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
These days, industries all over the world are looking for better ways to analyze data to make smarter decisions that result in superior business results. The healthcare industry is no exception. Considering the need for improved classification of diagnosis and procedures to provide high-quality and more effective patient care, the U.S. Department of Health and Human Services (HHS) has proposed that all healthcare organizations replace the ICD-9-Clinical Modification code sets with advanced ICD-10 code sets. The date of compliance is October 2015. However, the transition to ICD-10 holds a host of challenges for healthcare organizations. An overhaul of the current coding systems and substantial investments in ICD business and IT remediation is the need of the hour.
How HCL can Help
HCL’s i-CRM tool leverages GEMs mapping and additional, more extensive, mapping rules created by Certified Medical coding specialists and Clinical Physicians from HCL using:
- Coding Guidelines
- Coding Rules
- CPT Mapping Rules
- Clinical Integrity Rules
- Combination Rules
- Pricing and Default Rules
Modelling Solution: ICRM’s modelling feature ensures that reimbursements and co-payments are not impacted as a result of the transition. They help highlight areas in the business that has to be mitigated from risks. Diagnosis Related Groups (DRGs) can be moved to a higher or lower reimbursement bracket as a result of the new code set adoption. HCL will guide providers through the task of understanding the DRG assignment and reimbursement implications, thus helping them understand the impact to their business and the contracts proposed by payers.
Mapping Solution: The core issue in remediation is the translation of ICD-9 codes to ICD-10. The complexities within each of these code sets and their subsequent mapping makes this extremely challenging. HCL helps in minimizing productivity impacts and eliminates, to the extent possible, interventions in claims processing due to mapping discrepancies. Different systems within a hospital are made to apply the same set of code selection practices to enable uniform, organization-wide code set adoption.
Some of the uses of translation tools are:
- To translate ICD-9 codes to ICD-10 codes
- Convert DRGs from an ICD-9 environment to an ICD-10 environment
- ICD-10 to ICD-9 cross-walking to assist in reimbursement
While offering translation tools services as part of its overall solution, HCL encourages customers to factor in the ICD translation that will be offered by their product vendors within their core applications. HCL ensures that vendor timelines are included in an overall plan that is laid out to test the individual product’s readiness. With the prospect of multiple product vendors, great stress is laid on ensuring ICD-10 mapping across the different applications, and that all stakeholders work in unison without any clinical or financial impact.
- Conversion Solution: Mapping of patient bills during ICD-9 to ICD-10 conversion will be an essential requirement for all provider organizations. Our conversion solution provides a robust transaction processor to convert patient bills from one code set to another either in batch or online modes. This works as a crosswalk solution for organizations who have considered not to natively remediate their application. It is also a contingency solution for organizations that may be challenged to complete application remediation within the compliance timelines.
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