The first round of ICD-10 end-to-end testing yielded positive results for the CMS' claims-handling but a mixed picture for how providers and others are doing in properly submitting claims.
Providers and others have their work cut out for them to be ready for the Oct. 1 implementation of the new diagnostic and procedural coding system, experts warned.
The testing, conducted between Jan. 26 and Feb. 3, “demonstrated that CMS systems are ready to accept ICD-10 claims,” the CMS said in a statement (PDF) announcing the results.
Fewer than 10 claims out of nearly 15,000 received from 661 participating providers, suppliers and clearinghouses were rejected because of errors in how CMS systems handled claim dates. No claims were rejected by the CMS “due to front-end CMS systems issues,” according to the agency.
The testing produced an acceptance rate of 81%, better than the 76% rate posted late last year in an earlier round of less-stringent testing.
The bad news is that 19% of claims—more than 2,700—were rejected, almost all due to errors by claims submitters. The rejections were caused by including invalid codes for ICD-9, ICD-10 and “non-ICD-10-related errors,” according to the CMS. Those errors included submitting incorrect national provider identifiers, insurance claim numbers, submitter IDs and other miscues.
If that same failure rate, for whatever reason, occurs on Oct. 1, when the nation is to shift from ICD-9 diagnostic and procedural code system in current use to the more complex ICD-10 family of codes, the results would be “catastrophic,” said Robert Tennant, senior policy adviser for the Medical Group Management Association.
Participants in this first round of end-to-end testing, of which 56% were medical professionals, “are on the leading edge” of technology adoption and preparedness, Tennant points out. “And if they're experiencing issues, when they flip the switch, that 19% (failure) rate would increase.”
Stanley Nachimson, principal of Nachimson Advisors, a health IT consultant and ICD-10 expert, was heartened by the CMS's approach to its own errors.
“It emphasized the need for testing,” Nachimson said. “It's good that it's discovered and can get fixed by Oct. 1.”
Still, he said, “It looks like submitters have a lot of work to do.” Providers should get some testing in “so they don't run into these errors when they move to production on Oct. 1,” he said.
Follow Joseph Conn on Twitter: @MHJConn
