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  • ICD-10 Testing Rates Improve, CMS Offers Concession for Certain Coding Errors

    As the October 1 startup date for the ICD-10 coding system creeps closer and closer, the compliance picture seems to be brightening, just as the US Centers for Medicare and Medicaid Services (CMS) announces that it's taking a somewhat softer approach to how it will handle provider mistakes in the new system.

    Recently, CMS announced that during the last round of "end-to-end" testing of ICD-10 June 1-5, 90% of claims filed were accepted. This acceptance rate was up from the 88% mark achieved during the second testing phase, and from the 80% figure achieved during the first week of testing.

    As in the previous tests, according to a report from Healthcare Informatics, most rejections in the June tests "resulted from improperly developed test claims unrelated to ICD-10." The report cites CMS as stating that most rejections were due to "provider submission errors in the testing environment that would not occur when actual claims are submitted for processing."

    On the same day CMS announced the testing results, it also confirmed that after October 1, it will reimburse for incorrectly coded claims "as long as that erroneous code is in the same broad family as the right one," according to a story in Modern Healthcare. The policy will be in effect for 1 year. CMS has outlined its approach in an FAQ document (.pdf) released recently.

    A recent sold-out APTA webinar on successful ICD-10 implementation offered additional information to help providers prepare for the October 1 deadline:

    • CMS will set up a communication and collaboration center to resolve issues.
    • An ICD-10 ombudsman will help receive and triage provider issues.
    • If Part B Medicare contractors are unable to process claims, an advance payment may be available.

    A recording of the webinar will be released for download in the coming weeks and is part of a suite of APTA resources on ICD-10.

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