No News is Good News When It Comes to ICD-10

If you’ve been paying attention to CMS’s blog—or ours—you may already know that CMS released its final 2015 ICD-10 metrics at the end of February. In the release, CMS compared data from the fourth quarter of 2015—the three months immediately following the ICD-10 transition on October 1, 2015—to historical baselines. Surprisingly, there was little difference between the claim submission and denial numbers pre- and post-transition—and the total percentage of rejected claims actually decreased after the ICD-10 launch: from a historical rate of .17% to .07% in Q4 of 2015.

In a recent press release, one of the industry’s largest clearinghouses, McKesson’s RelayHealth Financial, announced its own denial rate: 1.6% of the more than 262 million claims that the company processed between October 1, 2015, and February 15, 2016, were denied. According to RelayHealth, “This denial rate is expressed as a percentage of claim dollars that were initially denied for ICD-impacted denial categories in relation to dollars billed on remitted claims. This rate reflects only the denial categories of Authorization/Pre-Certification, Medical Coding, Medical Necessity, and Untimely Filing.” The denial rate—which hasn’t changed significantly since November 2015—represents about $12.9 billion in denied claims (the total estimated dollar amount of claims submitted was $810 billion). According to this article—which summarizes the announcement—“more than 2,400 hospitals and 630,000 providers used RelayHealth Financial revenue cycle management solutions during that time.”

In the press release, Marcy Tatsch, RelayHealth Financial’s vice president and general manager of reimbursement solutions, says, “The good news is that we’re not seeing a marked increase in claim denial rates when it comes to ICD-10, and there is heightened interest in denial management and prevention.” But it’s not all sunshine and rainbows: “The bad news is that as many as one in five claims is still denied or delayed within the normal hospital and provider revenue cycle world, which can mean a dip of as much as 3% in a hospital or health system’s revenue stream.” So, what can you do to improve your own denial rate? Tatsch suggests that providers keep a pulse on overall denial trends by continuing to track the KPIs on the RelayHealth Financial Denials Dashboard as well as “ramp up their broader denial prevention and management efforts.” RelayHealth also created an online resource to help providers strategically reduce and manage denials.


How’s your clinic doing in terms of denials? Have you experienced any rejections since the switch to ICD-10? Complete the form below to tell us your story.