Optum360 coding books logo
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
March 27, 2018

Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More

Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More

OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More

View Article Archive

To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:

Medical Coding News Archives

CMS Deems First End-to-End Test of ICD-10 in 2015 a Success

March 25, 2015:

The Centers for Medicare and Medicaid Services (CMS) reported promising results from its first successful ICD-10 end-to-end testing week from January 26 through February 3, 2015. Of the 14,929 test claims received, 81 percent were accepted, and only 3 percent of claims were rejected because of incorrect ICD-10 codes.

Of the remaining rejected claims, about 450 contained incorrect ICD-9-CM codes, and nearly 2,000 were rejected for reasons not related to ICD-10, such as an invalid national provider identifier, incorrect dates of service, or invalid HCPCS code. Of the coding errors, CMS notes that many of the errors could have been avoided had submitters understood that ICD-9-CM codes should be used for all services provided before October 1, 2015, and ICD-10 codes for services provided after that date.

The test involved 661 Medicare fee-for-service providers, clearinghouses, and billing agencies registered under 1,400 national provider identifiers (NPI). They submitted claims for processing to all Medicare administrative contractors and the durable medical equipment MAC Common Electronic Data Interchange (CEDI) contractor.

In November, CMS conducted a week-long acknowledgment test involving more than 500 providers, suppliers, billing companies, and clearinghouses. They submitted approximately 13,700 claims with an overall acceptance rate of 76 percent. Although the overall acceptance rate seems low, the rate over the course of the week slowly increased as problems were solved. By Friday, 87 percent of claims were being accepted.

The testing of claims processing success before this fall’s ICD-10 implementation has four parts:

  • CMS internal testing of its claims processing systems
  • Provision of Beta testing tools to providers
  • Acknowledgment testing
  • End-to-end testing

All of CMS’s internal testing since October 2013 has indicated that all Medicare fee-for-service claims processing systems are ready for the new coding system. To encourage providers to assess their own readiness, CMS provides Beta testing software on its website that includes ICD-10, national coverage determination, and local coverage determination crosswalks.

Acknowledgment testing is open to everyone—providers, suppliers, billers, and clearinghouses. Until October 1, 2015, anyone can submit claims anytime to their MACs to see if they are accepted as valid. Note that none of these claims will be paid; MACs will merely return an acknowledgment that the claim was received. During two particular weeks in March and June, real-time support will be available to answer submitters’ questions. MACs will identify on their websites the specific weeks support will be available.

End-to-end testing is where the rubber meets the road. Just 2,550 randomly selected volunteers create and submit claims, which are then processed all the way through the system as if they were real claims. With the first week of testing now over, there are two more weeks of testing before October: one from April 27 to May 1, and one July 20 through July 24. Those who want to participate can go to their MACs’ websites to check the eligibility requirements and to enroll. Each MAC will randomly choose 50 participants per jurisdiction, making sure that five are clearinghouses.

Those who are chosen for end-to-end testing can submit 50 claims containing ICD-10 codes within the designated week. The MAC will review the claims as if they were for payment; unlike acknowledgment claims, they will be subject to NCDs and LCDs. After reviewing the claims, the MAC will return a remittance advice to the submitter explaining the adjudication decision.


Sign in to
Your Account
Forgot your username?
Forgot your password?
Don't have an account?
It's easy to create one.

Promo code

Have a promotional source code? Enter it here:

What is this?
Shop our catalog
Request or check out the electronic version of our latest catalog.

Medical Coding Books Winter 2018 Catalog