Summary
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.
Question
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Acknowledgement Testing
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End-to-End Testing
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Do I need to register for testing?
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No, you do not need to register for acknowledgement testing.
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Yes, end-to-end testing volunteers must register on their Medicare Administrative Contractor (MAC) website during specific time periods.
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Who can participate in testing?
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Acknowledgement testing is open to all Medicare Fee-For-Service (FFS) electronic submitters.
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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.
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How many testers will be selected?
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All Medicare FFS electronic submitters can acknowledgement test.
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50 end-to-end testers will be selectedper MAC jurisdiction for each testing round. You must be selected by the MAC for this testing.
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What will the testing show?
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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.
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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.
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Will the testing test National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)?
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No, acknowledgment testing will not test NCDs and LCDs.
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Yes, end-to-end test claims will be subject to all NCDs and LCDs.
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Will the testing confirm
payment and return an ERA to
the tester?
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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.
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Yes, end-to-end testing will provide an
ERA based on current year pricing.
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How many claims can testers
submit?
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There is no limit on the number of
acknowledgement test claims you can
submit.
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You may submit 50 end-to-end test
claims per test week.
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How do testers submit claims
for testing?
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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.
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You submit end-to-end test claims
directly with test indicator “T” in the
ISA15 field or through DDE.
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When should testers submit test
claims?
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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.
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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.
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What dates of service do testers use during testing?
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You must use current dates of service
during acknowledgement testing.
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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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