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From Health Law Daily, February 26, 2015

CMS readiness for ICD-10 demonstrated in successful end-to-end testing

By Patricia K. Ruiz, J.D.

The first week of end-to-end testing of the 10th revision of International Classification of Diseases (ICD-10) coding has ended successfully, according to an announcement by CMS Administrator Marilyn Tavenner. The test run, during which 660 providers and billing companies submitted approximately 15,000 test claims, puts CMS on track to implement ICD-10 by October 1, 2015, as planned.

Background. The International Classification of Diseases standardizes the codes used by providers to describe conditions and procedures. These codes are incorporated extensively in the Medicare and Medicaid billing process. ICD-9, the version still used by the United States, is more than 35 years old and incorporates terms that are outdated, obsolete, and inconsistent with current medical practice, according to a CMS fact sheet. The structure of ICD-9 limits the number of codes that can be created, making it difficult to describe conditions and procedures with specificity. ICD-10 provides room for code expansion, allowing providers to describe diagnoses in greater detail. The United States is the last major industrialized nation to adopt ICD-10.

Testing of ICD-10. “CMS has undertaken an unprecedented level of outreach, training, and education to prepare the health care community for ICD-10,” the announcement stated. CMS’ comprehensive program of testing relies on the participation of health care providers, billing agencies, and equipment suppliers. In the first round of testing, which ran from January 26, 2015, to February 3, 2015, participants were able to successfully submit their ICD-10 claims, which were processed through CMS’ billing systems properly. If claims were rejected, the errors were unrelated to ICD-9 or ICD-10, CMS said.

Previously, CMS’ preparation for ICD-10 has been scrutinized, with concerns surrounding the lack of end-to-end Medicare fee-for-service testing of the system, as well as the lack of education efforts targeted at providers (see Concerns abound around ICD-10 transition, stakeholders critique CMS preparation efforts, February 9, 2015). Overall, the testing demonstrated that CMS systems are prepared to begin accepting ICD-10 claims. Additional testing will occur in April and July 2015.

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