 codes for the past several months. With the implementation date on Oct. 1, physicians have participated in end-to-end testing offered by the Centers for Medicare and Medicaid Services. The agency recently finished its third and final testing period during the week of July 20-24 in preparation for the upcoming deadline. The CMS released a report highlighting the successful results

Providers partake in third end-to-end testing
A number of health professionals across the industry participated in the testing, from billing agencies to doctors and clearinghouses, all of which sought assistance from Medicare Administrative Contractors and the Durable Medical Equipment MAC Common Electronic Data Interchange when filing their claims. Many of the participants were health providers and professionals who partook in previous testings, some of which saw improvements in the rates in which their claims were accepted. 

The report released by the CMS showed that the July test was a success. Of the 29,286 claims submitted, there was an 87 percent acceptance rate and a 1.8 percent rejection rate due to the same small errors that occurred in previous test periods. However, the CMS noted that most of the rejected claims were not denied because of ICD-10-related mistakes. Instead, the errors included claims that were outside of the covered date range, invalid National Provider Identifiers and invalid place of service. 

However, some of the rejected claims were submitted with errors made on purpose. This helps the CMS ensure that its rejection process is accurate and functioning properly so that when the agency receives a provider's invalid claim, it successfully rejects it. The CMS also explained in its report that the cross-section of volunteers was larger for the July test period than it was in previous tests. Around 1,200 organizations were chosen to participate in the test, 493 of which had taken part in previous tests. Approximately 12 percent of the 1,400 NPIs  that participated in the test were repeats as well. 

"Overall, participants in the July end-to-end testing week were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems," CMS officials stated in the report. "In some cases, testers may have intentionally included errors in their claims to make sure that the claim would be rejected, a process often referred to as negative testing. The acceptance rate for July was similar to the rates in January and April, but with an increase in the number of testers and test claims submitted."

CMS testings show consistent success rates
When compared to the testing session that took place between Jan. 26 and Feb. 3, the CMS noted that there was a 6 percent increase in acceptance rates in July. The number of volunteers for this testing was also much larger compared to the 661 volunteers who chose to participate in the previous test. The test conducted in April was also successful, with a slight increase in volunteers – 875 participants – compared to the January testing. A large majority of the rejections were due to nonprovider-related issues, just like the January and July results. 

These promising results are important for the health care industry to take note of, as the ICD-10 deadline is a daunting event for most providers and these numbers may allow for some much-needed relief. If health professionals are aware of these success rates, it may put some of their worries at ease. The CMS' approval systems have shown consistent accuracy for each of the past three testings. Now, providers just have to make sure that they have properly trained their staffs and updated their electronic health records to prepare for the new set of codes.