The Six-Month Mark: An ICD-10 Status Update

May 17th, 2016

Even after all of the pushback and panic, the transition to ICD-10 seems to have been a successful one. And over the last six months, pre-switch fears about denials, lost revenue, and reduced productivity have proven to be mostly unfounded.

Maybe that’s because providers worked hard to prepare for the transition—or maybe it’s that payers are being more lenient about their requirements (Medicare “grace period,” anyone?). Whatever the case may be, life in the ICD-10 world seems—for the most part, anyway—to be business as usual. In fact, according to a recent Physicians Practice survey:

  • 47.3% of the digital publication’s readers haven’t seen any changes in their denial rates;
  • 60% of practices haven’t seen any impact on monthly revenue; and
  • Denial rates are at a relative baseline, with less than 1% difference between ICD-9 and ICD-10.

The results of this survey seem promising, and news on the ICD-10 front remains fairly quiet. And as the old adage goes, “No news is good news.” Right? Not so fast.

The Silence

Just because we aren’t hearing about problems doesn’t mean they aren’t occurring. This ICD-10 Monitor article highlights a few of the biggest issues that could cause a ruckus:  

  • Medicare Administrative Contractors (MACs) are still working to correct and update local coverage policies. This might sound like a good thing—and it is. However, what MACs aren’t doing is automatically accepting the claims that Medicare wrongly denied (ugh). That means providers have to do the legwork to resubmit those claims.
  • Some EMRs automatically map ICD-9 codes to ICD-10 codes, which is causing costly coding mistakes. Furthermore, some software are just too burdensome to use, and that also has caused unnecessary coding mistakes and drops in provider productivity.
  • A number of the commercial plans that follow Medicare guidelines are incorrectly denying claims based on the NCD and LCD errors. That means—again—that providers are suffering the consequences of the payers’ mistakes.

So, if problems are occurring—but not yet garnering much attention—how do we know the true status of ICD-10? Furthermore, how will these problems affect the future of ICD-10 claim submission?

The Future

Despite the aforementioned issues, CMS is forging ahead with more ICD-10 changes. In fact, in 2017, a hefty crop of new ICD-10 codes will join the code set. “To date, there are 1,900 new ICD-10-CM codes proposed for the October 2017 release,” the AAPC announced. “Of that number, there are 313 deletions and 351 revised codes.” That means ICD-10’s future is looking more complicated than ever. Not only will providers need to account for new codes, but also payers are expected to tighten up their claim acceptance requirements this fall (after the conclusion of Medicare’s “grace period” is over). And once the rest of the major payers start becoming more strict with their coding rules, we’ll truly see whether providers have been coding specifically enough—or if they’ll need to work harder to ensure payment in the future.

The Work

Ultimately, to be successful in the age of ICD-10, providers need to put in the effort to code as accurately as possible. But, how do you know if your coding practices are up-to-snuff? One way practices can get a pulse on their coding know-how is to conduct internal audits. Once you have an idea of which codes are getting denied—and why—you might start seeing patterns. From there, you can work to correct common issues, and thus, reduce your denial rates.


What news have you heard about ICD-10? Is your practice experiencing problems, or does it feel like nothing’s changed? Fill out the form below to tell us about your experience.

The Role of Benchmarking in ICD-10

March 18th, 2016

It’s been nearly six months since the US adopted the ICD-10 diagnosis code set. And overall, providers are feeling pretty solid about the transition. But, to truly call the ICD-10 switch a success, we need to look more at the facts than the feelings. And the best way to get straight to the point is to measure your own success through benchmarking. Here’s what you should evaluate:

Claim Rejection and Denial Rates

You should already know your pre-switch average rejection and denial rates (based on data from your claims containing ICD-9 codes). But, if you don’t, it’s imperative that you go pull some data from claims with dates prior to October 1, 2015. As this ACA International article points out, “Benchmarking is a key component to any effective ongoing revenue cycle management strategy.” So once you have your ICD-9 stats nailed down, you can use them as a benchmark for comparing your clinic’s current performance to its success prior to the transition. Why go to all that trouble? Because doing so will help you see whether the transition has had a positive or negative impact on your clinic’s claim acceptance. In this case, the old adage holds true: you really can’t measure what you don’t track. Plus, the more that payers—including Medicare—toughen up on their specificity requirements, the more rejections or denials you’re likely to see. And if that happens, you can use the data you’ve collected to turn that trend around. To do so, narrow down the codes you submit to the ones with the highest volume and value. Once you’ve identified these codes, you can then review the causes for the rejections, and work to resolve and prevent those issues in the future.

