The payer may accept a given claim because the technical parameters are met-i.e., the code is a valid and properly entered ICD-10 code. But there is no guarantee that the claim will be paid at the rate the provider expects, Tennant notes. Testing would help spot those problems early enough to avoid a financial hit for the physician.
"We have to know if, on the technical side, CMS is able to accept Medicare claims with ICD-10 codes, and if the code submitted by the provider is appropriate and will be reimbursed by CMS," he says. "It is critical that CMS be out front and lead the industry. If they choose not to test, what message does that send to the large commercial health plans?"
Industry pressure could convince CMS to reverse its decision and do some end-to-end testing prior to the regulatory deadline, says Kari Hutchison, RN, senior advisor at Impact Advisors, a healthcare information technology consulting firm in Naperville, Ill.
"Essentially, CMS is saying their file format, readjusted for 5010, is able to accept seven characters in an alphanumeric structure and they completed this testing along with that previous effort, so they are ready to go," she says. "They are saying it is up to the health systems, hospitals, and physician practices to ensure they can send the data in that format and they are ready to accept it."