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Medical Coding News Archives

CMS Begins Testing ICD-10

February 26, 2014:

Nichole VanHorn, Clinical/Technical Editor

The Centers for Medicare and Medicaid Services (CMS) has announced the start of system testing ahead of the ICD-10 implementation to ensure claims containing ICD-10 codes will be readily accepted for processing on October 1, 2014. All physicians, providers, and suppliers submitting claims on and after October 1, 2014, will be required to use the ICD-10 code sets adopted under the Health Insurance Portability and Accountability Act (HIPAA).

CMS will use a four-pronged approach to prepare for testing:

  • CMS internal testing of its claims processing systems
    • Uses a three-tiered approach:
      • alpha testing performed by each fee-for-service (FFS) claims processing system maintainer for four weeks
      • beta testing performed by a separate integration contractor for eight weeks
      • acceptance testing performed by each MAC for four weeks to ensure that local coverage requirements are met and the systems are functioning as expected.

Note: As of October 1, 2013, all Medicare FFS claims processing systems were ready for ICD-10 implementation, although CMS continues to test its ICD-10 software changes with quarterly releases.

  • Provider-initiated beta testing tools
    • NCDs converted from ICD-9 to ICD-10
      • Providers need to prepare themselves by reviewing the variety of beta versions of CMS’s software that include ICD-10 codes as well as national coverage determination (NCD) code crosswalks to test the readiness of their systems. Some NCDs have been cross-walked and can be found at: http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html.
    • ICD-10 Medicare severity-diagnosis related groups (MS-DRGs) conversion project (along with payment logic and software replicating the current MS-DRGs), which uses the general equivalence mappings (GEM) to convert ICD-9 codes to ICD-10-CM codes
      • Hospital providers should review this information located at: http://cms.hhs.gov/Medicare/Coding/ICD10/ICD-10-MS-DRG-Conversion-Project.html on the CMS website
    • Pilot version of the October 2013 Integrated Outpatient Code Editor (IOCE) using ICD-10-CM (IOCE final version scheduled for release in August 2014)
      • Outpatient providers should review this information located at: http://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/Downloads/ICD-10-IOCE-Code-Lists.pdf on the CMS website. The final version of the IOCE that uses ICD-10-CM is expected to be released August 2014.
    • Crosswalks for local coverage determinations (LCDs) available April 2014
    • Free billing software from CMS MACs
      • If providers will not be able to complete the necessary systems changes to submit claims with ICD-10 codes by October 1, 2014, MACs can provide physicians, providers, and suppliers with the software needed to support ICD-10 code submission; an internet connection is required. Many MACs also offer provider internet portals, which providers can register for to ensure that they have the flexibility to submit professional claims and comply with ICD-10 implementation.

  • Acknowledgment testing
    • Scheduled for March 3-7, 2014; gives providers, billing companies, and clearinghouses the opportunity to submit claims to CMS and determine whether the format they are using will be accepted with ICD-10 codes. Test claims will not be adjudicated, but MACs will return an acknowledgment to the submitter (a 277A) to confirm whether the submitted test claims were accepted or rejected.
    • Other weeks may be offered based on results from March 2014 testing week

  • End-to-end testing
    • Summer 2014 end-to-end testing will be offered to a sample group of providers
    • Testing includes submission of test claims with ICD-10 codes and receipt of an RA explaining adjudication.
    • Sample group who participate will represent a broad cross-section of provider, claims, and submitter types.
    • Goal of testing will demonstrate the following:
      • CMS software changes made to support ICD-10 result in appropriately adjudicated claims.
      • Providers or submitters are able to successfully submit claims containing ICD-10 codes to the FFS claims systems.
      • RAs are produced correctly.


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