ICD-10 Testing with CMS CMS is offering two different levels of testing for ICD-10. The first level, Acknowledgement-Based Testing, allows healthcare stakeholders that submit claims to Medicare to determine if their claims will be accepted by the Medicare Administrative Contractors (MACs). The second level, Limited End-to-End Testing, allows selected industry stakeholders to submit ICD-10 test claims to the MACs and receive a Remittance Advice (RA) in return. Acknowledgement-Based Testing Acknowledgment-based testing is meant to ensure providers’ claims and files with ICD-10 codes will pass into their MAC’s adjudication system and to demonstrate that CMS as well as the MACs are prepared for the ICD-10 implementation. For this testing, claims will be validated that they meet the HIPAA 5010 transaction standard, ICD-9 and ICD-10 edits plus transaction dates. Once the claim file is submitted, CMS will return a 277CA or 999 acknowledgement to confirm that the claim was accepted or rejected by Medicare. Acknowledgement-based test claims may be submitted up to the implementation date of October 1, 2015. Leading up to the implementation date, MACs will host special acknowledgement testing weeks. During those weeks, the MACs will increase the help desk staff to handle increased call volume and offer real-time support during the hours between 9:00 AM and 4:00 PM. Acknowledgement-based testing will also allow CMS to analyze the testing data submitted to gauge industry readiness. Limited End-to-End Testing CMS will be doing limited end-to-end testing with 850 providers in three testing weeks. Registration for this testing is required. CMS recommends using claim examples that will go through the adjudication process without additional documentation to support the services billed. To participate in the Limited End-to-End testing, claims from the selected providers will need to meet specific criteria: Each provider will be allowed to test 50 claims over the course of the week. To allow the MACs to set up their test systems, the selected providers must submit the • Medicare Beneficiary ID Numbers (HICNs) – up to ten numbers • MAC PTAN and NPI – you may use up to five NPIs Test files must have a “T” in the ISA15 field ICD-10 codes should be on test claims with a date of service on or after 10/1/2015 ICD-9 codes should be on test claims with a date of service before 10/1/2015 The MACs will return the RA three days after submission of the test file. These files will be marked as test with a “T” in the ISA15 field. Pricing on the RA will be the pricing contained in the test environment at the time the test claims are processed. Every tester will be limited to 50 claims: therefore, if you do not submit claims directly to Medicare, you will need to work with your clearinghouse or practice management vendor to determine if your claims will be tested. Each level of testing offers slightly different validation for providers. If selected for the Limited End-to-End testing, consider using claims that represent your most frequently billed services. The testing environment is also a good opportunity to test your policies and procedures. North Carolina Healthcare Information and Communications Alliance, Inc. RED ALERT COUNTDOWN 260 Days (As of January 13, 2015) Acknowledgement Testing Dates March 2 -6, 2015 June 1-5, 2015 End-to-End Testing Dates January 26 -30, 2015 April 27 - May 1, 2015 July 20 -24, 2015 ICD-10 Training Wake AHEC Comprehensive Coding Using ICD-10CM for the Physician’s Office February 17, 2015 Raleigh, NC AHIMA Advanced ICD-10-PCS Skills Workshop March 4-6, 2015 Morrisville, NC NCHICA formed the ICD-10 Taskforce in February 2009 to assist members in their ICD-10 implementation efforts. If you would like additional information, click here. PO Box 13048, 3200 NC Hwy 54, Cape Fear Bldg., Suite 200, Research Triangle Park, NC 27709-3048
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