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Mar 18, 2014

CMS Offers End-to-End Testing of ICD-10 Claims and Beta Software to Support Providers through the ICD-10 Implementation

Published

Mar 18, 2014

From July 21 to 25, CMS will conduct end-to-end testing on the International Classification of Disease, Tenth Revision (ICD-10) coding system.

Originally, CMS stated it would only conduct internal testing; however, due to healthcare.gov rollout criticisms, as well as pressure from the American Medical Association (AMA) and other stakeholders, CMS announced on March 10 that they will expand testing to ensure a smooth transition.

To be eligible for end-to-end testing, providers must: 1) apply through their MAC, 2) have updated ICD-10 software in place and 3) have completed internal testing prior to the testing dates. Each MAC will randomly select a set of 32 providers to participate, each of whom will be able to submit a total of 50 test claims.

CMS will define successful end-to-end testing as: 1) testing entities are able to successfully submit ICD-10 claims to the shared systems, 2) software changes made to support ICD-10 result in appropriately adjudicated claims and 3) remittance advices are produced.

As of Oct. 1, 2014, all Health Insurance Portability and Accountability Act (HIPPA)-covered entities will be required to use the ICD-10 code sets. The AMA will likely continue its ICD-10 implementation repeal efforts, which its studies have shown could cost nearly three times previous projections, with specialty practices absorbing the greatest implementation costs.

With the release of NCDs and LCDs crosswalks in April, providers, manufacturers, and other stakeholders will have insight as to whether CMS will narrow coverage based on the increased granularity of the coding.  This also may provide indicators as to how private payers may limit or expand their coverage.

Applications for the end-to-end testing sample group are currently available through the MAC and CEDI’s websites and must be submitted by March 24. Selected providers will be notified by April 14. In addition to end-to-end testing, CMS has or is soon to release a variety of Beta versions of the ICD-10 software to help providers prepare for the switch to ICD-10.

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