Rich Daly | January 13, 2015
The latest round of testing follows survey findings that some hospitals may be lagging in their preparation for the switchover to ICD-10.
Jan. 13—Medicare has given hospitals two more weeks to apply to participate in testing for the long-delayed transition to new code sets.
Hospitals have until Jan. 21 to volunteer as participants in the second round of ICD-10 end-to-end testing with Medicare administrative contractors (MACs) and the Common Electronic Data Interchange contractor from April 26 through May 1.
The end-to-end testing aims to demonstrate that providers are able to successfully submit claims containing ICD-10 codes to the Medicare fee-for-service claims system, and that the Centers for Medicare & Medicaid Services (CMS) is able to appropriately adjudicate claims by Oct. 1, the scheduled date of ICD-10 implementation.
The agency expects the April testing to total about 850 submitters, including a broad cross-section of provider, claim, and submitter types.
“Hospitals need to take advantage of this testing opportunity with CMS to ensure that their largest payer—Medicare—will be able to receive, correctly adjudicate, and remit claims following the ICD-10 implementation,” said Sandy Wolfskill, director, healthcare finance policy, revenue cycle MAP for HFMA.
In 2013, CMS delayed implementation of the switchover to ICD-10 for all entities covered under the Health Insurance Portability and Accountability Act, and Congress voted in March 2014 to delay the transition by another year.
“The changes in the code set are significant,” Wolfskill said. “Although modeling expected reimbursement from Medicare is a well-established practice, this implementation requires providers to closely track the claim adjudication results to ensure accurate reimbursement.”
Preparations Continue
Hospitals have previously reported good preparedness among their finance staff for the transition but shortfalls in other areas of ICD-10 preparation. For instance, most hospitals have had the majority of their financial and billing IT systems updated to support ICD-10 codes, but more than 40 percent lacked a testing plan with their top commercial payers, according to an April 2014 HFMA survey of hospitals.
Since then, hospitals report that they are continuing their own testing and other preparations for ICD-10 implementation, Wolfskill said.
A third round of 2015 end-to-end testing will occur July 20-24.
In addition to identifying potential payment processing problems, the end-to-end testing is expected to be reviewed by members of Congress and could affect legislators’ decision to push for further delays, according to some industry observers.
CMS also offers providers and others the chance to submit acknowledgement test claims any time up to Oct. 1. Three weeks of formal acknowledgement testing will give submitters real-time help-desk support and allow CMS to analyze testing data.
Also offering implementation assistance is the Coalition for ICD-10, to which HFMA belongs.
Providers interested in volunteering for end-to-end testing should use forms on their MAC’s .
Source: HFMA
https://www.hfma.org/Content.aspx?id=27280