4) Types of ICD-10 Testing
credit: CMS & HHS, 7.24.15
ICD-10 Preparation for Mental & Behavioral Health and Substance Usage Providers
"While ICD-10 is less than 75 days away, you still have time to get ready. But you must get ready now.
In acknowledgement testing, providers and other submitters, like clearinghouses, submit claims with ICD-10 codes and ICD-10 companion qualifiers. While claims are not adjudicated, submitters receive an acknowledgement that their claim was accepted or rejected.
Tip: Be sure to use ICD-10 qualifiers, which differ from ICD-9 qualifiers. Some providers have reported that ICD-10 qualifiers had to be manually set up in their systems.
Beyond testing with Medicare as described below, you can check with your commercial health plans, clearinghouses, and billing services for more acknowledgement testing opportunities.
Medicare FFS Acknowledment Testing
All Medicare fee-for-service (FFS) providers who submit electronic claims can conduct acknowledgement testing with their Medicare Administrative Contractor (MAC) at any time until September 30:
- You do not need to register to participate
- You may submit an unlimited number of claims
You can acknowledgement test claims directly or through a clearinghouse or billing agency
To submit claims for testing, you must use:
- Current dates of service
- The test indicator “T” in the Interchange Control Structure (ISA) 15 field
Analysis of acknowledgement testing to date has found no issues with Medicare systems for FFS claims. Rejected claims have been largely due to improperly prepared test claims—issues unrelated to ICD-10. Specific issues have been:
- An invalid National Provider Identifier (NPI), or an NPI that is not on the NPI crosswalk
- Invalid Healthcare Common Procedure Coding System (HCPCS) codes on professional claims
- Invalid postal ZIP codes on professional claims
During end-to-end testing, providers submit claims containing valid ICD-10 codes. Health plans process the claims through system edits to return an electronic remittance advice (ERA).
While registration has closed for the Medicare FFS end-to-end testing described below, some health plans continue to offer opportunities. If you have not conducted end-to-end testing yet, check with your health plans, clearinghouses, and billing services about opportunities.
Medicare FFS End-to-End Testing
Medicare’s last round of end-to-end testing is taking place this week, ending tomorrow, July 24. Advance registration was required to participate. Medicare FFS end-to-end testing is no longer open to new volunteers. (Please note that volunteers who took part in the January or April end-to-end testing are able to participate in the current testing, even if they did not register for July).
Results from the July will be analyzed and released next month.
Results from the last round of Medicare FFS end-to-end testing, held April 27 to May 1, showed that overall, participants were able to successfully submit ICD-10 test claims and have them processed through the Medicare billing systems. Testers included providers, clearinghouses, and billing agencies. CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim, and submitter types.
The acceptance rate for April was higher than for January, with an increase in test claims submitted and a decrease in the percentage of errors related to either ICD-9 or ICD-10 codes:
- 23,138 test claims received
- 20,306 test claims accepted
- 88% acceptance rate
- 2% of test claims rejected due to invalid submission of ICD-10 diagnosis or procedure codes
- <1% of test claims rejected due to invalid submission of ICD-9 diagnosis or procedure codes
Additional rejections were from non-ICD-10 related errors, including:
- Incorrect NPI
- Incorrect Health Insurance Claim Number
- Incorrect submitter ID
- Dates of service outside the valid range for testing
- Invalid HCPCS codes
- Invalid place of service
Testing has demonstrated that CMS systems are ready to accept ICD-10 claims.
To learn more about getting ready, visit the cms.gov/ICD10 for free resources including the Road to 10 tool designed especially for small and rural practices, but useful for all health care professionals.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for and CMS ICD-10 Industry Email Updates and follow us [CMS] on Twitter." (source: CMS)
Leigh-Ann Renz is the Marketing & Business Development Director of PIMSY EHR and is very passionate about helping practices prepare for the upcoming ICD-10 transition. For more ICD-10 resources, especially geared towards mental / behavioral health, see our ICD-10 Resource Center. For information about electronic solutions for your practice, check out Mental Health EHR.