Neurology & Pain Management Coding Alert

Here’s your chance to see how prepared you are for the new system. 

With the ICD-10 implementation date only months away, CMS is taking a four-pronged approach to ensuring that CMS and Medicare Fee-for-Service (FFS) practices are prepared. Read on to know what to expect, based on what Stacey Shagena with Medicare Contractor Management Group/CMS shared about Medicare’s testing plan during an MLN Connects call “Transitioning to ICD-10” on Nov. 5, 2014. 

The four areas of focus for CMS are: 

• CMS internal testing of its claims processing system (completed in October 2013)
• Beta testing tools available from CMS
• Acknowledgement testing
• End-to-end testing. 

What’s been accomplished: CMS completed its first Acknowledgement Testing Week with submitters in March 2014. Approximately 2,600 providers, suppliers, billing companies, and clearing houses participated, submitting more than 127,000 claims with ICD-10 codes. The participating group included large and small physician practices or hospitals, ambulatory surgical centers, dialysis centers, home health providers, and ambulance providers. 

Nationally, CMS accepted 89 percent of the test claims, with some regions having an acceptance rate as high as 99 percent, according to Shagena. The normal rate for Medicare FFS claims is 95 to 98 percent. 

Test your own practice: Providers, billing companies, and other groups can submit acknowledgement test claims at any time until the ICD-10 implementation date to verify that their claims are reaching CMS. In addition, two weeks in 2015 will give providers the chance to submit claims and access real-time help desk assistance (which will also allow CMS to analyze testing data). The dates will be March 2-6, 2015, and June 1-5, 2015. Registration is not required – you simply submit claims and take advantage of the extra help. 

End-to-end testing: Providers will have the chance to take part in end-to-end testing with MACs, the Railroad Retirement Board, and the Common Electronic Data Interchange contractor in January, April, and July of 2015. CMS says this testing phase is designed to show that: 

• Providers and submitters can successfully submit claims with ICD-10 codes to the Medicare FFS system 
• CMS software changes that were made to support ICD-10 will allow for properly adjudicated claims 
• The system can produce accurate remittance advices. 

Approximately 850 providers will take part in each end-to-end testing phase, for a total of 2,550 testers. Each MAC will choose 50 volunteers to participate in each testing round. Each practice will submit 50 claims during their testing week. Once selected, a practice can participate in the following end-to-end testing weeks without re-registering. 

Registration takes place several months before each testing time (volunteers were notified in October if they were selected for the January testing).  

“If you weren’t selected to participate in January, we encourage you to reapply for the subsequent rounds of testing in April and July,” Shagena said. “Information will be on the CMS website in December 2014 about registering for the April week.”