Ten percent of claims filed under ICD-10 rejected

One in 10 reimbursement claims filed under the new ICD-10 codes has been denied since the codes became active Oct. 1. But only a fraction of those denials were the result of coding errors.

The Centers for Medicare & Medicaid Services (CMS) recently released statistics from the first 27 days of ICD-10. It said it received 4.6 million claims per day. Of those, 2 percent were rejected for having incomplete or invalid information.

Including an invalid ICD-10 code caused the rejection of 0.09 percent of claims submitted. End-to-end testing conducted earlier this year had estimated 0.17 percent of total claims would be rejected for this reason.

Having an invalid ICD-9 code caused the rejection of 0.11 percent of claims submitted, compared with the expected 0.17 percent, again based on end-to-end testing.

Of all claims processed, 10.1 percent were denied.

CMS and the American Medical Association earlier announced that physicians would have more leeway when filing claims under ICD-10 in the first year, which may explain the low rejection rate for invalid ICD-10 codes.

The agency said it expects to release more information on the ICD-10 rollout this month. It takes Medicare several days to process claims, and the law requires CMS to wait two weeks before issuing payment. Meanwhile, states can take up to 30 days to process Medicaid claims.

Overall, implementation of ICD-10 has been much smoother than some had expected.

Posted on Nov 04, 2015 by David Twiddy