CMS to conduct 'end-to-end' ICD-10 testing for some providers

The Centers for Medicare & Medicaid Services on Wednesday announced that it will offer "end-to-end" ICD-10 testing for a "small sample group of providers" this summer. The move confirms reports from last fall by MedPage Today that the agency, despite previously proclaiming it would not conduct any external testing for providers, was willing to revisit the issue.

For the testing, providers--who will "represent a broad cross-section of provider types, claims types and submitter types"--will submit test claims to CMS with ICD-10 codes and receive remittance advice explaining the adjudication of the claims, according to the agency. CMS, through the testing, hopes to show that:

  • Providers can submit claims with ICD-10 codes to the Medicare fee-for-service claims systems
  • Software changes made by CMS to support the switch to ICD-10 result in properly processed claims
  • Accurate remittance advice is being given

The announcement comes just a day after for U.S. senators--Tom Coburn (R-Okla.), John Barrasso (R-Wyo.), John Boozman (R-Ark.) and Rand Paul (R-Ky.)--sent a letter to CMS Administrator Marilyn Tavenner questioning the agency's previous plan to only perform front-end ICD-10 testing for the first week in March.

"The significance of this transition can hardly be overstated," the senators wrote. "The economic impact of the ICD-10 transition on insurers and medical providers will be billions of dollars. … Before either Medicare or Medicaid could conceivably transition to any new diagnostic coding method, CMS must establish clear metrics and perform system-wide tests to certify its readiness."

The move also comes in the wake of criticism by the American Medical Association, which just last week published a report concluding that ICD-10 implementation costs will be more expensive than previous estimates for physician practices. In coordination with the report's release, AMA Executive Vice President and CEO James Madara called on CMS to "strongly … reconsider" the mandate for ICD-10, in a letter to U.S. Department of Health & Human Services secretary Kathleen Sebelius.

Several groups--including the Medical Group Management Association, the American Hospital Association and the Workgroup for Electronic Data Interchange--previously had called for CMS to consider end-to-end testing in preparation for the ICD-10 switch. In a statement emailed to FierceHealthIT, MGMA President and CEO Susan Turney said that while her organization is pleased with CMS' decision, the agency should expand the scope of its testing to include "any provider who wishes to test with them." She also urged CMS to "quickly disseminat[e] results from all Medicare and Medicaid testing efforts."

To learn more:
- here's the CMS announcement (.pdf)
- read the letter to Tavenner (.pdf)

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