CMS: ICD-10 Data Show Few Coding-Related Claims Denials

On Thursday, CMS announced that about 10% of claims submitted since the Oct. 1 transition to ICD-10 have been rejected, but only a small percentage of those were denied because of coding issues, Healthcare Finance reports.

Background

The U.S. health care system transitioned from using ICD-9 codes to the ICD-10 code set on Oct. 1. The switch required health care providers and insurers to change out about 14,000 codes for about 68,000 codes.

Stakeholders had reported few problems several weeks into the transition.

Transition Progress

According to CMS, about 4.6 million claims were submitted per day between Oct. 1 and Oct. 27, about the same rate as the historical baseline.

Of all claims processed, 10.1% were rejected, up slightly from the historical baseline of 10%.

In addition, CMS said:

2% of all claims submitted were denied because of incomplete or invalid information;
0.09% of all claims submitted were rejected because of invalid ICD-10 codes; and
0.11% of all claims submitted were rejected because of invalid ICD-9 codes.

According to CMS, the percentage of rejected ICD-9 and ICD-10 codes was slightly lower than the 0.17% estimate for each code based on end-to-end testing (Slabodkin, Health Data Management, 10/30).

CMS, which said that “[c]laims are processing normally” so far, noted that Medicare claims take several days to be processed, at which point CMS is required by law to wait two weeks before issuing payments. The agency added that Medicaid claims can take up to 30 days to be submitted and processed by states.

CMS said it plans to issue another update in November (Walsh, Clinical Innovation & Technology, 1029).

Reaction

Robert Tennant, director of health IT policy at the Medical Group Management Association, said that the transition so far is going “remarkably” smooth, in part because the industry was able to complete enough “‘prep work’ … in the time leading up to the compliance date” (Health Data Management, 10/30).

Meanwhile, George Arges, senior director of the American Hospital Association’s health data management group, said, “The data CMS released … indicate claims are being received and passing the first round of edits at rates similar to pre-ICD-10 levels.” However, he said the organization “will not have a complete assessment of the transition until mid-November,” noting that “the normal rate for processing claims from submission to payment is an average of 43 days”

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Originally Published On: iHealthBeat