Physician Note: Relay Health Sees Just 1.6 Percent of ICD-10 Claims Denied

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article summarizes reported ICD-10 claim denial results from a claims processor, highlights a CMS toolkit aimed at helping practices review ICD-10 readiness, and notes OIG’s continued use of analytics-based fraud detection. It is relevant to revenue cycle, compliance, and coding professionals who want a high-level update on claims performance and federal oversight activity related to ICD-10.

Why This Topic Matters

The piece brings together payer-side claims experience and federal guidance that can affect denial management, coding accuracy, and compliance monitoring. It helps readers understand the broader operational environment surrounding ICD-10 adoption and fraud analytics.

Article Sections

  1. ICD-10 claim denial results from RelayHealth

    This section reports claims-processing results from a revenue cycle management vendor during the early ICD-10 period. It focuses on overall denial trends and the scale of claims processed.

  2. CMS Next Steps Toolkit

    This section describes a CMS resource intended to help practices assess ICD-10 progress and identify areas for improvement. It emphasizes general readiness support and coding accuracy resources.

  3. OIG fraud report and predictive analytics

    This section reviews OIG’s annual fraud and abuse control reporting and its emphasis on analytics-based fraud detection. It also references the Fraud Prevention System and its role in Medicare oversight.

What You Will Learn

  • How a claims processor reported early ICD-10 denial trends
  • What type of ICD-10 readiness resource CMS made available
  • How OIG describes its use of predictive analytics in fraud detection
  • Why denial management and prevention remain a focus for providers

Who Should Read This

  • Medical coders
  • Compliance professionals
  • Revenue cycle managers
  • Billing staff
  • Health system administrators
  • Payer relations teams

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