HighPoint Solutions

With much of their time and energy devoted to Meaningful Use, healthcare reform, and HIPPA, payers have realized that remediating every application and system that uses diagnosis or procedure codes is an overwhelming task with uncertain business value. Instead, firms are taking a more modest approach in which core systems are remediated by vendors while in-house, legacy applications use crosswalks to ‘step down’ inbound transactions from ICD-10 to ICD-9 for processing and ‘step up’ outbound transactions from ICD-9 to ICD-10.

There are several challenges that arise when taking this approach, however.

Core system vendors will provide different offerings and utilize divergent approaches to ICD-10 crosswalks. Consequently, business rules will not be consistent from one application to the next, resulting in errors and anomalies.
Payers will find it challenging to obtain meaningful clinical and financial analytics with historical data still in ICD-9, neo-historical data in both, and future data in ICD-10.
With so few exact matches between ICD-9 and ICD-10 codes, organizations need the ability to define their own business rules and set overrides and exceptions to the standard mappings for specific partners and business functions.

Approach to Avoid – Separate Mappings for Each Vendor/Application

To address these problems, HighPoint Solutions has teamed with Informatica on a master data solution that creates a single business process management layer with centralized rules, mappings, and translations that can be applied uniformly to all applications. Our ICD-10 Appliance, available as software or SaaS, serves as a centralized point for disease and procedure master data and is pre-populated with ICD-9 and ICD-10 CM and PCS codes and GEMS and Reimbursement mappings.

Our Approach – Central Business Process Management Layer with ICD-10 Master Data

In addition to addressing the most common challenges of compliance, the ICD-10 Appliance offers numerous benefits:

Enables selective remediation without sacrificing compliance or analytic excellence
Applies business rules uniformly across all processes and supporting applications
Facilitates consistency in approach and rules when major COTS applications are sourced from multiple vendors and integrated with internally-developed applications
Supports standard mappings while permitting overrides or extensions based upon customer, business process, function, etc.
Can be easily updated with future changes in mappings (e.g. ICD-11) or additional value-added mappings (e.g. CM to PCS)

The ICD-10 Appliance eases the ICD-10 transition by allowing clients to avoid using the dubious ICD-9 to ICD-10 crosswalks and postpone remediation of back-end systems, thus saving time and money. With our experience, tools, and assets, HighPoint’s subject matter experts can help you not only comply with the ICD-10 mandate, but benefit from your investment as well.