Monthly Archives: November 2015

ICD10 Updates and News

CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally. Generally speaking, Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment. Based on the metrics comparing ICD9 and ICD10 there are lesser claims denied due to invalid coding with ICD10 when compared to ICD9. So far so god, though Noridian for California and Nevada were denying all claims for chiropractic initially they have corrected their error and have reprocessed all previously denied claims.

 

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

 

 

Aetna has reported they are not experiencing any issues with processing ICD-10 claims. Other carriers have so far made no formal announcement but we have not had reports of carriers with any problems or issues with ICD10 processing.

 

Be aware that workers’ compensation claims and personal injury can be exempt from use and does vary from state to state as well as by carrier. The following is a breakdown of what states are using ICD10 and the others who are using ICD9 as well as personal injury carriers.

 

For workers’ compensation, twenty-one states have adopted ICD-10 billing for physicians, hospital inpatients and outpatients, according to WEDI.

They are: Alabama, California, Florida, Georgia, Hawaii, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, South Dakota, Texas and Washington.

Three states have adopted ICD-10 codes for hospital inpatient billing only: Indiana, Maine and South Carolina.

This leaves 26 states that have no plans for adopting ICD-10 for workers comp claims, unless there's a pending ICD-10 regulation: Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Wisconsin and Wyoming.

Personal injury verify with each carrier prior to billing but the following providers have indicated their use of ICD10

  • State Farm Insurance: Will transition to ICD-10 on 10/01/2015. All claims submitted with ICD-10 will be processed accordingly. Additionally, State Farm will continue to process as usual, all claims submitted with ICD-9 diagnoses for an indefinite period of time.
  • American Family Insurance: American Family Insurance is prepared to accept ICD-10 effective 10/01/2015. American Family Insurance will also continue to accept and process claims with ICD-9 diagnoses for an undetermined, but, limited time after 10/1/2015.
  • Progressive Insurance: Progressive Insurance will be transitioning to ICD-10 on the mandated date of 10/01/2015. Claims submit with ICD-9 will be rejected. Providers will receive remittance explaining the rejection and requiring providers to resubmit the claim using ICD-10 diagnosis.
  • GEICO: Will begin accepting ICD10 codes on 10/1/15. Bills with a date of service on or after 10/1/15 must contain a valid ICD10 code. For a date of service prior to 10/1/15 use only valid ICD9 codes. ICD9 and ICD10 codes cannot be combined on a bill.
  • Farmers: Accepting ICD10
  • Nationwide: Accepting ICD10.
  • Safe Co: Accepting ICD10
  • Travelers: Accepting ICD10
  • AAA: Accepting ICD10
  • Allstate & USAA: No confirmation