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Payerpath aces an ICD-10 test

Are you ready for October 1, 2014? As most U.S. healthcare providers know, the Centers for Medicare & Medicaid Services (CMS) will only accept claims that use ICD-10 codes after that date.

To make sure we’re all ready for this deadline, CMS and its Medicare Administrative Contractors (MACs) recently conducted National ICD-10 Testing Week. Because our Payerpath® solution submits claims to Medicare on behalf of our clients, we participated in the event.

We had some great results. Of the 1,852 test claims we submitted, 99% passed ICD-10 related edits. And 100% of our 96 test files got a positive acknowledgement of receipt. This is a great sign that Allscripts Payerpath solution is ready to help clients transition to ICD-10.

How the testing process worked

Participating clients submitted a small number of test Medicare claims to Payerpath, which contained valid ICD-10 and ICD-9 codes. Test claims included professional and institutional claim types, as well as Durable Medical Equipment (DME), Anesthesia and a variety of specialties.

Payerpath processed these claims in a test database, applied ICD-10 related edits and created ANSI 837 claim files. Payerpath then submitted designated test files directly to Medicare.

After receiving the test claim file, the MACs acknowledged successful receipt. Then it returned a report to confirm that the test batch was successfully processed along with the status of each claim: Accepted or Rejected. Rejected claims included the reason for rejection. Payerpath analyzed these reports and made changes to the system as needed.

At this time the CMS and Department of Health and Human Services (DHHS) only offer front-end testing. That means they’re just testing to make sure providers and clearinghouses can successfully submit claims meeting ICD-10 requirements into the MAC systems.

A more extended testing, called end-to-end testing, involves tracking a test claim through the entire process from submission, through adjudication, remittance and accurate payment. CMS will offer end-to-end testing July 21 – 25, 2014 and will involve more than 500 volunteer submitters for a statistically meaningful, nationwide sample of providers.

Given the lengthy approval process to be a volunteer tester, we’re moving forward with the organizations that participated in the front-end testing.  They are in the best position for us to move quickly and have the best chance to be selected for testing.

Lessons Learned

During testing the Payerpath team learned that ICD-10 injury codes cannot be the primary diagnosis codes. This scenario imitates the injury/E-Code edits many payers already have in place for ICD-9. Payerpath will fix this issue in future versions.

For more information about ICD-10 with Payerpath and other Allscripts solutions visit our website, or clients can access information on ClientConnect.

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About the author

Matthew Fusan is a Strategic Sales Consultant at Allscripts. In this role he is focused on clients’ transition from fee-for-service to value-based care, develops solutions and provides strategic guidance to help clients succeed with alternative payment models and population health management. Prior to this role, Matthew was part of the Allscripts Regulatory Team providing guidance as Allscripts prepared products and services for new opportunities and challenges based on the transition to value-based care. Prior to Allscripts, Matthew held a variety of program management and delivery leadership positions at Blue Cross and Blue Shield of North Carolina and Highmark Blue Cross and Blue Shield. Matthew has more than 15 years of experience in the healthcare industry and holds a Bachelor of Science degree from Penn State University.

1 COMMENT on

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Shari says:

03/27/2014 at 12:43 pm

Congratulations!

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