Payment Delays

Just because you’re not seeing a lot of claim denials doesn’t mean your clinic’s revenue hasn’t slowed in the wake of ICD-10. That’s because payers can take an average of 42 days to release payments, and you need to be aware of—and comfortable with—these delays. Now, you don’t have total control over this timeline, but when you know how long it takes to get payment from your payers, you’ll have a better idea of how to manage your cash flow. Furthermore, knowing these limitations can help you manage your response to denials, because you’ll have a good idea of how long it’ll take for a resubmission to be paid. And while you’re at it, this ICD10Watch article explains that “ICD-10 presents an opportunity for process improvements that will enhance the entire revenue cycle.”

Coding Questions

When your staff has coding questions, you should be making note of those questions and ensuring that you—or someone else in your clinic—is following up with answers. If you notice a particular question comes up over and over again, use it as an opportunity to educate your entire staff. Once you start tracking this information and comparing it to your denial and rejection rates, you may find a correlation between the two. As this CureMD article warns, “Negligence in monitoring this information can result in delays and inconsistent coding procedures.” So, the sooner you start managing coding questions, the better.




Benchmarking is the clearest indicator of your ICD-10 success, and now that you know what to look for, you can take the steps to better evaluate your own performance. Are you benchmarking in your own practice? Have questions? Submit them using the form below.

3 Lessons Learned from the ICD-10 Switch

January 19th, 2016
ICD-10, Transition

This month, folks everywhere are making plans to get healthy in 2016. But, unlike many resolutions made in January, ICD-10 is here to stay. We’re already more than halfway through the month, and while gym-goers might start to slack, HIPAA-covered providers don’t have the option to drop the weight of ICD-10. Even if using a new code set isn’t exactly like a new year’s resolution, it’s definitely a new habit. And with any new habit comes a learning curve, and, inevitably, a few lessons learned. So, here’s what we’ve learned since the switch:  

1. Preparation pays.

You’ve probably read this—and, hopefully, experienced it for yourself: ample preparation across the healthcare continuum made the ICD-10 transition a success—so far. This ExecutiveInsight article highlights one piece of the puzzle: “The Centers for Medicare and Medicaid Services offered extensive education and testing services, while private payers and clearinghouses provided a framework for success.” But, it wasn’t just CMS, payers, and clearinghouses that worked hard to get ready for the switch. Providers, billers, and coders put in a tremendous amount of effort, too. They audited their processes, learned how to use the new code set, found solutions to coding and transitional challenges, and stayed on top of communicating with their vendors and payers. Hopefully, the healthcare community as a whole will remember this lesson as we come upon more changes—and challenges—in the future.

2. Mistakes happen.

Prior to October 1, many providers were confused about when to submit ICD-10 codes—especially for those patients with cases spanning the transition date. And after the transition, confusion quickly gave way to mistakes. For example: “Some providers coded ICD-10 based on the calendar date thinking that they needed to use the new ICD-10 code set for claims submitted on or after October 1. ICD-10 requirements actually call for providers to code ICD-10 on claims with dates of service or discharge on or after October 1,” explains the same ExecutiveInsight article. Now that we’re several months into the transition, these mistakes are steadily waning. However, that doesn’t mean practices should coast until another coding change comes around. This Government Health IT article explains the importance of remaining vigilant in auditing processes: “Payers and providers will be well-served by instituting a program for ongoing analysis that specifically compares their assumptions about the effects of the transition against the real time activity they are observing as claims accumulate over the next 12 months.” In summation: providers need to pay close attention to detail if they want to avoid making simple—yet costly—mistakes.

