What’s new with ICD-10?

The latest news from Centers for Medicare & Medicaid Services (CMS) is that the transition to ICD-10 has been successful with just a few small problem areas.

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CMS said the Medicare fee-for-service claims are processing normally.

What is the rejection rate of claims?

  • 2% of claims are rejected due to incomplete or invalid information;
  • 10.1% of all claims are denied.

Rejection at 2% for incomplete or invalid information is the same as normal.

The total Medicare claims denial rate was at 10%, so there has been a small increase. The October denial rate has also been slightly above normal at 1.7%.

In July it was at 1.5% and in August and September the denial rate was 1.6%.

Other problem areas also exist.

For example, screenings for problems have given providers some issues. Providers need to put a non-specific code on the claim because there is no diagnosis.

CMS has been praised as being responsive and efficient in fixing provider problems.

ICD-10 success is not consistent throughout the country. Certain states, such as Mississippi and Indiana experienced much higher percentages of Medicaid claims denied.

We help our clients put the necessary training in place to limit denials and allow claims to process smoothly.

ICD-10 is still fairly new and the success rates of claims will continue to be monitored.

In our next blog post, we will keep you informed of related issues.  To get this important information delivered directly to your mail box, click here to Subscribe.

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P.S. If you or your patients are interested in consumer healthcare issues, check out myhealthspin.com.

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