CMS Issues ICD-10 Progress Report

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For the first time since the ICD-10 compliance deadline went into effect Oct. 1, the Centers for Medicare and Medicaid Services on Thursday released data indicating that the code transition is going smoothly for those providers that have submitted claims to CMS.

The agency made public metrics detailing Medicare fee-for-service claims from Oct. 1-27. Over the nearly four-week period, CMS reported that 2 percent of total claims submitted were rejected due to incomplete or invalid information—the same rejection rate according to the historical baseline.

In addition, CMS revealed that 0.09 percent of total claims submitted during that timeframe were rejected due to invalid ICD-10 codes, compared to 0.17 percent of total claims rejected based on CMS end-to-end ICD-10 testing conducted last year. The agency also disclosed that 0.11 percent of total claims submitted were rejected due to invalid ICD-9 codes versus0.17 percent of total claims rejected based on end-to-end testing.

CMS noted that metrics for total ICD-9 and ICD-10 claims rejections were estimated based on end-to-end testing conducted in 2015 since the agency has “not historically collected this data” and that other metrics are “based on historical claims submissions.” Overall, CMS indicated that 4.6 million claims per day were submitted Oct. 1-27—the same volume according to the historical baseline—and that 10.1 percent of total claims have been denied, which is almost identical to the historical baseline.

In its release of the ICD-10 metrics, CMS reminded stakeholders that Medicare claims take several days to be processed and that—once processed—by law the agency must wait two weeks before issuing a payment. At the same time, Medicaid claims can take up to 30 days to be submitted and processed by states. “For this reason, we will have more information on the ICD-10 transition in November,” according to CMS.

Also See: 10 Surprises about ICD-10

Robert Tennant, director of health information technology policy for the Medical Group Management Association, commented that the numbers coming out of CMS suggest that the ICD-10 transition is going “remarkably” smooth so far.

“Part of the answer for this, I contend, is the enormous amount of ‘prep work’ the industry completed in the time leading up to the compliance date,” says Tennant, who argues that the “additional time” afforded by delays in the code switchover actually helped in terms of industry readiness. “The additional time was certainly needed by practices and many of their trading partners and it seems that additional time was put to good use. We are continuing, however, to monitor the claims submission and adjudication environment to determine if ICD-10 is having any impact on reimbursement or productivity.”

At the MGMA15 annual conference held earlier this month in Nashville, Tennant told an ICD-10 Town Hall Meeting that he had concerns that clinicians might see less patients because “they’re spending more time on the documentation.” He also said he believed some practices were “holding” claims longer than normal before submitting them to “double check” and make sure that the codes are correct.  

“Medicare fee-for-service systems are processing claims normally and we will continue to monitor operations,” said CMS press officer Jibril Boykin in a written statement, adding that the CMS ICD-10 Coordination Center in Baltimore “continues to help providers across the country.”

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