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Rate of denied claims mostly unchanged since ICD-10 implementation date

The increased specificity and volume of ICD-10 codes in comparison to its predecessor ICD-9 hasn’t complicated medical coding, judging by the amount of claims denied since Oct. 1, 2015.

That date signifies the deadline by which U.S. healthcare providers were required to begin coding patient diagnoses and treatment episodes using ICD-10. According to vendor RelayHealth — which is owned by McKesson Corp. — among the the 2,400 hospitals and 630,000 providers that use its revenue cycle management services, only 1.6% of their total claims were denied between the ICD-10 implementation date and Feb. 15, 2016. Of the $810 billion in processed claims since last October, only $12.9 billion resulted in denied claims.

Andy Slavitt, acting administrator of CMS, wrote a blog post about the nationwide implementation of ICD-10 that was accompanied by statistics that compared ICD-10 claims and rejections in the last quarter of 2015 to a historical baseline. The results were quite similar and support the idea that ICD-10 hasn’t stopped providers from filing claims. The average number of claims submitted each day in Q4 of 2015 was 4.6 million, matching the number of daily claims measured by CMS’ historical baseline. The total percentage of rejected ICD-9 and ICD-10 claims decreased, with both dropping from historical averages of 0.17% of all submitted claims to 0.07% in 2015 Q4.

In his blog post, Slavitt emphasized the following four lessons learned by CMS in the months since the ICD-10 implementation date that could apply to health IT vendors:

  • Focus on the customers first. Specific to ICD-10, this means understanding providers’ resource and technological needs and answering their financial questions.
  • Collaborate with organizations that share your goals. CMS worked with the American Medical Association, American Hospital Association and many other groups to oversee the transition from ICD-9 to ICD-10.
  • Be available and responsive. CMS received roughly 1,000 questions from providers during the first month of ICD-10 and responded to all of them within three business days.
  • Keep track of data. CMS plotted ICD-10 implementation stats and issues on scorecards and heat maps as a way to track coding trends as they happened.

The preceding advice from Slavitt appears to be worth considering, particularly after the RelayHealth and CMS reports showed that ICD-10 has positively affected claims denial rates.

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