3. Communication is key.

While we’re a long way from achieving total interoperability, making the switch to ICD-10 was a step in the right direction. That’s because interoperability relies heavily on communication, and ICD-10 allows providers a simpler, more accurate way to communicate detailed patient diagnoses to other parties. But, communication isn’t solely about providing accurate and complete diagnosis codes; providers also need to communicate with their payers and even their software vendors to prevent simple misunderstandings. Many practices did a good job of doing just that in the lead-up to the ICD-10 transition. As for those who didn’t? Many of them ended up making mistakes—and suffering delayed payments as a result. So, the lesson here is that communication pays—literally.


Like a good—and sustainable—habit, ICD-10 has given providers plenty of positive takeaways. And for those practices that embrace the changes that lie ahead with a positive mindset and a willingness to put in some effort, the future looks bright for many new years to come. Have you learned any ICD-10 lessons? Fill out the form and tell us your story below.

How Soon Until the US Switches to ICD-11?

December 17th, 2015

First comes love; then comes ICD-10; then comes ICD-11 in, uh, a baby carriage? If only transitioning from code set to code set were so romantic. Unfortunately for us, such is not the case. And in the coming decades, we’re more likely to encounter opposition than the prompt adoption of a fresh-like-a-baby code set—at least in the US. And though some might argue that the recent transition to ICD-10 doesn’t look a whole lot like love, we’re married to the code set now; so, how long until we’re “due” for a transition to ICD-11 (get it)? Here’s what we’ve heard so far:

ICD-10: Less Than Comprehensive

Many healthcare professionals anticipated that the ICD-10 code set would include and account for nearly every single diagnosis and procedure under the sun. And it does—well, almost. Despite ICD-10’s massive list of 69,823 diagnosis codes, this Practice Fusion article explains that “CMS is already issuing corrections and adding new codes to to the ICD-10 set. Just last week, CMS approved additional diagnosis codes that were missing from osteopenia and its ICD-10-CM codes in subcategory M85.8-Other specified disorders of bone density and structure.” If corrections like this one are happening this early in the game, surely we can expect additional updates and expansions as we move forward.

The World Health Organization: Working on It

So, if ICD-10 truly is out of date, when will ICD-11 go into effect and resolve these issues? The short answer: Who knows? Well actually, WHO (The World Health Organization) does know what’s in store for the future of ICD-11. That’s because WHO has been working on its implementation for years. Even this past fall, as providers across the US were adopting ICD-10, ICD-11 was already undergoing updates, testing, and peer review.

And as far as the immediate future is concerned, the WHO has released its plans to present ICD-11 to the World Health Assembly in May of 2018 for endorsement. But, ICD-11 isn’t expected to be a huge transition like the one we experienced with ICD-10. So, for the sake of improvement, maybe another change isn’t so bad, as this HealthcareDIVE article emphasizes: “the good news is the next iteration won’t be coming for awhile, and the change should be significantly less complex.”

ICD-11: The Timeline

In terms of an ICD-11 release timeline, the WHO has formed a plan for ICD-11 that spans from 2015 to 2018. Here’s what’s in store for the next few years, as adapted from this document:

Testing and Peer Review Process

  • January to March 2016: Executive Board update with ICD-10 review
  • April to June 2016: World Health Assembly (WHA) update, including revision process and ICD-10 review
  • September 2016: Revisions conference (hosted in Japan)
  • October to December 2016: Consolidation period with testing and peer review

Testing Strategy and Updates

  • January to March 2017: ICD-11 full testing strategy begins
  • April to June 2017: World Health Assembly update, including revision process and strategies for ICD-10 improvement; testing continues
  • July to September 2017: Full testing strategy finalized

Endorsement Process

  • September to October  2017: Full report on ICD-11 process released; future management approach and endorsement of final products prepared for Executive Board approval
  • November to December 2017: WHO endorses final products and future management approach; WHO readies health information development strategy to present at WHA
  • January to May 2018: Endorsement of final products, future management, and health information strategy
  • May 2018: WHA includes a full report on ICD-11 and endorsement of final products, future management, and health information development strategy


Like I said before, there’s a lot for the WHO to accomplish before 2018. But, even if all of these plans come to fruition, it’ll likely be at least a decade before the US adopts ICD-11. And that means that—just like we had time to adjust to the idea of ICD-10—we still have some time to fall in love with ICD-11. You know—before the wedding bells start ringing (again).

