CMS releases latest 2015 ICD-10 findings

According to a report issued by the Centers for Medicare & Medicaid Services, the introduction of the latest iteration medical coding regulations – ICD-10 – was quite successful. This is especially noteworthy because, as the CMS stated, many people within the healthcare industry and beyond were very skeptical that the transition would be smooth and would not disrupt revenue flow or increase denials.

Bloomberg reported that part of this success has to do with a one-year grace policy that the CMS has afforded. A fair warning and plenty of time for providers to prepare was also instrumental in making sure ICD-10 was minimally disruptive, if at all.

When it was first announced, there was immediate backlash and trepidation. Since then, however, the industry has done a commendable job at adapting to these new regulations. The CMS found that there were very few increases in administrative or logistical errors, and rejection rates for claims were especially low.

Minimizing rejections
According to the CMS report, there were 4.6 million Medicare claims submitted each day in the final quarter of 2015. Not only is that number on par with the kind of submission rates found under ICD-9, but it is a consistent number overall.

Overall, an average rejection rate of 2 percent is to be expected for all claims, the report found. In the final quarter of 2015 under ICD-10, roughly 1.9 percent of claims were rejected. This finding indicates that implementing ICD-10 did not in fact raise rejection rates as some had feared. 

In the fourth quarter, both ICD-9 claims and ICD-10 claims were rejected at a rate of 0.07 percent. Historically, ICD rejection rates have been closer to 0.17. This may be because the industry is getting more comfortable with ICD use, but also that this latest version is in fact easier to use.

Even beyond an initial rejection, the CMS report stated that historically, roughly 10 percent of all claims are denied. Under ICD-10, there has been a denial rate of 9.9 percent, which is yet another metric suggesting that ICD-10 has not interfered with daily operations within the industry.

According to Bloomberg, the U.S. was the last industrialized country to implement ICD-10 regulations, and now health outcomes in this country are analogous to those around the world. American medical professionals now also can integrate new, global data. 

Moving forward
Healthcare professionals across the country deserve credit for the level of flexibility and preparation that went into making ICD-10 successful. As the world of medicine becomes more connected, ICD-10 regulatory efforts will prove helpful in standardizing the industry while helping minimize clerical errors. While this may improve understanding of population health and make it possible to visualize health emergencies and prepare for new trends, Bloomberg stated there is still work to be done.

Training new professionals on how to use ICD-10 may cause a dip in productivity for some practices, although from there the benefits should compensate for any lost time or concerns on that front. By exhibiting the same proactive thinking that made ICD-10 initially successful, any practice can ensure these sorts of changes come with minimal growing pains.