All Still Quiet on the ICD-10 Front

It has been just over a month since the transition to ICD-10 and so far there have been no major glitches.

The Medicaid claims system, NCTracks, reports that roughly two-thirds of the claims being received are ICD-10 and that the current rate of successful claim adjudication mirrors that for claims submitted prior to October 1, reflecting that most providers have adapted well to the new code set.

The Centers for Medicare and Medicaid Services (CMS) has been carefully monitoring the switch to ICD-10 and says that claims are processing normally, although due to the lag in payment (Medicare must – by law – wait two weeks before issuing a payment) CMS will have more information about the transition in November.

In the meantime, they have issued the following metrics from Oct. 1-27:

 Metrics October 1-27 Historical Baseline*
Total Claims Submitted 4.6 million per day 4.6 Million per day
Total Claims Rejected due to  incomplete or invalid information 2.0% of total claims submitted 2.0% of total claims submitted
Total Claims Rejected due to invalid ICD-10 codes 0.09% of total claims submitted 0.17% of total claims submitted (estimated based on end-to-end testing)
Total  Claims Rejected due to invalid ICD-9 codes 0.11% of total claims submitted 0.17% of total claims submitted (estimated based on end-to-end testing)
Total Claims Denied 10.1% of total claims processed 10% of total claims processed

If you do experience issues with ICD-10, the North Carolina Medical Society (NCMS) has listed resources on our website as well as live help from our Solution Center Coordinator, Belinda McKoy, 919-833-3836 x142.

CMS offers the following resources:

For general ICD-10 information: CMS’ Road to 10 website and www.cms.gov/icd10.

Your first line for help for Medicare claims questions is your Medicare Administrative Contractor. They’ll offer their regular customer service support and respond quickly.

You can contact the ICD-10 Coordination Center.

The ICD-10 Ombudsman, Dr. Bill Rogers, can be your impartial advocate.

 

 
 

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