Final Findings From Medicare

Thankfully, the transition to ICD-10 took place without nearly as much commotion as most of us expected—and prepared for. In fact, according to this article, CMS released its final ICD-10 Medicare claims data at the end of February—and that data showed that “claim denials and submissions post-ICD-10 deviated very little from historical benchmarks.” In other words, three cheers to the entire healthcare industry for turning what could have been chaos into something completely manageable. The article—which summarizes this CMS blog post—notes that CMS attributes much of that success “to its own efforts in physician-facing, collaborative, and education-focused coding initiatives.”

In the post, CMS’s acting administrator, Andy Slavitt, writes, “The ICD-10 implementation had all the hallmarks of how CMS could drive a successful implementation and aim for excellence. The approach we took, which has become our doctrine for getting things done, had four major elements.” Specifically, CMS demonstrated:

  1. A customer-focused mindset
  2. A high degree of collaboration
  3. Responsiveness and accountability
  4. Strong attention to metrics

While we here at ICD-10 for PT are happy to acknowledge CMS’s fruitful efforts and wholeheartedly agree with the importance of these four elements, we believe that a lot of the credit for the ease of this transition rightly goes to you—and all of the other healthcare practitioners who stepped up to the plate to ensure their practices were ready to use the new codes well before October 1, 2015.

With that being said, let’s get on to the findings. Here they are in a handy-dandy table we adapted from CMS:

Final 2015 ICD-10 Claims Dashboard | Medicare Fee-for-Service Metrics

Metrics Historical Baseline Q4 2015 (Oct–Dec)
Total Claims Submitted 4.6 million per day 4.6 million per day
Total Claims Rejected 2% of total claims submitted 1.9%
Total ICD-10 Claims Rejected* .17% of total claims submitted .07%
Total ICD-9 Claims Rejected* .17% of total claims submitted .07%
Total Claims Denied 10% of total claims processed 9.9%

*CMS notes that while the other metrics are based on historical claims submission data, the metrics for total ICD-10 and ICD-9 claim rejections are estimates based on end-to-end testing conducted in 2015, because CMS had not collected this data in the past.


How do Medicare’s claim stats compare to your practice’s? Did you experience any claim rejections or denials following the switch? Fill out the form below to tell us your story.