CMS Reverses Policy on End-to-End Testing; Associations Partially Approve

Feb. 20, 2014
The Centers for Medicare & Medicaid Services (CMS) announced this week that is reversing course and will conduct end-to-end testing for a small sample group of providers. The news won partial approval of CMS from the American Medical Association (AMA) and the Medical Group Management Association (MGMA).

The Centers for Medicare & Medicaid Services (CMS) announced this week that is reversing course and will conduct end-to-end testing for a small sample group of providers.

CMS announced the news in a MLN Matters news report late Wednesday. The brief informs providers about the latest changes to its programs. At the bottom of the report, CMS says in the summer of 2014, it will offer end-to-end testing for a small sample group of providers. Details about the end-to-end testing process will be released at a later date, CMS says.

End-to-end testing is when the submission of test claims to CMS with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims. Ultimately, it proves that a provider or submitter can submit claims containing ICD-10 codes to Medicare, CMS software changes support ICD-10 result in the proper claim, and accurate RAs are produced.

Many organizations, such as the American Medical Association (AMA) and the Medical Group Management Association (MGMA), pleaded with CMS to initiate end-to-end testing. The main reason was to ensure that vendors’ software would be ready for the Oct. 1 compliance date. However, CMS initially didn’t comply, and only offered a more limited round of external testing with providers in March.

With this latest news, CMS has won the partial approval of MGMA.  Susan Turney, M.D., president and CEO of MGMA, in a statement said that MGMA is pleased CMS has heeded its recommendation and reversed its policy on end-to-end testing. However, she says CMS has to go the extra mile.

“MGMA urges CMS, however, to expand the scope of this testing approach to include any provider who wishes to test with them, as well as quickly disseminating results from all Medicare and Medicaid testing efforts. This more robust testing is imperative to identify potential operational problems similar to what was experienced with the rollout of healthcare.gov. At the same time, it will help to decrease the potential of catastrophic cash flow disruption that could impact the ability of practices to treat patients. MGMA recommends physician practices continue to prepare for the transition to ICD-10 and provides tools and resources to assist members meet this complex challenge,” Dr. Turney said in a statement.

Similar to MGMA, AMA is partially happy about the end-to-end testing news.  Ardis Dee Hoven, M.D., the president of AMA, said in a statement the group applauds CMS’ decision and believes it will ensure that the industry does not suffer massive disruptions in claims and payment processing. However, AMA is still not on board with ICD-10 in its entirety.

“While the AMA is pleased by the federal government's decision today to conduct end-to-end ICD-10 testing, the AMA continues to urge CMS to reconsider the ICD-10 mandate during a time when physicians are struggling to keep up with many other costly, federal mandates,” Dr. Hoven said in a statement.  

Hoven also asked CMS to conduct the testing as soon as possible and to ensure that there is an adequate sample which includes a variety of different sized medical practices and specialties.

Sponsored Recommendations

Going Beyond the Smart Room: Empowering Nursing & Clinical Staff with Ambient Technology, Observation, and Documentation

Discover how ambient AI technology is revolutionizing nursing workflows and empowering clinical staff at scale. Learn about how Orlando Health implemented innovative strategies...

Enabling efficiencies in patient care and healthcare operations

Labor shortages. Burnout. Gaps in access to care. The healthcare industry has rising patient, caregiver and stakeholder expectations around customer experiences, increasing the...

Findings on the Healthcare Industry’s Lag to Adopt Technologies to Improve Data Management and Patient Care

Join us for this April 30th webinar to learn about 2024's State of the Market Report: New Challenges in Health Data Management.

Findings on the Healthcare Industry’s Lag to Adopt Technologies to Improve Data Management and Patient Care

2024's State of the Market Report: New Challenges in Health Data Management