Friday, August 5, 2011

Approaches to ICD-10 Compliance: Beyond Eenie Meenie Miney & Moe

Payers and providers have quite a number of applications and business processes they’ll need to bring into compliance by October 1, 2013. It’s popular to hear and read that applications and business processes will be assessed and “remediated’ while, in fact, applications and processes will be brought into “compliance.”

 

In some cases, vendors will handle the chore of ICD-10 compliance. In other cases, payers and providers will address compliance in-house or with assistance from 3rd parties.  In all cases, one of four general approaches will be used to bring an application or business process into compliance with the ICD-10 mandate:


Insulate

 

This is where logic utilizes ICD-9 only. Any ICD-10 code introduced into the logic is backward mapped to an ICD-9 code.  This is typically the least expensive option for the short run and will be most used with systems that will be retiring.  The downside is this option requires use of a backward crosswalk.

 

Remediate

 

This is where logic utilizes ICD-10 only. Any ICD-9 code will be forward mapped to ICD-10. A benefit of this approach is that it reaches the end state with the least effort and lower system maintenance cost than dual processing.  The downside is remediation requires a forward crosswalk to process run off claims received after the October 2013 cutover date.

 

Dual Process

 

This is where logic is modified to handle both ICD-9 or ICD-10 codes depending on the compliance date and type of claim. The benefit of this approach is that a crosswalk is not needed and it is the least risky option from a service disruption perspective. This option is likely the best approach for strategic business processes and applications.

 

Manual Process

 

This is where business is processed manually; to the point of forcing transactions through the process.  This might be a valid approach for low volume, retiring systems.


A major part of your ICD-10 assessment process should include determining the current lifecycle of your business processes and applications along with their strategic value to your organization. You may be better off retiring, replacing or manually processing some of your business instead of spending a lot of money on full-blown, automated, nearly risk-free compliance.

Good Luck!

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