An ICD-10 Ode to Rudolph

December 11th, 2015
Codes, ICD-10

Your old favorite, with a new twist.

Rudolph the Red-Nosed Reindeer (W55.31XA Bitten by other hoof stock, initial encounter),
Had a very shiny nose (Q30.8, Other congenital malformations of nose).
And if you ever saw it (H53.60, Unspecified night blindness),
You would even say it glows (T67.9XXA, Effect of heat and light, unspecified, initial encounter).

All of the other reindeer (W55.89XA, Other contact with other mammals, initial encounter)
Used to laugh and call him names (R45.81, Low self-esteem).
They never let poor Rudolph
Join in any reindeer games (Z60.4, Social exclusion and rejection).

Then one foggy Christmas Eve (T69.9XXA, Effect of reduced temperature, unspecified, initial encounter),
Santa came to say (R47.81, Slurred speech),
“Rudolph, with your nose so bright,
Won’t you guide my sleigh tonight (V80.791A, Occupant of animal-drawn vehicle injured in collision with other nonmotor vehicles, initial encounter)?”

Then how all the reindeer loved him (R00.2, Palpitations),
As they shouted out with glee (H93.13, Tinnitus, bilateral),
“Rudolph the Red-Nosed Reindeer,
You’ll go down in history (Z86.59, Personal history of other mental and behavioral disorders).”

How is CMS Resolving ICD-10 Issues?

December 7th, 2015
ICD-10, Insurance

The Centers for Medicare & Medicaid Services (CMS) recently announced that the transition to ICD-10 caused barely a blip on its radar. As it turns out, though, that optimism doesn’t outweigh the fact that there have indeed been issues on Medicare’s end—and they’ve caused more than a blip in providers’ workflows. Here’s what we know so far:

NCDs and LCDs

The “isolated” issues surround National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). This AACE document defines these terms as follows: “NCDs (National Coverage Determinations) and LCDs (Local Coverage Determinations) are decisions by Medicare and their administrative contractors that provide coverage information and determine whether services are reasonable and necessary on certain services offered by participating providers.” Translation: NCDs and LCDs outline allowable diagnosis codes for payment—which means that when there’s an issue affecting these policies, claims don’t get paid.


In the case of NCDs, claims have been inappropriately rejected or denied. CMS has indicated it is committed to resolving these issues quickly. Specifically, the organization is:

  • automatically reprocessing wrongly rejected or denied claims (in most cases), without requiring any action or additional fees from the affected providers;
  • providing further clarification on, and refinement of, NCDs;
  • creating a permanent system to resolve issues by January 4, 2016; and
  • making information available on Medicare Administrative Contractors (MAC) websites.


Some MACs failed to update certain LCD criteria, which resulted in additional errors. CMS is postponing processing these claims until the updates are complete. In the future, if any claims come in with these same errors, CMS will pause processing until the MACs make the required updates. If providers have any questions, they should contact the appropriate MAC.


Before October 1, CMS made it a point to announce its ICD-10 readiness. Even back in July, the testing results touted success: “the agency stated that its last test run resulted in an 87 percent claims acceptance rate of the 29,286 tests the agency received. The rejection rate for ICD-10 errors was 1.8 percent and the rejection rate for ICD-9 errors was 2.6 percent.” Furthermore, CMS repeatedly assured providers that they had enough resources and staff to effectively handle the transition. In essence, CMS appeared to be totally prepared to tackle the transition.

