CMS Reports Few Claim Rejections with ICD-10 Coding System

October 29, 2015 - On October 1 of this year, healthcare organizations including payers and providers around the nation switched over from ICD-9 coding to the new ICD-10 version for diagnostic coding. Along with affecting direct patient care, the ICD-10 coding system impacts billing and reimbursement between providers and insurers.

While there was great debate in the months coming up until the transition deadline for the ICD-10 coding system as to how prepared the healthcare industry is and whether it will delay medical payments, no horrific outcomes have been observed so far.

The Centers for Medicare & Medicaid Services (CMS) reports that claims are processing normally since the deadline passed. Essentially, the new ICD-10 coding system is beneficial when it comes to storing more details about a patient’s case and overall health status.

It is thought that the ICD-10 coding system will improve population health monitoring and overall patient care. Medicare claims take several days to process through the system and, once processed, law requires CMS to wait two weeks before making a Medicare payment to a healthcare provider.

Additionally, Medicaid claims take as long as 30 days to process by individual states. As such, CMS will only be able to offer more information on Medicaid claims since the ICD-10 transition deadline once November rolls around.

CMS has been keeping a careful eye on the claim denials and claims processing since October 1. Some of the Medicare fee-for-service claims metrics show that, out of 4.6 million claims submitted per day, only 0.09 percent were rejected due to incorrect ICD-10 codes. Additionally, 0.11 percent of claims submitted were rejected due to null ICD-9 codes.

When comparing these results to ICD-10 end-to-end testing, the percent of rejected claims due to coding errors are even less than expected. CMS also reminded healthcare payers and providers about the need to use ICD-10 qualifiers when filling out diagnoses codes on claims after October 1. More information about ICD-10 qualifiers can be found on the CMS website.

While CMS is reporting overall success with the transition to the ICD-10 coding system, it seems that the size of a healthcare organization determines whether an entity is struggling with the new codes or has effectively transitioned, according to EHRIntelligence.com.

The Coalition for ICD-10 found that larger health systems were successful in pushing forward with the ICD-10 implementation. However, the ICD-10 transition seems to bring a heavier toll on small medical providers, such as those with only one or two physicians running a practice.

“For the commercial payers, everything has gone through smoothly and we're getting paid for that,” family practitioner Linda Girgis, MD, FAAFP, told EHRIntelligence.com. “We still haven't received anything back from Medicare or Medicaid. We're still not sure about that, but all those claims were accepted into their systems to be processed. Nothing was rejected, so that's a good sign. With the commercials, everything has been reimbursed the way it's supposed to be.”

“One of the biggest problems is that our claims go from us to the clearinghouse and then to the insurance company,” explained Girgis. “Even though each one of those people were prepared, the process of mapping it from this place to this place didn't always line up.”

“In the end, everything is going to be smooth, but I also don't know that it was a necessary change other than just adding another mandate on to us. If you think about it, we have meaningful use and now these other criteria. It's really burdensome to small practices trying to keep up with all these mandates,” Girgis posed.

Those seeking additional resources to ensure their hospital or practice doesn’t fall behind in moving forward with ICD-10 can check the Road to 10 website. To answer any questions regarding Medicare claims, providers are advised to speak with their Medicare Administrative Contractor.