The good news is that there’s nothing but positives to report with regard to the ICD-10 transition. Claims continue to move through the process, payors are accepting, and rejections are very low. The healthcare clearinghouse industry has reported no substantial increase in rejections related to ICD-10. Clearinghouses are finding that their rejection numbers are running about the same as they were prior ICD-10; there has been no significant increase or decrease reported. By the end of October, clearinghouses reported that 99.8 percent of providers are coding claims in ICD-10.
Since the October 1st start to ICD-10, payer front-end rejection rates remain at pre-ICD-10 levels. Both clearinghouse and payer rejection rates are within pre-ICD-10 baseline levels since the transition. We believe that early testing and education were an important component of readiness.
Clearinghouses are seeing some claims with ICD codes with incorrect qualifiers. This issue is likely due to incorrect settings within the vendor’s software (ADVOCATE has not been impacted by this issue). We are seeing pockets of unforeseen issues with very small payers, but these payors are reacting quickly to fix them. Some payers have made changes to their systems after October 1st that are causing unwarranted rejections not related to ICD-10.
All things considered, the transition has been exceptionally smooth. As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.
Kirk Reinitz, CPA