June 9, 2014

ICD-10 Test Results Post 89 Percent Acceptance Rate


Although narrow in scope, results from the ICD-10 National Testing Week conducted early last March revealed that the Centers for Medicare & Medicaid Services (CMS) accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent, according to CMS.

The normal FFS Medicare claims acceptance rates average 95-98 percent.


On March 3-7, CMS conducted the highly anticipated and critically needed ICD-10 National Testing Week via all the Medicare Administrative Contractors (MAC). Providers, clearinghouses, and others participated in the first-ever ICD-10 claims acknowledgement testing. Before the implementation delay passed by Congress and signed into law by President Barack Obama, the national testing week was a major milestone on the ICD-10 implementation timeline. Previously, CMS had taken the position that Medicare would not conduct end-to-end testing—disheartening news to an industry that had continued to face postponements and delays.

The primary purpose was to ensure that claims can be processed successfully by the providers, then passed along to the clearinghouses and then on the Medicare system. The secondary purpose, albeit unintentional, was to provide an “early win” for all participants.

Although the test was not truly end-to-end, participants achieved a major milestone simply by participating and receiving a confirmation that their claims made it to the CMS system through the MACs and clearinghouses. 

In announcing the results, CMS reported that testers submitted more than 127,000 claims with ICD-10 codes to the Medicare Fee-for-service (FFS) claims systems and received electronic acknowledgements confirming that their claims were accepted.

Approximately 2,600 participating providers, suppliers, billing companies, and clearinghouses participated in the testing week, representing about five percent of all submitters.

CMS, in its report, said clearinghouses, which submit claims on behalf of providers, were the largest group of testers, submitting 50 percent of all test claims. Other testers included large and small physician practices, small and large hospitals, labs, ambulatory surgical centers, dialysis facilities, home health providers, and ambulance providers, according to CMS.

“For clearinghouse clients, this testing week gave them the opportunity to communicate with their clearinghouses to ensure a smooth testing procedure,” notes Tim McMullen, JD, CAE, executive director of the Cooperative Exchange, the association for the clearinghouse industry. “It also gave providers comfort knowing that this process is not as difficult as some have indicated.”

CMS reported that testing did not identify any issues with the Medicare FFS claims systems.

 This testing week allowed an opportunity for testers and CMS alike to learn valuable lessons about ICD-10 claims processing.  

“In many cases, testers intentionally included such errors in their claims to make sure that the claim would be rejected, a process often referred to as negative testing,” wrote CMS in its report. “To be processed correctly, all claims must have a valid diagnosis code that matches the date of service, and a valid national provider identifier.”

According to CMS, the claims using ICD-10 had to have an ICD-10 companion qualifier code and the claims using ICD-9 had to use the ICD-9 qualifier code. Claims that did not meet these requirements were rejected.  

“Providers, suppliers, billing companies, and clearinghouses are welcome to submit acknowledgement test claims anytime up to the anticipated October 1, 2015 implementation date,” wrote CMS, advising submitters to contact their local Medicare Administrative Contractor (MAC) for more information about acknowledgment testing.

CMS suggested, however, that those who submit claims may want to delay acknowledgement testing until after October 6, 2014, when Medicare updates its systems.


Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.

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