CMS Announces a Third Round of Successful ICD-10 Testing, Says They Won't Deny Claims for One Year

July 7, 2015
Nationally, the Centers for Medicare & Medicaid Services (CMS) accepted 90 percent of claims from the more than 1,200 submitters who participated during CMS’ third round of ICD-10 end-to-end testing.

Nationally, the Centers for Medicare & Medicaid Services (CMS) accepted 90 percent of claims from the more than 1,200 submitters who participated during CMS’ third round of ICD-10 end-to-end testing.

This round of testing took place between June 1-5. During the first ICD-10 end-to-end testing week, which took place from January 26 until February 3, 81 percent of claims were accepted; on June 2, the agency announced that 88 percent of submitted claims were accepted in t he second round of testing,  which took place from April 27-May 1.

No Medicare fee-for-service claims systems issues were identified during this testing week or the previous acknowledgement testing weeks, CMS said. In the June test, as in previous acknowledgement testing weeks, CMS found that most rejects resulted from improperly developed test claims unrelated to ICD-10. The agency said, “Most rejects were the result of provider submission errors in the testing environment that would not occur when actual claims are submitted for processing. CMS will continue to conduct extensive outreach to testers on setup of test claims to avoid these issues for providers who plan to acknowledgement test.”

After CMS announced the first round of testing results, nearly 100 physician groups representing state and specialty medical societies wrote a letter to the agency expressing their remaining ICD-10 concerns as well as voicing displeasure with the first round of results, despite CMS’ praise.

Additionally, CMS has announced a joint effort with the American Medical Association (AMA) to help physicians get ready ahead of the Oct. 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will aim to allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.

In that guidance includes:

  • While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015. It is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons. 
  • CMS will have an ICD-10 Ombudsman to help receive and triage physician and provider issues. The Ombudsman will work closely with representatives in CMS’s regional offices to address physicians’ concerns.

Sponsored Recommendations

Ask the Expert: Is Your Patients' Understanding Putting You at Risk?

Effective health literacy in healthcare is essential for ensuring informed consent, reducing medical malpractice risks, and enhancing patient-provider communication. Unfortunately...

Beyond the Silos: Transforming Coordinated Care Across Healthcare Systems

Coordinated healthcare is vital to delivering a high-quality patient experience, yet it has been difficult to systematize across all healthcare settings. Although it has largely...

The Healthcare Provider's Guide to Accelerating Clinician Onboarding

Improve clinician satisfaction and productivity to enhance patient care

ASK THE EXPERT: ServiceNow’s Erin Smithouser on what C-suite healthcare executives need to know about artificial intelligence

Generative artificial intelligence, also known as GenAI, learns from vast amounts of existing data and large language models to help healthcare organizations improve hospital ...

According to an Oct. 10 press release, a report by the World Health Organization (WHO) finds that vaccines against 24 pathogens could reduce the number of antibiotics needed by 22% or 2.5 billion defined daily doses globally every year, supporting worldwide efforts to address antimicrobial resistance (AMR). While some of these vaccines are already available but underused, others would need to be developed and brought to the market as soon as possible. AMR occurs when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medicines, making people sicker and increasing the risk of illness, death and the spread of infections that are difficult to treat. AMR is driven largely by the misuse and overuse of antimicrobials, yet, at the same time, many people around the world do not have access to essential antimicrobials. Each year, nearly 5 million deaths are associated with AMR globally. Vaccines are an essential part of the response to reduce AMR as they prevent infections, reduce the use and overuse of antimicrobials, and slow the emergence and spread of drug-resistant pathogens. The new report expands on a WHO study published in BMJ Global Health last year. It estimates that vaccines already in use against pneumococcus pneumonia, Haemophilus influenzae type B (Hib, a bacteria causing pneumonia and meningitis) and typhoid could avert up to 106 000 of the deaths associated with AMR each year. An additional 543 000 deaths associated with AMR could be averted annually when new vaccines for tuberculosis (TB) and Klebsiella pneumoniae, are developed and rolled out globally. While new TB vaccines are in clinical trials, one against Klebsiella pneumoniae is in early stage of development.
dreamstime_xxl_210174616_1