Part B Insider (Multispecialty) Coding Alert

Physician Notes:

CMS: 90 Percent of ICD-10 Claims Have Been Accepted So Far

Published on Mon Nov 02, 2015

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Plus: Even Obamacare is at risk of fraud.

ICD-10 has only been in effect for a month, but CMS already appears ready to declare it a success. The agency released some stats about the new diagnosis coding system on Oct. 29, and those numbers are quite positive.

Between Oct. 1 and Oct. 27, Medicare processed 4.6 million ICD-10 claims per day, and only 10.1 percent of them were denied. Out of the denials, 0.1 percent were rejected due to an invalid ICD-10 code, and another two percent were denied because of incomplete or invalid information.

“CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally,” the agency said in the news release. “Generally speaking, 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. For this reason, we will have more information on the ICD-10 transition in November.”

In other news…

You’ve heard about Medicare fraud and even vulnerabilities in Medicaid and Tricare—but who knew that Obamacare was at risk of compliance issues? That’s the word from an Oct. 23 Government Accountability Office (GAO) report entitled Preliminary Results of Undercover Testing of the Federal Marketplace and Selected State Marketplaces for Coverage Year 2015.

As part of the GAO investigation, ten undercover government representatives attempted to enroll in various insurance plans through the Patient Protection and Affordable Care Act (PPACA) portal using either fake Social Security Numbers, duplicate enrollment information or other snags that should have prevented them from enrolling in Obamacare. However, all ten were actually approved by the federal marketplace.

The undercover applicants got approval to join Medicaid or other subsidized health plans, despite obvious problems with their credentials, including one applicant who was not asked for any supporting documentation and was approved via phone.

Somehow, unfortunately, the undercover applicants all slipped through the verification cracks. “Specifically, our fictitious applicants provided invalid Social Security identities, where their information did not match Social Security Administration records, or claimed they were noncitizens lawfully present in the United States and declined to provide Social Security numbers,” the report said. “In situations where we were asked to provide immigration document numbers, we provided impossible immigration document numbers.”

When the GAO presented its findings to CMS, the agency said the federal marketplace only inspects for documents “that have obviously been altered,” so the federal and state government don’t further authenticate documentation that looks genuine. However, several states told the GAO that they intend to tighten security checks for applicants based on the report.

Resource: To read the entire GAO report, visit www.gao.gov/assets/680/673286.pdf .