Feb. 21—The Centers for Medicare & Medicaid Services (CMS) will conduct some end-to-end testing of the new provider codes mandated for widespread adoption in the fall, the agency announced this week.

CMS will conduct end-to-end testing this summer on several components of ICD-10, which providers are required to use beginning Oct. 1. The testing will include the submission to CMS of test claims that use ICD-10 codes and the providers’ receipt of remittance advice (RA) notices, which explain the adjudication of the claims.

The testing aims to determine whether providers or submitters are able to successfully submit claims containing ICD-10 codes to the Medicare fee-for-service claims systems; whether CMS software changes for ICD-10 result in appropriately adjudicated claims (based on the pricing data used for testing purposes); and whether accurate RAs are produced.

The end-to-end testing will focus on a small sample group of providers that represent a broad cross-section of provider types, claims types, and submitter types.

The testing announcement reversed CMS officials’ months-long rejection of requests for end-to-end tests by healthcare advocacy groups concerned that problems would arise from the switch to the new codes.

Previous provider concerns over implementation of ICD-10 led CMS to delay the originally scheduled Oct. 1, 2013, launch for one year.

Details to Come

The agency plans to release details of the end-to-end testing process “at a later date.”

“Although details have not been finalized, we continue to urge CMS to include as many providers as possible in this new round of testing to protect cash flow following the conversion,” said Sandy Wolfskill, director of healthcare finance policy, Revenue Cycle MAP for HFMA. “Providers must be assured that their claims will flow correctly through the entire adjudication and remittance processes.”

A representative of the American Hospital Association told a National Committee on Vital and Health Statistics ICD-10 panel that concerns remain about the timing of the testing process, according to AHA News Now. George Arges, senior director of the health data management group at AHA, urged CMS to complete testing by the end of June to allow providers, payers, and clearinghouses to resolve any issues discovered during testing and complete training well in advance of the October transition.

Publication Date: Thursday, February 20, 2014