ICD 10 Transformation
The direct impact of ICD code change on the application level may not be big but the ongoing implications of this change will be massive considering its indirect impact affecting complete Financials, Adjudication and Payments, Disease management, Benefit management and other applications & workflows. Therefore, ICD 10 related change should be considered more than just a tactical IT exercise.
The Situation Today
An improved classification of diseases in the diagnostic and the procedure codes is crucial for providing high-quality and effective patient care. Among the developed nations, the U.S. has been a late adopter of ICD 10 codes. The U.S. Department of Health and Human Services (HHS) has proposed that all healthcare organizations replace the current ICD-9-Clinical Modification codes with the ICD 10 codes by October 2014.
However, ICD 10 conversion involves multiple challenges, such as substantial investments in ICD business and IT remediation, an overhaul of existing systems to fit ICD 10 codes, and the development of more-effective models for deriving useful insights from ICD 10 data.
How HCL Can Help
HCL’s ICD 10 Transformation Framework
With vast experience and domain knowledge in healthcare and in the ICD space, HCL can help organizations address most challenges related to the transition to ICD 10. Our ICD 10 transformation framework is designed to mitigate the risks introduced by complex ICD 10 coding structures, align them to the principles of neutrality, and identify and deal with business and technical impacts of the transition. We employ the latest ICD transformation suite to comply with ICD 10 codes.
Through its domain experts, technical CoEs, testing CoEs, and its robust program management and governance model, HCL provides the following services:
Assessment: Business and technical impact assessment using HCL’s Prizm™ framework and eXact methodology
- Enabler: Prizm™ holistically assesses the impact of ICD 10 solutions by processing data from various sources and providing decisive intelligence to management
Remediation: Code analysis and mapping, policy remediation, and application remediation.
- Enabler: HCL’s proprietary iCRM tool (ICD Cross walk and Reimbursement Mapping) helps in mapping, modeling, and cross walk between ICD 9 and ICD 10 codes. CMS-defined GEMs guidelines provide 1-1 approximate maps for up to 77% of the ICD codes. HCL has built more than 200,000 clinical rules along with the GEMs guidelines to reduce 1-many ICD 10 code mappings by 23%. With these rules the iCRM solution delivers 1-1 mappings up to 94%, compared with 77% under GEMs.
Post-Remediation: E2E testing services that include test planning, data generation, and text execution and management.
Test Strategy and Planning: Establishment of the overall test strategy and plan, including details on schedule, metrics, environment, stakeholder identification, and more, and a defined road map with a robust governance framework.
Test Data Generation: Bi-directional translation of the source ICD 9 to ICD 10 code(s) of a given transaction to the equivalent target ICD 10/9 code(s), using custom maps and cross walks. HCL’s tool can convert ICD 9 X12 (837) claim files to their equivalent ICD 10 X12 (837) files.
End-to-End Test Execution and Management: Execution of prioritized test cases for affected areas through implementing testing methodologies, identifying defects, and retesting through HCL’s proprietary TFIB (Test Factory in a Box) framework.
What You Can Expect
- End-to-end ICD 10 transformation services that help payers adhere to compliance mandates and remediate claims processing systems
- A one-stop-shop solution for end-to-end ICD 10 transformation services using HCL’s proprietary tools (i-CRM and iDPC) and services.
- The integration of business, technical, and operation units, and reductions in gaps to stabilize the ICD plan
Enabler: HCL’s iDPC (ICD Data Prepare & Compare) tool helps payers address the challenges in benefit and financial neutrality testing as part of the ICD 10 conversion. iDPC identifies valid test data from historical claims and provides ICD 9 code coverage statistics at various levels, including test deck, test scenario with proper case mix, and more. It also supports end-to-end test management, from data generation to performing case/scenario management.
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