81 percent of submitted ICD-10 test claims were accepted during the first ICD-10 end-to-end testing from January 26 through February 3, 2015, according to CMS. 661 healthcare organizations including providers, clearinghouses and billing agencies participated submitting a total of 14,929 ICD-10 test claims, 12,149 of which were accepted. Overall, the results demonstrate the CMS systems are ready to accept ICD-10 claims.
ICD-10 claim test results found the reasons for rejected claims include:
– 3% – Invalid submission of ICD-9 diagnosis or procedure code
– 3% – Invalid submission of ICD-10 diagnosis or procedure code
– 13% – Non-ICD-10 related errors, including issues setting up the test claims (e.g., incorrect NPI, Health Insurance Claim Number, Submitter ID, dates of service outside the range valid for testing, invalid HCPCS codes, invalid place of service).
The results found the types of claims received include:
– 56% – Professional
– 38% – Institutional
– 6% – Supplier
Overall, the first week of ICD-10 test claims demonstrate CMS systems are indeed ready to accept ICD-10 claims. For institutional claims, the testing found that home health claims with dates that spanned the October 1, 2015, implementation date were not processed correctly impacting less than 10 test claims. CMS has noted that this issue will be resolved prior to the next testing week, and testers will have an opportunity to re-submit these claims.
Blue Cross Blue Shield executive Justine Handleman says these are basic issues that can be resolved well in advance of theOct. 1, 2015 ICD-10 compliance date.“The purpose of end-to-end testing is to identify issues so they are resolved in a timely manner,” said Justine Handelman, vice president, legislative and regulatory policy for the Blue Cross Blue Shield Association in statement. “The recent testing uncovered basic errors that can be resolved well in advance of the October 1, 2015 ICD-10 compliance date. All Blue Plans are working to ensure they are ready to receive and use ICD-10 codes on claims and we are actively engaged with all healthcare stakeholders in making the transition to ICD-10 successful.”
The Coalition for ICD-10 congratulated CMS on its positive ICD-10 testing results stating: “With seven months remaining to correct issues discovered during testing, the high rate of successful submission of ICD-10 codes is especially encouraging for physician offices since more than half the claims submitted for end-to-testing were professional claims. Of the 19 percent of rejected claims, 16 percent were rejected due to errors unrelated to ICD-10, including incorrect National Provider Identifier (NPI), incorrect Health Insurance Claim Number, incorrect Submitter ID, date of service outside the range valid for testing, invalid HCPCS codes and invalid place of service.”