Or Not

Now, it appears that CMS wasn’t as prepared as we’d all hoped—and believed. Plus, as this Healthcare Payer News article points out, “it’s worth keeping in mind that the government agency has taken several temporary steps to smooth the transition to ICD-10 which may be masking problems that could manifest themselves down the road.” Ouch. But, CMS isn’t the only entity that could encounter problems. This Healthcare Finance article also gives a grim forecast for providers: “Providers that considered themselves unprepared for ICD-10 as October 1 approached shouldn’t assume their currently low claims rejection rates mean their self-assessment was overly pessimistic. If they felt they were unprepared, they probably were. And if they were unprepared for ICD-10 on October 1, they probably still are.”


As explained here, “CMS contractors have moved quickly to take action, such as temporarily suspending edits and/or claims, making fixes as quickly as possible, and reprocessing claims to minimize impact on providers.” That may be reassuring, but we’ve yet to see whether providers themselves were truly ready for the transition.


How Are Providers Handling the Switch?

November 20th, 2015
ICD-10, Insurance, Transition

So far, ICD-10 has arrived on the healthcare scene with very little fanfare. And we haven’t witnessed any major roadblocks or negative impacts on payers, claims, or payments. So with that in mind, how are providers handling the switch?


One of the biggest fears providers had going into the ICD-10 transition was the potential for a huge loss in productivity. So far, though, providers haven’t reported any massive interruptions to their daily workflows. But, could that be because their claims haven’t been denied yet? As this Politico New York article explains, we’ve yet to see ICD-10’s true impact across the board: “One month into the transition to a new, expansive coding system for diseases and health problems, health care providers say it’s still too early to know what sort of repercussions the new system will have on their operations.” As more data comes in about claims and payments—or denials—providers will have a better sense of whether their productivity will suffer moving forward (i.e., how much time they’ll spend correcting and resubmitting claims).


One aspect of ICD-10 that providers worked hard to prepare for was the inevitable change in their coding process. Because the new code set is much more specific, they had to adjust their coding habits to code more accurately. And in these beginning stages, it looks like their efforts are paying off—at least according to this RevCycle Intelligence article: “Nearly 1,000,000 ICD-10 claims were successfully processed the first time around within the first three weeks of October.”

But, to keep this momentum going, providers can’t kick back and get comfortable with their current habits. This Modern Medicine Network article stresses the importance of constant attention to detail and evaluation of processes: “Providers will continue to require coaching on documenting to ICD-10 level specificity and the importance of providing it from the time care is being authorized, all the way through the patient’s treatment plan.”


Even if there is a chance providers could suffer productivity loss in the future, they still stand to gain advantages from the ICD-10 switch. Because the new code set allows for more specificity, claims can be paid more easily—without the time-consuming back-and-forth communication between payers and providers. This Healthcare Informatics article explains that ICD-10 cuts down on “the ‘gigantic paper chase’ for providers, as historically commercial payers have frequently asked for more information or additional details about a procedure when providers submit claims.” So, as long as the transition continues as it has thus far, providers might find that ICD-10 offers more potential than it does pain.


How’s the transition going for you? Are you seeing a drop in productivity? Or has your preparedness helped you take on this transition with ease? Fill out the form below and tell us about your experience, and keep an eye on the blog for more ICD-10 news as information is released.

Thanksgiving Leftovers: ICD-10 Style

November 17th, 2015

What comes to mind when you think of the day after Thanksgiving? Sales? Crazed shoppers fighting over the cheapest television? Furbys? I’ll tell you what I think about: sandwiches. I’m talkin’ awesome turkey-stuffed stacks, complete with Miracle Whip-slathered bread, buttery stuffing, and tart cranberry sauce—served with a heaping side of cold mashed potatoes. Because who really has the time to heat up yesterday’s potatoes when you’ve got a delightful sandwich waiting for you? Amirite? So, what do my day-after-Thanksgiving habits look like in the language of ICD-10? I’m glad you asked. It might look a little something like this:

The Aches

First, I’d probably get a bad case of R14.0, Abdominal distension (gaseous). All that turkey, Miracle Whip, cranberry sauce, and stuffing has to do some damage, right? But to me, a little bloating is a small price to pay for sandwich heaven.

