News: Despite predictions, few problems with ICD-10 in 2016

At this time last year, many CDI specialists, providers, and coders worried about the arrival of ICD-10; some spoke of doomsday scenarios with mountains of claim denials and delayed payments. One year later, the debut of ICD-10 is earning widespread comparisons to Y2K, the turn-of-the-century transition for all things computerized that went down in history as a non-event.

Analysts attribute the uneventful launch of ICD-10 to a number of factors, including a one-year launch delay that gave CDI specialists and physicians more time to prepare, and a one-year grace period from CMS that accepts imperfect claims from providers as long as they are in the correct coding category.
 
“The things we’ve heard from the commercial plans is that things have gone much better than expected,” says Rob Tennant, health information technology policy director for the Medical Group Management Association in Washington, D.C. “At the very least, we haven’t heard of any widespread problems with rejected claims and practices not being paid, which was the fear heading into this.

CMS issued a report that showed the rate of rejected claims during the first four weeks of October was the same as it was the previous month under the old ICD-9 coding system. Those trends continued for the remainder of the year.

From October 1 through December 31, 2015, CMS processed an average of 4.6 million claims per day and reported that only 2% of those claims were rejected. That’s compared to a 1.9% rejection rate during the same three-month period in 2014. In total, 10% of claims submitted to CMS during that time were rejected for various reasons compared to 9.9% in the same time period in 2014, results that indicate ICD-10 had virtually no impact on claims data.

Providers reported isolated problems in a few niche areas, most notably in local coverage determination (LCD) edits. LCDs are adopted by individual Medicare Administrative Contractors (MAC) and detail how the MACs will pay for services. The initial problem with LCDs appeared to stem from equivalent ICD-10 codes not being adapted from ICD-9 codes. A similar problem cropped up in the first few months of ICD-10 with national coverage determinations but was corrected with new codes in January. “Most of the issues we heard about from commercial plans were with local coverage determination edits,” says Tennant. “But even that issue has gotten much better.”
Editor’s note: This article was originally published in Physician Practice Perspectives.