CMS Announces More Successful ICD-10 Testing, Names Ombudsman

The Centers for Medicare & Medicaid Services (CMS) has announced another successful round of week-long ICD-10 end-to-end testing.

Medicare fee-for-service (FFS) healthcare providers, clearinghouses, and billing agencies participated in a third successful ICD-10 end-to-end testing week with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor from July 20 through 24, 2015, the agency said. CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim, and submitter types.

Approximately 1,200 submitters were selected to participate, including 493 returning testers from the January and April testing weeks. Approximately 1,400 National Provider Identifiers (NPIs) were registered to test, of which 174, or 12 percent, were repeat NPIs from previous testing weeks. This indicates that many clearinghouses that participated in previous weeks chose different providers for July.

This round of testing resulted in an 87 percent acceptance rate. 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. The deadline for ICD-10 implementation is Oct. 1, 2015.

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. 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,” CMS said.

CMS revealed that about 1.8 percent of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code, while 2.6 percent of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code.

Additionally, CMS has announced the hiring of an ICD-10 ombudsman to oversee the new medical coding system, beginning on Oct. 1. The ombudsman, William Rogers, M.D., is currently an emergency room physician and director of CMS’ Physicians Regulatory Issues Team.