New Guidance on End-to-End ICD-10 Testing With Medicare

Just-released guidance from the Centers for Medicare & Medicaid Services walks providers, clearinghouses, suppliers, and billing firms through preparing claims for ICD-10 end-to-end testing with Medicare.

The agency reminds stakeholders that while acknowledgement testing—confirming claims sent to Medicare are accepted or rejected—is open to all electronic submitters, end-to-end testing is limited to a smaller subset of participants who volunteer and are accepted. Those doing end-to-end testing with their Medicare administrative contractor can submit up to 50 claims.

Before testing, an organization must submit to the contractor data that includes up to two submitter identifiers, up to five national provider identifiers or provider transaction access numbers, and up to 10 health insurance claim numbers (HICNs). These data may be used in any combination on the 50 test claims. The HICNs must be real beneficiaries who are not deceased.

Once selected for end-to-end testing, such as in the January 2015 round, an organization need not reapply for later rounds; they are automatically registered. An organization can submit the same data to the contractor as previously sent in the first round of testing, or send a new set.

Medicare also requires specific dates on the ICD-10 coded claims being tested. Professional claims must have a date of service on or after October 1, 2015, with inpatient claims having a discharge date on or after October 1, 2015. Supplier claims must have a date of service between October 1, 2015 and October 15, 2015. Professional and institutional claims may have dates up to December 31, 2015. ICD-9 and ICD-10 codes cannot be submitted on the same claim.

The guidance covers additional testing scenarios such as Returned to Provider claims (they count toward the 50 limit and can't be resubmitted), and specific data submissions for supplier, home health, hospice, inpatient rehabilitation facility, and skilled nursing facility claims. The guidance is available here.

Source: Health Data Management