CMS’ First ICD-10 Claims Check-up Looks Good

CMS’ First ICD-10 Claims Check-up Looks Good

Metrics for Oct. 1-27 provided by the Centers for Medicare & Medicaid Services (CMS) indicate claims are processing normally, the agency claims. Especially heartening for CMS is that rejected claims, so far, are below the baseline in all but one category.

Comparing claims during that period with historical data and results of this year’s end-to-end testing, CMS said the data looks like this:

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
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

CMS said more data will be available later in Novembers, as Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment. Medicaid claims can take up to 30 days to be submitted and processed by states.

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Brad Ericson

Brad Ericson

Publisher at AAPC
Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
Brad Ericson

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Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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