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 | 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 submit? | There is no limit on the number of acknowledgement test claims you can submit. | 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 claims? | 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. |
