Friday, August 7, 2015

CMS releases updated frequently-asked questions for ICD-10 acknowledgement and end-to-end testing

The Centers for Medicare & Medicaid Services (CMS) recently updated frequently-asked questions and answers for health care providers and billing houses participating in testing programs for the upcoming transition to the International Classification of Diseases, 10th Edition (ICD-10).

Health care providers and billing agencies who participate in acknowledgement testing and who are selected to participate in Medicare ICD-10 end-to-end testing should review the following questions and answers before preparing claims for ICD-10 acknowledgement testing and end-to-end testing. The FAQs provide information about the guidelines and requirements for successful testing.

Acknowledgement Testing
End-to-End Testing
Do I need to register for testing?
No, you do not need to register for acknowledgement testing.
Yes, end-to-end testing volunteers must register on their Medicare Administrative Contractor (MAC) website during specific time periods.
Who can participate in testing?
Acknowledgement testing is open to all Medicare Fee-For-Service (FFS) electronic submitters.
End-to-end testing is open to:                        ·Medicare FFS direct submitters;                  ·Direct Data Entry (DDE) submitters who receive an Electronic Remittance Advice (ERA);                                        ·Clearinghouses; and                                    ·Billing agencies.
How many testers will be selected?
All Medicare FFS electronic submitters can acknowledgement test. 
50 end-to-end testers will be selectedper MAC jurisdiction for each testing round.               You must be selected by the MAC for this testing.
What will the testing show?
The goal of acknowledgement testing is to demonstrate that:                ·Providers and submitters can submit claims with valid ICD-10 codes and ICD-10 companion qualifier codes;         ·Providers submitted claims with valid National Provider Identifiers (NPIs)                    · The claims are accepted by the Medicare FFS claims systems; and                 ·Claims receive 277CA or 999 acknowledgement, as appropriate, to confirm that the claim was accepted or rejected by Medicare.
The goal of end-to-end testing is to demonstrate that: · Providers and submitters can successfully submit claims containing ICD-10 codes to the Medicare FFS claims systems;                                                      · Software changes the Centers for Medicare & Medicaid Services (CMS) made to support ICD-10 result in appropriately adjudicated  claims; and          · Accurate Remittance Advices are produced.
Will the testing test National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)?
No, acknowledgment testing will not test NCDs and LCDs.
Yes, end-to-end test claims will be subject to all NCDs and LCDs.
Will the testing confirm
payment and return an ERA to
the tester?
No, acknowledgement testing will not
confirm payment. Test claims will receive
277CA or 999 acknowledgement, as
appropriate, to confirm that the claim was
accepted or rejected by Medicare. 
Yes, end-to-end testing will provide an
ERA based on current year pricing.
How many claims can testers
There is no limit on the number of
acknowledgement test claims you can
You may submit 50 end-to-end test
claims per test week.
How do testers submit claims
for testing?
You submit acknowledgement test claims
directly or through a clearinghouse or
billing agency with test indicator “T” in
the Interchange Control Structure (ISA)
15 field.
You submit end-to-end test claims
directly with test indicator “T” in the
ISA15 field or through DDE.
When should testers submit test
You may submit acknowledgement test
claims anytime. We encourage you to test
during the highlighted testing weeks:
March 2 – 6, 2015; and
June 1 – 5, 2015.
You must submit end-to-end test claims
during the following testing weeks:
January 26 – 30, 2015;
April 27 – May 1, 2015; and
July 20 – 24, 2015.
What dates of service do testers use during testing?
You must use current dates of service
during acknowledgement testing.
You must use the following future dates of service during end-to-end testing:
Professional claims – Dates of
service on or after October 1, 2015;
Inpatient claims – Discharge dates
on or after October 1, 2015;
Supplier claims – Dates of service
between October 1, 2015, and
October 15, 2015; and
Professional and institutional
claims – Dates up to December 31,
2015. You cannot use dates in
2016 or beyond.

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