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March ICD-10 Testing Delivers Mixed Results

Results from the initial March round of CMS claims process testing for the proposed ICD-10 conversion are being touted by the government, while at least one critic questions their meaning.

Nationwide, 89% of 127,000 Medicare fee-for-service claims were accepted by claims-processing contractors from about 2,600 participating testers, including claims clearinghouses, billing companies, providers, and suppliers, according to an update by the CMS' Niall Brennan, acting director, offices of enterprise management.

Some regions reported claims acceptance rates “as high as 99%,” well above the average range of 95% to 98%, according to the Brennan statement. 

“Testing did not identify any issues with the Medicare FFS claims systems,” he said. 

Details of the March test results were still unavailable, but some items regarding the announcement were problematic, says Robert Tennant, senior policy advisory for the Medical Group Management Association, which has lobbied the CMS for more and better ICD-10 testing. 

If the average acceptance rate was 89%, and the high was 98%, that implies that in some regions, the acceptance rate was far lower, Tennant notes. Why? 

“We don't know the specifics,” he says. “Any time you've got issues, it's a problem and this is the most rudimentary of testing. I can only imagine the type of disruption that might occur with end-to-end testing,” which is what the industry needs to feel assured the ICD-10 conversion won't disrupt claims and cash flow, Tennant says.

“It's also disconcerting it took them three months to get the results out,” he says. “If they delay end-to-end testing until 2015, we won't get the results early enough to react on it.”

The CMS had planned to do more comprehensive end-to-end claims process testing in July, but pulled the plug on that program last month, setting no new date and irking critics who had lobbied the agency for extensive testing. 

Brennan said the CMS will be conducting end-to-end testing in 2015. Details about that program will be released soon. 

“HHS expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015,” according to the Brennan statement. Until then, covered entities are expected to continue to use ICD-9 codes. In March, Congress forced HHS to delay by at least one year its Oct. 1, 2014 scheduled ICD-10 upgrade compliance deadline. 

The CMS also recently announced a “partial freeze” on the issuance of updates to ICD-9 and ICD-10 codes. 

Baltimore-based HIT and ICD-10 consultant Stanley Nachimson says the percentages quoted by the CMS for its “acknowledgement testing” experiment are “nice information, but it doesn't tell you a whole heck of a lot.” 

“It does not tell you the CMS system can process claims for ICD-10,” Nachimson says. “It tells you it can get them in the door. It really shouldn't give anybody any great comfort that ICD-10 will go smoothly.”

Source: Modern Healthcare