ICD 10 Services

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US Healthcare is going through some mandatory compliance changes which will have a direct impact on the way information data exchange happens between Providers and Payers. ICD10 migration which impacts the Healthcare codes used for Patient diagnosis and procedures performed on them is one among these changes and has a massive voluminous impact within existing healthcare systems using these ICD (International Classification of Disease) codes.

International Classification of Disease (ICD) is used to provide a standard classification of diseases, symptoms, complaints and external cause of injury for the purpose of health records.

It is the responsibility of The World Health Organization (WHO) which assigns, publishes, maintains and uses the ICD to classify diseases and to track mortality rates based on death certificates and other vital health records. These codes are revised periodically and currently they are in its tenth edition commonly called as ICD10CM. Next version which will be ICD11 is slated to be rolled out around 2015.

The change adopted within US Healthcare systems has two final changes supporting the continued transformation of the U.S. healthcare system toward a comprehensive electronic data exchange environment.

First is the adoption of the Accredited Standards Committee (ASC) X12 005010 standards for healthcare transactions and the National Council for Prescription Drug Programs (NCPDP) Version D.0 for pharmacy transactions (ASC X12 5010/D.0.). This is a pre-requisite for the implementation of the second rule which addresses the adoption of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding.

The ICD-10 Challenge

  • The foremost requirement of EDI 5010 implementation should have been successfully achieved. This is a preset if not achieved, the Trading partners will not be able to exchange the data having ICD10 codes.
  • Since the complexity and volume of code change is huge this requires an extensive training at both the Provider and Payer ends. Physicians, nurses, Business users needs to be sufficiently trained in order to make themselves best quipped with the interpretations of the new codes.
  • During the transition phase and perhaps for some time after – both payers and providers will need forward and backward electronic crosswalks between ICD-9-CM and ICD-10-CM diagnosis codes, and between ICD-10-PCS and ICD-9-CM procedure codes. These should be clearly defined standard crosswalks established out of CMS - Gem’s mapping and which will help in tracking both data and quality and also calculating appropriate reimbursements.
  • Extensive Database testing to validate new codes and Transactions which should include Test Data creation and Management.
  • Regression testing across multiple applications or Test Beds and Ensuring interoperability and successful Transaction processing of the new code sets.

In order to assist healthcare entities with meeting the ICD-10 transition deadline, Shree Partners currently offers the following services to healthcare payers and providers and integrated delivery networks to help them achieve a smooth transition to using ICD-10 code sets.

Shree Partners will work with your organization to help guide the transition to ICD-10 at an accelerated pace using our pre-built jump-start solutions that will be customized to your specific needs.

What Client Need

  • ICD-10 Specific Test Data
  • ICD-10 Specific Test Scenarios / Test Cases
  • Internal Testing
  • External Trading Partner Testing

Some of the important feature a Testing solution should have:

  • Automatic Test data generation
    • Targeted scenario Testing - Provision of Targeted scenario testing to update the individual Claims data within an entire transaction for different Procedure and Diagnosis codes. This is especially useful in creating Business user specific data and also when there are (One – Many, Many – One and Many – Many) mapping of ICD codes
  • Comprehensive dashboard which will track an Input test transaction against a Payment or corresponding response from the core remediated systems
  • Payment comparison dashboard - This is to ensure Business as usual. The dashboard will have facility for the Claims payment comparison when the EDI 837 Claims were processed having ICD9 codes and when the similar Claim has been migrated having ICD10 codes and processed in the remediated system

Shree Partners Testing Solutions

  • Testing Methodology, Automation Tools and TCoE Support
  • ICD-10 Test Scenarios & Test Cases Repository
  • ICD-10 Test Data Generation Tool
  • Cloud Hosting Capabilities
  • Onshore & Offshore Healthcare Domain and Testing Resources

Shree Partners Point of View - Understanding v5010 and ICD-10 System Impacts

5010 AND ICD-10 APPLICATIONS IMPACT ILLUSTRATIVE

Patient Access System Patient Care and Ancillary Systems Patient Care Management Systems Records Management and Coding Systems Billing and Editing Systems Claims Process and Management Systems Contract Management Performance Management
Scheduling EHR Clinical Documentation EHR Ordering Case Management Billing Claims Submission and Claims Reconciliation Provider Management Clinical Performance
Pre-Registration     Charge Capture Host Edits Claims EDI Evaluation of Care Financial Performance
Eligibility and Verification     Discharge Planning Care Completion Billing System Edits Rejections Processing Clinical Performance  
Registration and Admission     Chart Compliance Management Contract Pricing Denial and Appeals    
      Coding/ Grouper and/ or Regrouping        

ICD – 10 Testing Methodologies - Provider

  • Workflow Testing
    • Configuration
    • Patient Administration
    • Ordering
    • Coding
    • Charting
    • Billing
  • Regression Testing
    • Execute Regression Test cases provided by the vendor
  • Patch Testing
    • Analyze Release Notes
    • Create Test cases
    • Execute Test cases
    • Log Issues
    • Report the status

ICD-10 Tools Overview

ICD-10 Tools