The Pains

A few hours later—after my good ol’ stack has digested—I’m guaranteed to have some wicked heartburn, or R10.13, Epigastric pain. But that’s okay, because by this time, the turkey’s tryptophan is kicking in.

The Gains

All of that brings me to my next diagnosis: I’m showing symptoms of R46.4, Slowness and poor responsiveness. Inevitably, my general grogginess will lead to an afternoon nap. Score! I’m headed straight to snoozeville. Hopefully, I won’t experience F51.5, Nightmare disorder, upon my arrival.

After waking up, maybe I’ll watch some sort of holiday-themed movie for the first time this season—at least I thought it was the first time. Turns out, I’ve had The Grinch on repeat since the end of October. I guess that means I’ve got a mean case of F22, Delusional disorders.


So, is it all worth it? I think experiencing some bloating, heartburn, and grogginess is a small price to pay for an afternoon spent blissfully devouring leftovers while simultaneously avoiding Black Friday sales. But, this year won’t be the first year I’ve indulged in a post-Turkey Day sandwich (or two). So, let’s hope I don’t end up developing K90.0, Celiac disease (e.g., a gluten allergy) come 2016.

Happy Thanksgiving!

ICD-10 News: Payers, and Clearinghouses, and Reimbursements—Oh, My!

November 11th, 2015
ICD-10, Insurance, Transition

“Business as usual” isn’t exactly what most providers expected to hear from The Centers for Medicare & Medicaid Services just a few short weeks after October 1. But, according to CMS, the transition to ICD-10 was just that: successful with nothing out of the ordinary. Of the estimated 4.6 million Medicare claims submitted every day, only 10.1% of those processed between October 1 and October 27 were denied. That’s just 0.1% more than the historical baseline number. But, even with numbers like these, has enough time passed for us to really gauge the transition’s success? Or are our assumptions a bit premature? Here’s the latest news:


Emdeon, one of the largest claim clearinghouses, recently explained in an ICD-10 Watch article that “claims coded in ICD-9 for services before October are still coming in, but 86 percent of claims now being received at Emdeon are ICD-10.” So, even though the majority of claims contain ICD-10 codes, it might be too early to judge the situation with commercial payer reimbursements, because there are still ICD-9 claims lingering in many payers’ backlogs.

To add to the uncertainty, this Medscape Article reveals that some commercial payers took a page from Medicare’s “grace period” book and have been more lenient with denials based on code specificity alone. But how long will this leniency last? The article goes on to warn that “physicians and their billing staffs need to closely monitor the number and causes of denied claims going forward. Commercial insurers, after all, aren’t obliged to overlook specificity mistakes on matters like location and laterality as Medicare is doing.” So, there are no guarantees that payers will forgive specificity mistakes. And it may take weeks or even months to get a pulse on just how unforgiving these commercial payers truly are when it comes to denials.


“Grace period” aside, Medicare payments are coming in at lower-than-average rates. That said, there’s no evidence that connects recent Medicare payment decreases with the transition to ICD-10. Health Data Management recently released an article that explains why: “Medicare payments on average are 7 percent less, but that is due to October payment policy changes.”

Even if these lower payments aren’t due to ICD-10, some providers might be experiencing other problems with Medicare and ICD-10. If that’s the case, CMS urges providers to:


If things seem to be going well for Medicare, the same must be true for Medicaid, right? Unfortunately, this is not a guarantee. Because Medicaid claims can take up to 30 days to be submitted and processed, we have very little information on whether these claims have been successfully submitted, denied, or paid. CMS has even announced they won’t have further news on Medicaid statistics until later this month, at the earliest. But, Mike Denison, senior director of regulatory compliance programs at Emdeon, says that that organization’s initial Medicaid claim data shows that the “average paid amount is 12 percent higher but denied payments—for several reasons that include a claim not meeting contractual policy or a subscriber is not recognized, among others—are down 9.6 percent.” Typically, Medicaid has the highest number of denials. So, why now are payment percentages up and denial percentages down? Maybe the grace period is making its mark in the Medicaid world. We won’t have a definitive answer until more time has passed and more claims have been submitted.


