Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

1 Million First Attempt ICD-10 Claims Yield 99% Success Rate

By Jacqueline DiChiara

- Nearly 1,000,000 ICD-10 claims were successfully processed the first time around within the first three weeks of October, confirms a press release from the Advanced Data Systems Corporation (ADS).

ICD-10 claims management codes denials

"ADS was ready for ICD-10 from its first deadline date of October, 2013. Now that ICD-10 is here, it has basically shown itself to be a non-event for our clients, which is excellent,” states David Barzillai, ADS President.

Barzillai predicts future numbers will remain just as high. “We fully expect calendar year 2015 to end the same way for our clients as did 2014: with no less than a 99% success rate on their first attempt clearinghouse claims," he adds.

Others confirm October's ICD-10 success

Similar results with victorious implications have been pouring in as November approaches. Over 13 million institutional and physician ICD-10 claims, valued at over $25 billion, have also been “successfully” processed by RelayHealth Financial since the start of October, as RevCycleIntelligence.com reported.

READ MORE: AHA: Uncompensated Care Costs Worksheet Inaccurate, Inconsistent

Such results are higher in comparison with the 87 percent claims acceptance rate confirmed in August via ICD-10 Medicare Fee-For-Service (FFS) End-to-End Testing conducted by the Centers for Medicare & Medicaid Services (CMS).

Some prominent healthcare leaders are not convinced such numbers from CMS, essentially the precursory data to this week’s update, reflect a truthful account of ICD-10 reality.

Said Robert M. Wah, MD, former President of the American Medical Association (AMA), to RevCycleIntelligence.com, CMS’s end-to-end testing results are severely flawed.

End-to-end testing results, Wah said, depict a sharp decline in claims acceptance from 97 percent to 81 percent. It is probable such results merely reflect physician practices that are highly prepared, he added.

Such numbers are still even higher than earlier reports from CMS regarding a 76 percent “successful acknowledgment testing” acceptance rate.

READ MORE: CMS Suggests Hospital Medicare Reimbursement Policy Changes

Echoing Wah’s opinions, said Jim Daley, Director, IT WEDI Past-chair and WEDI ICD-10 Workgroup Co-Chair of BlueCross BlueShield of South Carolina, to RevCycleIntelligence.com, productivity levels associated with end-to-end testing primarily depend on individual objectives and needs.

There were a limited number of participants involved with CMS’s end-to-end testing efforts, said Daley. He added there were also many who either were simply unprepared to participate in end-to-end testing efforts or simply did not care to involve themselves.

If such reported data from CMS is indeed an accurate indicator of what comes next, perhaps the post-ICD-10 landscape will be one of “very small” productivity loss, nonetheless contradicting numerous earlier surmised affirmations.

What's next around the ICD-10 bend?

Are the aforementioned numbers merely a case of testing a group of high-performing valedictorians via a narrow-minded data collection approach or are they an accurate depiction of how the healthcare industry is faring as the ICD-10 dust settles?

READ MORE: CMS Calls On Rural Hospitals to Join Alternative Payment Model

If the concept of maintaining status quo so quickly is indeed a reality and ICD-10 is, as ADS claimed, "a non-event," are those with revenue cycle management doubts merely worried about a whole lot of nothing?

Healthcare entities are perhaps not necessarily out of the clear just yet. Said George B. Breen, Member of Epstein Becker & Green (EBG) Firm in the Health Care and Life Sciences and Litigation Practices, Chair of the National Health Care and Life Sciences Practice Steering Committee, and Board of Directors member, and Bethany J. Hills, EBG Member in the Health Care and Life Sciences practice, to RevCycleIntelligence.com, healthcare entities should now be actively prepared to respond to aggressive private and public payor audits.

They should similarly anticipate enforcement efforts focused on whether or not clinical documentation supports the ICD-10 code selected, Breen and Hills maintain.

Revenue cycle challenges are perhaps on the immediate horizon. Training and work flow challenges will not necessarily cease when October ends, they confirm. Existing reimbursement arrangements will be affected with healthcare providers experiencing payment delays in coming weeks, they add.

The most immediate measure of overarching ICD-10 success will be financial, said Ken Bradberry, Chief Technology Officer for Xerox Commercial Healthcare, to RevCycleIntelligence.com.

ICD-10 is perhaps a welcome change from ICD-9, implemented in 1979 – the same year as the birth of the Walkman CD player to perhaps help put things more clearly into perspective. With perhaps still-too-soon talk of ICD-11 now appearing on the table, tangible uncertainty about what comes next in terms of denials, reimbursement woes, and the like lingers.

Said Teri Jorwic, Professor of Healthcare Informatics at the University of Illinois at Chicago and ICD-10 Educator, to RevCycleIntelligence.com, “[ICD-10 is] not going to be without its bumps, but for goodness' sake, since 1979, it's time for a change!” 

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