Y2K tests show Medicare claims data problems
September 1, 1999 4 minutes read
Y2K tests show Medicare claims data problems
While the news about Y2K preparations is largely encouraging, there is some cause for concern regarding Medicare’s fiscal intermediaries and carriers. Recent testing shows some are not ready for the big change.
The federal Health Care Financing Administra tion (HCFA) requires all intermediaries to future date-test their claims data exchanges with Medi care by submitting claims on a test basis with future dates, such as 01/01/2000, 02/29/2000. Such testing is intended to assure providers, HCFA, and its contractors that the data exchange processes are ready for Y2K.
According to a recent report from HCFA, one Medicare contractor, Nationwide, already has conducted a significant number of such front-end tests with some of their providers. Their experience may suggest problems to consider when assessing an organization’s Y2K readiness.
"Nationwide’s experience shows that a number of these tests are not successful on the first try," the HCFA report says. "Additionally, some small, but significant, percent of these tests fail due to significant problems in the submitter’s processes. These results clearly support the need for, and value of, Y2K testing. HCFA is publishing these results to underscore this testing need and to provide information on these problems in the hopes that other submitters will take steps NOW to identify and eliminate these problems."
Nationwide is a Part B carrier, handling claims from physicians and suppliers for Medicare services. Nationwide receives claims electronically from 7,500 submitters, representing about 17,300 providers. Of that number, 900 of the 7,500 electronic submitters use a claims software system known as MITCH. The software is provided by Nationwide to low-volume submitters to generate electronic claims. The MITCH software is in the National Standard Format (NSF) and is Y2K compliant, HCFA says.
NSF and ANSI formats used
The largest group of electronic billers (4,350) to Nationwide use NSF. Those submitters use a variety of software and other processes to generate claim files in the NSF formats. They are providers who bill Nationwide directly, as well as billing services and clearinghouses. The other group of electronic submitters consists of 2,250 billers who submit ANSI formats. The ANSI submitters also use a variety of processes to generate their claim files in the ANSI formats.
Nationwide has received 501 test files as of July 16, 1999, from the MITCH submitters. Of those, 107 failed to process initially. Upon investigation, Nationwide learned that the predominant errors in those files were related to the failure of the submitter to follow the instructions for conducting the future date front-end test.
Many of those submitters passed the test once they corrected their procedural mistakes and resubmitted the tests. However, it appears that 2% to 3% of the submitters experienced significant failures. Those submitters sent in claims with dates of service in 1900, 1901, etc., when the dates should have reflected 2000, 2001, etc.
Nationwide’s analysis indicates that these submitters were using the MITCH software correctly and followed instructions correctly. However, because the MITCH software relies on a system-generated date, the hardware and/or operating system of the computers the submitters used was not compliant. Thus, the submitters were unable to generate dates after 12/31/1999.
Because of the results of the MITCH submitters’ tests, Nationwide decided it needed to pursue other submitters as well for Y2K tests. As of July 16, it had processed 151 NSF test files. Ninety-two of those files failed on the first try. Again, the most frequent cause was failure to follow instructions.
Noncompliant OS, software may be culprits
However, a more disturbing finding was that 10% of these submitters failed because they supplied dates of service of 1900, 1901, etc., instead of 2000, 2001, etc. Some of these submitters face the same problem as MITCH submitters: The failure is likely attributable to a noncompliant PC or operating system (OS). However, the higher percentage of failures also suggests that their application software may be noncompliant.
These are the overall results:
• 31% of the 660 Y2K tests received have been unsuccessful.
• 21% of the 501 MITCH Y2K tests received have been unsuccessful.
• 44% of the 900 MITCH billers have tested successfully.
• 47% (423) of the 900 MITCH billers have sent in a test.
For more information on HCFA’s Y2K preparations, contact the HCFA Web site at http://list. nih.gov/archives/y2k-edi-provider-l.html. To receive updates by e-mail, send an e-mail note to [email protected]. Leave the subject line blank, and enter the following on the first line of the body of the message: SUBSCRIBE Y2K-EDI-PROVIDER-L Your Name.
"Your Name" should be your first and last name. Do not include middle initials. You may replace your first name with a nickname or any other name that you would like to be addressed by in the list.
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