Only a Small Percent of ICD-10 Claims Denied Due To Coding Errors

On October 1, 2015 health systems across the country transitioned to the International Classification of Diseases, 10th Revision – ICD-10. According to CMS, more than 4.6 million claims have been processed daily since the October 1st transition from ICD-9 to ICD-10, but only a small percentage of those denied claims have come from invalid ICD-10 codes.



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A recent announcement from CMS explains that, while 10 percent of the claims filed between October 1st and October 27th were denied, less than 1 percent of those were denied because of invalid codes. In comparison to their historical baseline, the current ICD-10 denials due to inaccurate codes are even less than the amount of claims denied from invalid ICD-9 codes.

“CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally,” the announcement notes.

HealthIT Outcomes and iHealth Beat quotes George Arges, senior director of the American Hospital Association’s health data management group, as saying, “The data CMS released indicate claims are being received and passing the first round of edits at rates similar to pre-ICD-10 levels.” However, he said the organization “will not have a complete assessment of the transition until mid-November,”noting, “The normal rate for processing claims from submission to payment is an average of 43 days.”

CMS also plans to issue another update in November because many ICD-10 claims have not yet been fully processed. Much of this wait period is due to Medicare claims, which take several days to be processed and, once processed, also take two weeks before issuing a payment. In addition, Medicaid claims can take up to 30 days to be submitted and processed by states.

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