Where does all of this information leave us? Analysis from RemitData found that “year-over-year data reveals that when you compare October 2014 claims processing figures to October 2015, only 24 percent of the anticipated claims volume has been processed for the month of October.” So, that means we still haven’t seen the full ICD-10 picture. However, I don’t think that means providers need to give up hope about seeing the fruits of their labor and preparedness; they just need to be patient. That’s because within the next 60 to 90 days, we might find that ICD-10 implementation is truly “business as usual.”

From the Transition to Today: An ICD-10 Status Update

November 4th, 2015

The ICD-10 transition was feared and fought—and for many, it was fraught with concern over lost productivity and revenue. And that was all for good reason: the transition to ICD-10 was the biggest change most healthcare providers have had to face in their careers.

With so many unknowns, there was bound to be some kind of negative impact, right? That’s the mindset many members of the medical community carried into the transition, and it’s the reason healthcare systems, providers, and payers all over the US braced themselves for the potentially devastating ICD-10 earthquake by preparing, planning—and planning some more. And all of that preparation must have lessened the blow, because it’s already November, and we’re hardly feeling an aftershock. Some organizations have even described coding in ICD-10 as “business as usual.” Case in point: CMS announced on October 30 that they’re “pleased to report that claims are processing normally.” So with total mayhem averted, what does ICD-10 look like today?

The Numbers

Thanks to the millions of ICD-10 claims submitted every day, we already have some definitive data points regarding the number of denials and rejections—and the reasons behind them. Here’s what CMS has found so far:

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
Total claims rejected due to invalid ICD-9 codes 0.11% of total claims submitted 0.17% of total claims submitted
Total claims denied 10.1% of total claims processed 10% of total claims processed

Nothing too shocking, right? Actually, the numbers seem pretty average compared to the historical baselines. But, can we really call the switch a smashing success this early in the transition?

The Waiting Game

Although the initial numbers look promising, some payers take up to 30 days to receive and process claims. That means we still have some time before we’ll know how the transition really went. In addition to the typical payer delays, Medicaid fee-for-service programs in California, Louisiana, Maryland, and Montana announced that they weren’t prepared for ICD-10—period. In this article, Charlotte Bohnett explains that “to work around this issue, those payers are accepting claims with ICD-10 codes, but then crosswalking the codes to ICD-9 in order to calculate reimbursements.” We’ve yet to see what kind of payment delays or inaccuracies will result from this messy workaround. But while we wait for the full payment picture to reveal itself, there are some things you can do in your own clinic to keep things running smoothly:

  • Make sure your staff members—including your front office employees, therapists, and billers—are communicating openly.
  • Figure out the reasons behind any incoming denials; then, work to prevent those types of denials in the future.
  • Audit and adjust your processes to improve productivity.

The Payment Delay Defense

When you focus on improving productivity and accuracy within your practice, your claims stand a better chance of getting paid—and paid quickly. But, how do you measure productivity within your own practice? “One suggestion to measure where your productivity is now is to look at your productivity by coder and/or type of coding from October 2014 through October 2015 to identify if any productivity loss exists, and if so, the percentage of loss,” explains this ICD10monitor article. “This should be a report that you run each month for the next 12 months, looking to make strides to get productivity back to what it was in 2014.” So, you need to not only evaluate your current claim denials, but also keep an eye on your productivity levels throughout the next year. This way, you’ll have a clear understanding of what delays and/or mistakes are holding up your revenue.


So, what does ICD-10 look like for you today? Are you seeing dips in productivity? How about denials? Did the transition leave you running for the nearest door jamb, or did you feel barely a tremble? Send us an email using the form below to share your experience.