ICD-10 @ 6 Months


With all the preparation and planning over the past few years for the ICD-10 conversion, one of providers’ biggest concerns was negative impacts on cash flow as providers anticipated reimbursement delays due to claim denials and resubmissions.

Yet, despite those concerns, reports 6 months post-ICD-10 conversion conclude that the conversion has gone better than expected.

The RemitDATA team wanted to uncover the real story, based on actual claims data, and compiled an ICD-10 six-month report to see what the data reveals.

Following is a snapshot of our data for the last six months (Oct. 1, 2015 – March 31, 2016), which we compared to the same six-month period from a year ago (Oct. 1, 2014 – March 31, 2015).

And the results are quite interesting:

  • By service, denial rates appear to be down slightly.
  • Processing times are down.
  • Claims appear to be getting paid faster.

SEE ALSO: ICD-10 Denials & Appeals

Looking at actual data, so far, we echo the industry buzz that touts a smooth ICD-10 conversion, with no major issues. In fact, it would appear so far that ICD-10 denials may be lower than ICD-9 denials.

But the story that isn’t being told is that denial rates and processing times are down, and claims are getting out the door faster – which we would chalk up to being an overall improvement post-ICD-10.

However, there are still many questions and unknowns that remain. For example, will the data change in October 2016, when the grace period ends? Or are we seeing an anomaly in the data?

To date, we’ve concluded that based on what the data is revealing, all appears to be quiet. However, more time and more data is needed to get at the real story, of which we’ll be keeping a close eye and reporting back on our findings.

Type of Service Level I

Denied Rate

(10.01.2015-3.31.2016)

Denied Rate

(10.01.2014-3.31.2015)

Tests

18.2%

17.8%

Exceptions/Unclassified

15.9%

16.6%

Durable Medical Equipment

15.6%

18.4%

Other

14.5%

16.7%

Procedures

12.5%

13.9%

Imaging

11.3%

11.7%

Evaluation and Management

10.8%

11.4%

Processing Time

Number of Days
(10.01.2016-3.31.2016)

Number of Days
(10.01.2014-3.31.2015)

Average Staff Processing Time

15

24

Average Payer Processing Time

13

17

Average Total Processing Time

29

43

Remittance Velocity

Paid within # of Days

Percentage of Claims Paid between

10.01.2015 and 3.31.2016

Percentage of Claims Paid between

10.01.2014 and 3.31.2015

0-30 Days

70.8%

65.3%

31-60 Days

20.9%

18.9%

61+ Days

8.3%

15.8%

Amber Civitarese is director, product management, RemitDATA.

About The Author

Each year more than 350,000 professionals advance their career with Elite Learning.