Another look at claims acceptance rates six months after ICD-10

Claims denial rates have not reportedly grown since the ICD-10 conversion this October.

At this point, the general consensus seems to be that the ICD-10 transition was more or less successful. Despite the lingering concerns over a major catastrophe, the long amount of preparation time and the emphasis on successful implementation may have influenced best practices.

A study announced late this February from RelayHealth Financial, showed that there was no "marked increase" in claim denials, according to Becker's Hospital Review. While this source did find that the denial rate since October 1 has been greater than 1.5 percent, RelayHealth Financial's vice president, Marcy Tatsch, said that the denial prevention efforts are getting more attention now.

Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services, touched on this in a recent post, where he presented some noteworthy statistics about ICD-10 claims.

According to Slavitt, the percentage of ICD-10 and ICD-9 claims rejected, out of those submitted, is about the same. He also referenced some important lessons to be taken from the conversion efforts, such as the need for the CMS to support accountability and collaborate with different organizations.

"It's not glamorous, but daily spreadsheets and scorecards keep complex implementations on track," Slavitt said. "Once we hit October 1, there were critical metrics to track. If doctors were sending us fewer claims, more claims than usual were denied, or a particular state was having trouble processing Medicaid claims, we needed to know as soon as possible." 

Although this can be an encouraging message for provider organizations, future compliance may still require vigilance and support to keep claims denials low. Healthcare coding and consulting services can help perform necessary monitoring and research tasks to help providers continue to adapt to code compliance successfully.

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