CMS Issues First Claims Metrics Since ICD-10 Implementation

29 Oct 2015 | SOURCE: EHR Intelligence

At the start of October, the healthcare industry transitioned from the old ICD-9 code sets to ICD-10. Although it was a highly anticipated transition that caused many industry stakeholders distress throughout the preparation process, many reports have come in stating that ICD-10 is going well.

According to a public statement, the Centers for Medicare & Medicaid Services (CMS) has issued metrics for Medicare fee-for-service payments throughout the first few weeks of ICD-10, substantiating claims that the transition has been successful.

Since the October 1 roll-out date, CMS has received 4.6 million Medicare fee-for-service claims per day. In total, 10.1 percent of claims processed have been denied. Approximately 2 percent of these denials were due to incomplete or invalid information, 0.09 percent were due to invalid ICD-10 codes, and 0.11 percent were due to invalid ICD-9 codes.

CMS reiterated their timeline for processing Medicare and Medicaid claims, stating that it will take several more pay cycles to have a full understanding of how the transition went. Medicare claims take two weeks to process, and by federal law, CMS cannot issue payment until 30 days after claim submittal. Medicaid claims can take up to 30 days to process after having been received by the states.

Provided all of this, CMS states that it will continue to monitor the transition.

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