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ICD-10 testing week numbers muddled by negative testing

Though they were part of a self-selected group that’s likely ahead of the game in transitioning to ICD-10, the results of trial claims submitted by healthcare providers to CMS may brighten the industry’s outlook on the viability of the coding update.

CMS accepted more than three-quarters (76%) of all claims submitted to the agency during an ICD-10 acknowledgement testing week. The percentage of approved claims increased throughout the testing week, culminating in an 87% acceptance rate, according to a CMS report on the November event.

The number of rejected claims was artificially inflated by a practice known as “negative testing.” Negative testing, in this case, refers to participants in the ICD-10 testing event that intentionally submitted erroneous claims to see if their claim would be rejected. Two common reasons for faulty claims were that they included incorrect National Provider Identifiers (NPIs) or were submitted for future dates.

CMS checked every test claim to ensure:
• Diagnosis codes matched the marked date of service.
• The NPI was correct for each submitter.
• Claims included “an ICD-10 companion qualifier code” to allow proper processing.

More than 500 providers, billing companies and clearinghouses submitted claims to CMS within the acknowledgment testing window. The healthcare providers ranged from large and small physician practices to labs and home health providers.

Future ICD-10 acknowledgement testing weeks will occur March 2-6, 2015, and June 1-5, 2015. Providers are allowed to submit ICD-10 claims to CMS any time prior to Oct. 1, 2015 — the official ICD-10 implementation deadline.

Those testing weeks may prove valuable to the providers that have pushed the majority of their ICD-10 preparation into 2015. A survey of 324 providers and other healthcare groups administered by the Workgroup for Electronic Data Interchange found that more than half of providers either expect to begin external testing of their ICD-10 readiness in 2015 or are unsure of their external testing plans.

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