Posted in ICD-10 & Coding

While we wait for ICD-10 claims data, let's look at big data

Carl Natale
by Carl Natale
While we wait for ICD-10 claims data, let's look at big data

We're still waiting to see how the ICD-10 transition will affect revenue cycles and productivity. There are initial reports but the conventional wisdom is that we need to wait to see trends emerge.

In the meantime,  it's worth considering how data is being used to make these determinations. More importantly, how it will be used. That's why Mike Millard and Tom Sullivan live blogged the Healthcare IT News Big Data and Healthcare Analytics Forum.

Data is going to drive more healthcare decisions than ever. It's important to understand where it comes from and how it can be used. Better you make those decisions than someone else.

ICD-10 Reality Check: The First 30 Days

RemitDATA offers a major reason why it's too early to determine the effect of ICD-10 implementation: Only 24 percent of the anticipated claims have been processed. (RemitDATA)

New ICD-10 Metrics Released

Mike Denison, senior director of regulatory compliance programs at Emdeon, offers insights:

  • Clearinghouse and healthcare payer rejection rates are at year-to-date baseline at the end of October.
  • 86 percent of claims received are ICD-10 claims.
  • Very little change in reimbursement rates so far.
  • Commercial payers have lower rates by less than 1 percent.
  • The "Blues" have slightly more than 1 percent lower rates
  • Medicare lowered rates by about 7 percent because of "payment policy changes."
  • Average Medicaid amount is 12 percent higher but its denial rate is down 9.6 percent.
  • Denison expects a better picture at the end of November.

(HDM Top Stories)

Payers Won't Always Be So Lenient in ICD-10

  • Healthcare payers accepting family of codes now will sooner or later want specificity.
  • Electronic health records (EHRs) may not have all the correct ICD-10 codes.

(Physicians Practice)

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