Think..... Before you Crosswalk...
Understanding the gravity of the associated risk as per me, payers should start their crosswalk solutioning with definition of High Level Requirements and the business need assessment. Understanding that forward crosswalk is challenging simple adoption of backward crosswalk will not mitigate the problem. Scenarios in backward map where more than one ICD-9 code is required to translate the ICD-10 code, determine if a 1:1 mapping is possible or to analyze the ICD-10 codes that do not have an ICD-9 map or even decide if a suitable ICD-9 alternative is available will always be a daunting task to accomplish. Above and all to reduce the substantial financial risk out of crosswalk there is an inherent need to identify DRG variations between original and mapped data. Pointing out areas where a more detailed analysis of the CMS maps is required and/or if an alternative map is required is also not that easy. The criticality will further lie in ensuring that the new ICD-10 mappings does not affect their existing benefit policy, pricing, care management or reimbursements to providers.
Honestly, significant work is left to the payer to analyze and determine how best to map the ICD-10 codes with the precursors to reach financial neutrality and clinical equivalency. Payer organization better answer the following before they decide to crosswalk, irrespective of the mapping direction they opt -
• Where in the business process is the need to go to find the ICD-10 equivalent for frequently used ICD-9 codes?
• How best can the GEMs be used and in what different business scenarios?
• What direction of GEMs (forward, backward or reimbursement) serves the transition goal?
• Will an enterprise level map serve the purpose? Or there is need of different maps across the functional areas?
A successful crosswalk implementation will invariably depend on right planning, assessment and analysis. Crosswalk though an intermittent solution, can cause some real catastrophe by defeating the purpose of the transition to ICD-10 which is more specific, accurate and complete to provide improved, effective and efficient healthcare. I would therefore suggest to take the time to do the hard work now instead of paying later!
