At Infosys, our focus on Healthcare is aimed at radical progress in affordability, wellness, and patient-centricity. We believe technology is a catalyst for game-changing healthcare solutions. In this blog, we discuss challenges, ideas, innovations, and solutions for the healthcare economy.

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April 20, 2012

ICD-10 and Meaningful Use - A Win-Win Transformation

Being governed by two separate federal directives, apparently "ICD-10" and "Meaningful use of EHR" are today touted as two distinct and possibly dissimilar goals, though they really are not. Both initiatives are an attempt to achieve two primary targets, i.e., 1) improved quality of care, and 2) reduced cost of care. It is just the means and approaches where they differ. Beyond the obvious congruence of objectives, there are similarities in implementation efforts also. Both "Meaningful use of EHR" and ICD-10 implementations impact not only the similar technology portfolio of the organization but also the same business process landscape and stakeholders, significantly. With understanding of such a common impact spectrum, when one is adopting EHRs for the purpose of meaningful usage, it makes absolute sense to add the ICD-10 logic in there at a small incremental cost rather than to leave the effort to a later day and incur additional, huge implementation bill.

Continue reading "ICD-10 and Meaningful Use - A Win-Win Transformation " »

August 4, 2011

ICD-10: What goes along with Financial Neutrality?

With the transition to ICD-10, payers will certainly leverage the added granularity to improve their existing policies, adjudication rules and benefit categories. So, now certain services will be covered and paid, while others will no longer be covered and might be pended or denied if the claim is filed. These decisions will be crucial during the transition from ICD-9 to ICD-10 because any loss or misinterpretation of information about clinical issues will invariably distort the ability to ensure neutrality with respect to claims payouts. We also know that payers do leverage certain software (DCG/MEG/DxCG/CRGs) to predict their member expenditures or prospective provider reimbursements for members with multiple, combination or complicated conditions. These prediction software systems (which are all in ICD-9 as of today) will be migrated to ICD-10. Lack of clinical coherence in their transformation process will invariably alter the coverage group and risk pool definition, along with the member risk profiling and stratification statistics - all of which will ultimately impact the bigger goal of achieving financial neutrality at an enterprise level.

Please read the complete article in my blog post at ICD10HUb.com.

October 28, 2010

Video: ICD-10: Provider's Best Friend

October 12, 2010

Video: ICD-10: A Next Generation Cost Cutting Tool

Video: Remediation Strategy Oriented ICD-10 Testing

September 24, 2010

Video: ICD-10 tactical solution - locate the landmines at the beginning!

September 23, 2010

Video: ICD-10 tactical solution - not as easy as you might think!

September 22, 2010

Video: ICD-10 tactical solution - when is it appropriate?

June 20, 2010

Payout neutrality using the new MS-DRGv26 is a debate...simulate your payments now

The released version of ICD-10 based MS-DRGs by CMS is technically only a "draft" and the final version expected by 3rd quarter of 2014 is still due for the federal rulemaking process. CMS initiated the project with an intention to produce a grouper that can replicate the existing DRG logic using ICD-10 codes and assign patients the same MS-DRG they would have been assigned to, if they were coded in ICD-9-CM. This means that Medicare is aiming towards financial neutrality for their trading partners.

Continue reading "Payout neutrality using the new MS-DRGv26 is a debate...simulate your payments now" »

June 9, 2010

Video: Necessity of Crosswalks for a successful ICD-10 Implementation

To Learn more about ICD-10 Implementation attend the Infosys' webinar 'Getting Ready for ICD-10'.


June 7, 2010

Video: Strategies for ICD-10 Implementation

To Learn more about ICD-10 Implementation attend the Infosys' webinar 'Getting Ready for ICD-10'.


June 2, 2010

Video: Role of ICD-10 in Health Reform

To Learn more about ICD-10 Implementation attend the Infosys' webinar 'Getting Ready for ICD-10'.


May 17, 2010

Mutually Mandated ANSI X12 275 is the only means for Payers to develop an agile CROSSWALK

The diversity in the nature of ICD-9 to ICD-10 coding means that the task of developing a workable translations and crosswalks is highly challenging and complex. To my opinion any healthcare organization that tries to address all of them only through GEM is at significant risk of paralyzing itself. A thoughtful and rational approach is essential to derive the best from the out of the box maps available in the GEM. But that cannot happen without availability of reference clinical data.

Continue reading "Mutually Mandated ANSI X12 275 is the only means for Payers to develop an agile CROSSWALK" »

March 29, 2010

ICD 10 – Effectiveness of Crosswalks

You’ve read about why ICD-9 to ICD-10 crosswalk is going to be needed during the dual processing period! You are probably also aware that any crosswalk will require additional data to be able to zero in on a single ICD-10 code corresponding to an ICD-9 code. So, what is this additional data? Where will you get the data from? Will whatever you are able get, be sufficient for effective crosswalk?

Continue reading "ICD 10 – Effectiveness of Crosswalks" »

January 29, 2010

ICD 10 – uncertainty around provider reimbursement

CMS has used the opportunity brought in by the increased specificity of ICD-10 codes to increase the granularity of DRG codes. This will help CMS streamline Medicare payments. Since significant number of Medicare and commercial claims is paid based on DRG codes, the added granularity is bound to cause uncertainty around provider reimbursements. This uncertainty combined with the payment reductions under SGR (Sustainable Growth Rate) has the potential to significantly impact providers’ bottom-line. Payers are not immune to the impact either. It’s crucial that payers and providers simulate claim payments, compare the payouts between I9 and I10, and be better prepared for the change.

Continue reading "ICD 10 – uncertainty around provider reimbursement" »

December 28, 2009

ICD 10 – processing adjusted claims

The necessity for dual processing with ICD-10 is not just a result of interoperability between entities on disparate code-sets. Even if we assume that all the payers and providers are migrating to ICD-10 (desirable, but hardly a pragmatic situation) on Oct 1st, 2013 (compliance date), dual processing is going to be required for some adjusted claims and inpatient claims.

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November 20, 2009

HIPAA 5010 transition – building a case for automation

Bad news first… HIPAA 5010 has nearly 1,000 unique changes. Some of these changes (like expansion of patient last name alone) could have thousands of impact points across your applications and databases. Overall, the number of impact points could easily run into a couple hundred thousand for an organization of average size. The direct and indirect impact of these 1,000 changes on the IT systems needs to be analyzed as the first step in the 5010 transition journey.

Continue reading "HIPAA 5010 transition – building a case for automation" »

September 15, 2009

ICD-10 – so what are the ideal timelines?

Is there too less time for ICD-10 transition? Or is there plenty of time? Will my vendor ensure that we’re compliant, or should we engage a consultant to do a thorough gap assessment? These are questions that should be and probably are on every program manager’s mind that’s been entrusted with the ICD-10 implementation in his organization.

Continue reading "ICD-10 – so what are the ideal timelines?" »

July 15, 2009

ICD-10 Coding and Superbill

In the ICD-9 era, the ICD Codes were small in number, though not highly organized as ICD-10 is. Given that the ICD-10 codes bring in the granularity and accuracy to the diagnostic and procedure coding, not to mention decades of familiarity of the coders in ICD-9, how does a provider ensure that these codes are coded correctly?

Continue reading "ICD-10 Coding and Superbill" »

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