CMS: 81 percent of initial ICD-10 test claims accepted

Of nearly 15,000 test claims received by the Centers for Medicare & Medicaid for the first round of end-to-end ICD-10 testing, 81 percent were accepted, according to statistics revealed by the agency Wednesday.

Overall, 661 volunteers participated in the testing, which lasted from Jan. 26 through Feb. 3. Of those whose claims were rejected:

  • 3 percent were due to an invalid submission of an ICD-9 diagnosis or procedure code
  • 3 percent stemmed from an invalid submission of an ICD-10 diagnosis or procedure code
  • 13 percent were due to non-ICD-10 related errors, including issues setting up the test claims

Outgoing CMS Administrator Marilyn Tavenner, in a blog post touting the testing results, said the testing period allowed CMS to identify one point of confusion for providers--that ICD-9 must be used for services provided prior to Oct. 1, and ICD-10 must be used after that date.

"That means ICD-10 can be used only for test purposes before Oct. 1," Tavenner said. "And only ICD-10 can be used for doctor's visits and other services that happen on or after Oct. 1. ICD-9 cannot be used to bill for services provided on or after Oct. 1. This rule applies no matter when the claim is submitted, so claims submitted after October 2015 for services provided before that date must use ICD-9 codes."

More than half of the claims received (56 percent) were professional, 38 percent were institutional and 6 percent were supplier claims.

Tavenner reiterated that CMS is ready for ICD-10, but encouraged medical practices and hospitals that bill in Medicare to take advantage of future test dates.

"These rules and others around adopting ICD-10 apply to all healthcare providers, not just those who accept Medicare or Medicaid," Tavenner said. "So, like CMS, health insurance plans across the country are engaging in robust testing programs with doctors, hospitals and other healthcare providers and suppliers. No major issues have emerged in the course of testing."

A Government Accountability Office report published earlier this month concluded that CMS has taken positive steps to help the healthcare industry prepare for ICD-10, but GAO implored every organization--providers, payers and vendors--to prepare in advance to make the transition a success.

And members of the House Energy and Commerce Committee's Subcommittee on Health made clear at a recent hearing examining ICD-10 implementation Feb. 12 that they do not want to see the transition delayed yet again.

To learn more:
- check out the testing results (.pdf)
- here's the CMS blog post