HighPoint Solutions Launches One-of-a-Kind Master Data Solution for ICD-10 Remediation
The ICD-10 Appliance was deployed on top of the Informatica Master Data Management (MDM) Hub, a single platform approach to multi-domain MDM and an ideal platform for providing a centralized hub for ICD-10/ICD-9 codes, mappings, and translations. The ICD-10 Appliance, serving as a centralized point for disease and procedure master data, is pre-populated with ICD-9 and ICD-10 codes (CM and PCS) and CMS-provided General Equivalent Mapping Specifications (GEMS) and Reimbursement mappings
"Chaos will ensue if payers and providers implement separate, vendor-specific, mappings and rules for each application. The key is to utilize a master data solution to create a single source for ICD-10 and ICD-9 codes, mappings and translations that can be applied uniformly to all applications," said John Wollman, executive vice president of Healthcare.
The appliance addresses key challenges confronting healthcare organizations' remediation initiatives:
- Most payers and providers procure core systems from independent software vendors and are looking to these vendors to remediate core systems. However, each vendor will take a different approach, potentially impacting all downstream systems and business processes.
- CMS has provided base mappings (in the form of GEMS and Reimbursement maps). However, these mappings are far from "one to one" and leave a significant number of decisions for each organization to make. For example, GEMS ICD-10 to ICD-9 mappings have only 4.89% exact matches for CM and only .09% exact matches for PCS. Organizations therefore need a solution that allows them to define overrides and exceptions to the standard mappings for specific trading partners and business functions, which cannot be done or tracked with simple cross-walks.
- ICD-9 will live on for quite some time and historical clinical and operational data is encoded in ICD-9. Obtaining meaningful trends and analytics poses a significant hurdle when firms must reconcile historical ICD-9 data, recent data in both ICD-9 and ICD-10, and future ICD-10 data.
- ICD-10 remediation is coming after most companies finish remediating systems for HIPAA 5010 and will coincide with remediation activities for healthcare reform. It is likely that for most payers and providers, time and cost pressures will make full remediation impossible. Some portion of the systems will need to support conversion between ICD-10 and ICD-9.
"Mapping between ICD-9 and ICD-10 is not a technical problem. It is instead a problem that will impact both clinical and business operations for both payers and providers," said Shekhar Iyer, senior vice president, Healthcare and Public Sector, Informatica. "Providing different translations for various business uses and governing and auditing these decisions automatically are critical to the successful transition to ICD-10. These requirements are tailor-made for Informatica's MDM platform and we think that will become apparent with the ICD-10 Appliance."
The ICD-10 Appliance delivers several key benefits. It enables selective remediation without sacrificing compliance or analytic excellence. It applies business rules uniformly across all processes and applications. The Appliance facilitates consistency in approach and rules when major commercial off-the-shelf applications are sourced from multiple vendors and integrated with internally-developed applications. While the Appliance supports standard mappings, it also permits overrides or extensions based on customer, business process, or function. Finally, it can be easily updated with future changes in mappings or additional value-added mappings.
While the HighPoint ICD-10 Appliance is not a panacea, it will ease the transition to ICD-10 compliance and entail less work than upgrading each application individually. "The deadline for compliance may seem distant, but with diagnosis and procedures codes in virtually every aspect of business operations, payers and providers are running short on time," said Wollman. "The Appliance gives you more time to determine the ROI of remediation by allowing you to gather data and build a knowledge base over time that enables you to make more informed decisions."
To learn more:
- Join our upcoming webinar on December 7th - Why You Need to Take a Master Data Approach to an ICD-10 Implementation with special guest Gregory Barnowsky, Chief Architect of Enterprise Architecture, Independence Blue Cross (IBC). (Link to: http://vip.informatica.com/?elqPURLPage=8264)
- Download our data sheet: ICD-10 Appliance: A Master Data Solution for ICD-10 Compliance (Link to: http://highpoint-solutions.com/documents/whitepapers/ICD-10_Appliance-10-26-10.pdf)
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Note: Informatica and Informatica MDM are trademarks or registered trademarks of Informatica Corporation in the United States and in jurisdictions throughout the world. All other company and product names may be trade names or trademarks of their respective owners.
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