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ICD-10 Coding: CMS Claims Third Successful Test

By: Nextech | September 2nd, 2015

ICD-10 Coding: CMS Claims Third Successful Test Blog Feature

Medical practices aren't the only organizations preparing for the major ICD-10 transition set to take place on October 1. The Centers for Medicare & Medicaid Services conducted its third end-to-end test of the year in regard to preparing for ICD-10 claims.icd10sign-1

The results? 

A huge success.

According to the report by CMS, the testing took place from July 20-24 with approximately 1.200 clearinghouses, health care providers and billing agencies selected to participate in the test.Here are the results of the test:

  • 29,286 test claims received
  • 25,646 test claims accepted
  • 87% acceptance rate
  • 1.8% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code
  • 2.6% of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code

Further proving the success of CMS' latest test, they acknowledged in the report that some rejections were intentional in order to ensure claims were rejected. In the prior two test this year -- in January and April -- acceptance rates were 81 and 88 percent, respectively.

Although this latest acceptance rate was a slight decrease from the test in April, the results are encouraging considering there were nearly 400 more participants as well as an increase in claims submitted in the July test.

  • No new ICD-10 related issues were identified in any of the Medicare fee-for-service claims processing systems
  • There were zero rejects due to front-end CMS systems issues
  • Issues identified during previous testing weeks were resolved prior to July testing

Therefore, the consistency in acceptance rates has led CMS to the conclusion that its systems are "ready to accept ICD-10 claims."