ICD-10 passes end-to-end testing, CMS chief Marilyn Tavenner says

Agency head says 81 percent of 15,000 test claims sent in past week were accepted, with most failures tied to errors not related to the coding.

ICD-10 hit very few snags in its first week of end-to-end testing, outgoing Centers for Medicare and Medicaid Services chief Marilyn Tavenner said on Wednesday, but it wasn’t quite perfect.

Of the 15,000 test claims sent by the government's hand-picked pool of 660 healthcare providers, billing agencies and equipment suppliers using the updated coding, 14,929 were received and 12,149 were accepted, a success rate of  81 percent.

Of the claims not accepted only 3 percent were result of bad ICD-9 coding and another 3 percent were caused by bad ICD-10 coding. The remaining 13 percent were due to errors not tied to the coding such as setup issues with the testing.

[Also: 6 ways to prepare for ICD-10]

“Testing allows us to identify areas of improvement, and we will work with outside entities and stakeholders to improve those very small deficiencies identified,” Tavenner wrote in a letter posted on the CMS blog. “And we will continue to do testing, especially in those areas we identify as needing improvement.”

Tavenner, who has resigned her post and will leave the CMS at the end of the month, said the testing uncovered some confusion about the dates for using ICD-9 or ICD-10 codes. All codes submitted for services performed on or after Oct. 1 must use ICD-10, but procedures performed before Oct. 1 must still be entered using ICD-9, even if the claim is being submitted after the switchover date.

Still, her verdict was clear: CMS is ready to handle the codes.

Tavenner, in her note, echoed the reasons why many think the industry needs the change to ICD-10, which has already faced several congressional delays.

“The U.S. is the last major industrialized nation to make the switch to ICD-10,” she said. “The structure of ICD-9, which is more than 35 years old, limits the number of new codes that can be created, and many ICD-9 categories are full. ICD-10 provides room for code expansion, so providers can use codes more specific to patient diagnoses.”

Earlier this month, a panel of healthcare experts testified to the Subcommittee on Health that providers are ready, and for the most part anxious, for the change.

“Our point of view is simple: It’s decision time. … Pull the trigger or pull the plug,” said Kristi A. Matus, chief financial and administrative officer for Athena Health.

[Also: Most ready, but worry persists]

But that doesn’t mean it’s unanimous. Most trepidation has come from physicians, who worry that the resources to convert and train their staffs will drain their already slim margins, especially if coding errors cause reimbursements to be held up. William Jefferson Terry, MD, of the Mobile Urology Group voiced those concerns to the panel.

“It’s going to kill me,” he said. “I can’t sit there through all those codes. Physicians have to have a guarantee we get paid if we don’t code right.”

In fact, a recent non-scientific poll by Healthcare Finance and Healthcare IT News found nearly 35 percent of respondents said they would support another delay, which could happen when Congress tackles the subject in March.

Tavenner, however, said healthcare providers should get prepared and to take advantage of the testing period. She also reminded practice managers to use the resources on the CMS website designed to help them navigate the change.

“CMS is ready for ICD-10. And, thanks to our many partners -- spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups --the healthcare community at large will be ready for ICD-10 on Oct. 1,” she said.

Here are the full test results:

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