Health Information Management

CMS releases promising update on early ICD-10 claims data

APCs Insider, October 30, 2015

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By Steven Andrews
CMS issued its first update this week on how ICD-10 implementation has impacted the industry and backs up early assertions of a relatively smooth transition.
The agency released a fact sheet comparing the number of Medicare claims submitted and denied compared to results from three rounds of end-to-end testing in 2015. Despite generally successful end-to-end testing, groups such as the AMA questioned how accurate the results could be considering the small sample of provider volunteers. The AMA also noted only providers who were likely to be prepared would be participating in the early rounds of testing.  
Despite that, early results compare favorably to those rounds of testing. From October 1-27, CMS received 4.7 million claims for per day. The total amount of claims rejected due to incomplete or invalid information was 2%, equal to the number during the testing rounds. The total number of claims denied was 10.1%, approximately equal to the amount during the testing phase (10%).
In terms of coding errors, providers showed marked improvement compared to the testing rounds. CMS only rejected 0.09% of total claims submitted due to invalid ICD-10 codes, nearly half the rate of 0.17% during end-to-end testing. Amazingly, the overall provider community managed to improve upon the ICD-10 coding of the early volunteers. The percent of claims rejected due to invalid ICD-9-CM codes also dropped from 0.17% during testing to 0.11%.
CMS notes that since Medicaid claims can take up to 30 days to be processed, more information will be available in November. This data also does not take into account claims submitted to third-party payers. 

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