CMS Issues ICD-10 Progress Report

Greg Slabodkin, OCT 30, 2015

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.

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."  

Can ICD-10 Be This Smooth or Has Reality Not Struck?

Health Data Management (10/21/15) Goedert, Joesph

The launch of tens of thousands of new government-mandated ICD-10 codes used to describe diseases and hospital procedures in the billing process has seen few problems in the early days of its launch. The new ICD-10 diagnosis coding system, with its 68,000 codes, is a step up in complexity from the ICD-9 version, with only 13,000 codes. The relatively smooth transition to ICD-10 has been a pleasant surprise for some health care organizations, reports Health Data Management. Alester Spears, CEO at Healthcare EDI Partners, an Atlanta-based consultancy, says that across the spectrum of stakeholders he has contacted, rejection levels on claims submitted to clearinghouses or to insurers and returned for corrections have not spiked. The final one-year delay to ICD-10 compliance gave the industry more time to prepare. Some providers are being especially careful with claims submissions, delaying sending them in until problems with ICD-10 codes were worked out. Everyone Spears has talked to is cautiously optimistic that the current experience will continue, he notes, "but they wonder if the tide has gone out and a big tidal wave is coming." However, industry officials speculate that about the only wave that could come would be a wave of payment denials or lower reimbursements as the volume of remittance advice builds, and a better picture develops.

Joette Derricks, MPA, of Derricks Consulting in Ann Arbor, Mich., said that although things are going well overall, Medicare Part B contractors have been listing a few issues on their websites. In one such example provided to MedPage Today, "a system error impacted providers who submitted claims for these services in which they reported ICD-10-CM diagnosis code Z23. The system issue has caused these claims to deny in error as having an invalid diagnosis code." In another one, "[name of contractor] has identified a claims processing issue in which claims for the following immunization and administration procedures codes incorrectly denied due to an incorrect diagnosis code. Codes: G0010, G0009, 90630, 90669, 90670, 90732, 90739, 90740, 90743, 90744, 90746, 90747." Despite these issues, "Overall it has been positive," Derricks states. "My clients were well prepared with new forms, procedures, and policies. We identified all high-volume diagnoses and it seems like we have about 97 percent of the ICD-10 codes identified. There [have] not been any productivity slowdowns."

Becker's ASC Review says six areas in which providers must be particularly vigilant include payers, technology, manual processes, internal communications, clearinghouses, and physician documentation. One survey reported that "nearly three-quarters [of payers had] begun or completed external testing" by July 30. However, these numbers may be skewed toward larger payers, so it may be months before definitive trend lines emerge providing more information on who was or was not prepared. During the transition, it may be helpful to eliminate as many manual processes as possible. Doing so can help to reduce productivity loss and introduce the practice to new, more efficient technologies. Such a complex transition also calls for seamless communication within the practice. Experts note that continual, efficient communication is essential to prevent repeated errors.

While the ICD-10 transition has been relatively smooth, it has not been without flaws, one of which resides in its EHR technology, according to "For one thing, in our EHR we have our problem lists and when it updated to ICD-10 it left all the problem lists in the ICD-9 format. Now we have to go back and re-change them all one by one," says family practitioner Linda Girgis, MD, of South River, N.J. The result is manual work by the two clinicians in the practice, Girgis and her husband, between patient encounters and beyond. "The doctors are doing it right now," she says. "I'm doing it as I come across different patients, but definitely it's adding time on to the workday." That extra work extends to billers who must spend more time completing their tasks and adapting to the new code set the size of which is hard to cut down because of the nature of the practice. "I'm sure specialists have a much smaller list," adds Girgis. Another issue is the result of the referral system the Girgis practice relies on to get reimbursed. "We had some problem initially doing referrals because the software at the insurance company was not accepting ICD-10, so that was a problem. A lot of the problems now are being smoothed out," Girgis states.