CMS Reports 10% Denial Rate in 4.6M Daily Oct. ICD-10 Claims
“CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally.”
By - The ICD-10 transition has come and gone. Although primary affirmations with large numbers to boot have been reported thus far throughout the month of October, is it perhaps too soon to declare ICD-10 implementation a merely underwhelming endeavor?
CMS says it has been vigilantly monitoring the ICD-10 transition's impact on healthcare providers’ enhanced ability to capture more detailed patient data.
“CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally,” the organization states within yesterday's fact sheet.
What will happen come November is still unknown, implies CMS. The ICD-10 waiting game continues as more information and metrics become tangible.
Since Medicare claims are commonly processed within several days and Medicare must wait two weeks before issuing payment according to law, says CMS, more information will become available once November hits.
As RevCycleIntelligence.com reported, CMS was quick to release the following statement on October 1, the day of ICD-10 implementation kick-off:
You may wonder when we’ll know how the transition is going. It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days.
Even after submission, Medicare claims take several days to be processed, and Medicare – by law – must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Because of these timeframes, we expect to know more about the transition to ICD-10 after completion of a full billing cycle.
10/1-10/27 highlights from CMS’s October ICD-10 findings
Nearly one month after such a statement was released, CMS confirms via its attentive monitoring process of the ICD-10 transition, the following Medicare Fee-for-Service claims information is now available:
- CMS reports out of 4.6 million total claims submitted per day, 2 percent were rejected due to either incomplete or invalid information.
- The number of total claims rejected in association with invalid ICD-10 codes was reportedly 0.09 percent.
- CMS confirms 0.11 percent of total claims submitted were rejected due to invalid ICD-9 codes.
- The total amount of claims denied is just over 10 percent, CMS confirms.
Is alleged ICD-10 success here to stay?
As RevCycleIntelligence.com reported, $25 billion worth of 13 million institutional and physician ICD-10 claims among 630,000 healthcare providers and 2,400 hospitals have been “successfully” processed since October 1.
Nearly 1,000,000 ICD-10 claims were successfully processed on the first go-around, resulting in a 99 percent success rate, as RevCycleIntelligence.com additionally wrote.
Although the healthcare industry will perhaps have to wait until a couple of more weeks or so have passed, according to CMS, to obtain a more accurate ICD-10 picture, it is indeed hopeful similar claims of success are not merely transitory victories soon forgotten.
CMS advises yet again to reach out with ICD-10 issues
CMS lists a hearty plethora of ICD-10 coding and claims resources to help guide the industry onwards and upwards come November and beyond.
As RevCycleIntelligence.com reported regarding last month's national provider call with CMS officials, CMS advises contacting the ICD-10 Ombudsman, the ICD-10 Coordination Center, and the Medicare Administrative Contractor.
