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ICD-10 End-to-End Testing: The Latest Results

February 25, 2015
by Lisette Wright
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I had two conversations yesterday about “ICD-10 End-to-End Testing.” The first was with an EHR vendor asking “how much testing is enough to be certain claims will get processed correctly after October 1, 2015?” The second was with someone about the results of the most recent round of CMS end-to-end testing (completed in early February 2015). What is end-to-end testing? It is the exercise of submitting "dummy" claims with ICD-10 codes on them to see how they get processed. This enables us to try and understand how the ICD-10 transition will affect our healthcare financing after ICD-10 goes live Octiber 1, 2015.

No one, including EHR vendors, clearinghouses, payers, or billers, or even CMS can predict what will happen to the revenue cycle after October 1, 2015. But hopefully we can rely the on sample claim submissions (“End-to-End Testing”) to help guide us and provide some reassurances. We cannot expect anyone to test every single payer in the system, for every client, with every primary/secondary insurance configuration or diagnosis. That is unrealistic, and an undue burden for anyone. So what can you do? My recommendation has always been to test a representative sample of claims, targeting your biggest revenue-generating payers first. Test a variety of CPT codes, diagnoses, per diems, individual versus group services, and different programs.  The results should give you a good idea of how your claims processing will go after October 1, 2015.

Keep in mind the recommendation is to have 3-4 months operating revenue on hand on October 1, 2015. It is also important to note that we may not have all the answers within the first month or two of go-live. For example, it took some payers 12+ months to sort out the new 2013 CPT codes in their systems, pay them correctly, only to flip-flop on what they would or would not cover. We can expect the same thing to happen with ICD-10 codes. What may initially get paid may be subsequently denied when the payer realizes the diagnosis has been paid "in error" (ie: F55.0: Abuse of Antacids?).

The good news is that CMS released a report yesterday regarding the last round of testing across all healthcare provider entities in the US. 81% of the claims were processed without problems. 3% were denied for having an ICD-9 code on them, 3% were denied for being an invalid submission of a ICD-10 diagnosis or procedure, and 13% were denied because folks could not figure out how to set up the test claims. I wonder how many entities who tested were in the mental and chemical health industry and how they scored. What can we make of these numbers?



Lisette Wright

IT Consulting for Health and Human Services

Lisette Wright


Lisette Wright, M.A., LP has over 20 years of experience in the healthcare...

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