CMS Bows to Pressure-Conducts End-to-End Testing of ICD-10

The Centers for Medicare & Medicaid Services (CMS) is caving to pressure from the American Hospital Association, the American Medical Association, and the Medical Group Management Association (MGMA) to conduct far more extensive end-to-end testing to assure proper adjudication and payment of claims as the October 1 deadline for the ICD-10 transition looms. Testing will take place from March 3—7, 2014.

The CMS issued a statement on February 19 about end-to-end testing, first reported by Modern Healthcare. According to the statement, a small sample group of providers will be offered the chance to participate in end-to-end testing by CMS. This will entail submission of test claims to the agency with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims.

The goal of testing is to show that providers or submitters can successfully submit claims containing the new ICD-10 codes to the Medicare fee-for-service claims system, that software changes made to support the transition to ICD-10 will result in appropriately adjudicated claims based on the pricing data used for testing purposes, and that accurate RAs are produced. The small sample group of providers who participate in end-to-end testing will be selected to represent a broad cross-section of provider types, claims types, and submitter types.

While test claims will not be adjudicated, the Medicare Administrative Contractors (MACs) will return an acknowledgment to the submitter (a 277A) that confirms whether the submitted test claims were accepted or rejected.

Notice of the testing program for “a small sample group of providers,” was posted to the CMS' Medical Learning Network newsletter.

Susan Turney, MD, MS, FACP, FACMPE, president and CEO of MGMA, said in a statement that the organization urges CMS “to expand the scope of this testing approach to include any provider who wishes to test with them, as well as quickly disseminating results from all Medicare and Medicaid testing efforts. This more robust testing is imperative to identify potential operational problems similar to what was experienced with the rollout of www.healthcare.gov. At the same time, it will help to decrease the potential of catastrophic cash flow disruption that could impact the ability of practices to treat patients."