ICD-10 Acknowledgement Testing Checklist for Providers | EHR and Health IT Consulting | Scoop.it

While ICD-10 acknowledgment testing is available any day of the year up until October 1, 2015, CMS is taking the first week in March to host another dedicated opportunity for providers.  The testing weeks serve as way to gather data about the way providers send their sample ICD-10 claims to Medicare and allow providers to ensure that their claims can be accepted by the adjudication system without any technical glitches.

Those organizations that have not participated in previous testing weeks are encouraged to join in during the next chance on March 2 through 6, or the final scheduled occasion at the beginning of June.

In order to successfully submit claims for ICD-10 acknowledgement testing, direct-submit healthcare organizations, including providers and clearinghouses, will need to keep the following questions, tips and, requirements in mind.

What is ICD-10 acknowledgement testing?

Acknowledgement testing is the most basic form of assurance that a claim can be accepted by a Medicare Administrative Contractor (MAC) for later adjudication.  It should not be confused with end-to-end testing, in which a claim is processed through all Medicare system edits in order to produce electronic remittance advice (ERA).  Acknowledgement testing simply provides a yes or no answer to the question of whether or not the sample claim can be accepted.

Providers are encouraged to use ICD-10 acknowledgement testing as a basic way to ensure that they are on the right track with their ICD-10 preparation.

How do I participate?

Information about acknowledgement testing will be provided on your local MAC website or by your clearinghouse.  Any provider that submits electronic Medicare fee-for-service claims is eligible for participation.  There is no registration required.  For more information on eligibility, click here.

ICD-10 acknowledgement testing does not test initial connectivity to the MAC system, nor does it ensure that your internal systems are capable of producing, accepting, storing, or transmitting codes.  Internal preparations for the generation and transmission of ICD-10 codes should already be completed before MAC testing.

How do I prepare my sample claims for submission?

Ensure that you have enough claims coded in ICD-10 to represent your typical submissions spectrum.  CMS reminds providers that claims must have the “T” in the ISA15 field to indicate the file is a test file.  Use a valid submitter ID, national provider identifier (NPI), and Provider Transaction Access Numbers (PTAN) combinations.  Claims that contain invalid identifiers will be rejected.

Be sure that the claims do not include future dates of service.  All claims must be dated before March 1, 2015 in order to be processed. Claims must also have an ICD-10 companion qualifier code or they will be rejected.

Providers may engage in “negative testing” by submitting purposely erroneous claims in order to confirm that the MACs will catch defects or incorrect information.

What information will I receive from my MAC?

Test claims will be assigned a 277CA or 999 acknowledgement as confirmation that the claim was accepted or rejected by the system.  The test will not confirm that the claim would be paid under ICD-10, nor will testers receive any remittance advice.  The MACs and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) will have extra staff available to take calls from providers who have questions about the process or their results.

Providers will need to engage in full end-to-end testing with their payers if they wish to receive information about their coding accuracy or payment rates.  While CMS has scheduled end-to-end testing for April 2015, participating providers have already been selected.  Providers are still encouraged to engage in end-to-end testing with their private payers as soon as possible.

What do I do next?

During prior acknowledgement testing, CMS has released basic data on acceptance rates several weeks after the dedicated testing period.  But providers participating in the opportunity do not need to wait until then to take action based on their own results.  With a mere seven months until October 1, 2015, organizations that experienced unexpected denials from acknowledgement testing should work with their ICD-10 preparation teams or consultants to resolve internal or coding errors quickly.

Healthcare organizations should also make sure that they are coordinating with their major payers to conduct additional, more robust testing of ICD-10 claims.  Providers should continue to utilize clinical documentation improvement programs, revenue cycle contingency planning, and coder training and education during the last few months of preparation in order to combat potential negative impacts from the new codes.