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CMS accepts 73% of claims submitted during ICD-10 testing week in November

CMS’ latest ICD-10 testing week drew far less response — and a lower acceptance rate — than a similar testing week held in March.

The federal Medicare agency accepted 73% of the roughly 7,800 claims submitted during the Nov. 17-21 testing week, according to preliminary results announced Nov. 25 by Diane Kovach, CMS Provider Billing Group Director.

By comparison, CMS held a testing week in March and accepted 89% of test claims sent by various types of providers, suppliers, billing companies and clearinghouses participating. Testers submitted more than 127,000 claims to the Medicare fee-for service (FFS) claims systems.

Normal FFS Medicare claims acceptance rates average 95 to 98%, according to CMS.

Some claims weren’t accepted in November because invalid ICD-10 codes were submitted. It is possible providers wanted to make sure ICD-9 codes would be rejected, Kovach said.

In addition, some claims were denied because they had future dates on them and some were denied because they had National Provider Identifier submitter issues, she added.

Front-end testing does not provide information about how the claim will be processed. But industry experts say it is helpful to provide assurance to agencies about whether they can get a claim accepted into the system.

Agencies also will be able to test whether a claim with ICD-10 codes was received by their Medicare administrative contractor (MAC) during testing weeks March 2-6 and June 1-5, CMS says.

“These special acknowledgement testing weeks give submitters access to real-time help desk support” and allow CMS to analyze testing data, the federal Medicare agency says.

In addition, “providers, suppliers, billing companies and clearinghouses are welcome to submit acknowledgement test claims anytime up to the Oct. 1, 2015, implementation date,” CMS says.

— Josh Poltilove (jpoltilove@decisionhealth.com)

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