Healthcare Solutions

Our Healthcare Solutions are instrumental for organizations to achieve the Quality Assurance that they need to meet their Compliance & Business Initiatives.

We work on a broad range of Healthcare QA & Software Quality Initiatives including, IT Upgrades, Portals and Compliance Requirements.  We recently have partnered with several organizations in their Quality Assurance efforts for 5010.  As the 5010 compliance projects conclude we are already ramping up our ICD-10 Compliance Approach.

Compliance

  • ImpactAssessments
  • HIPAA
  • 5010
  • ICD-10

IT Initiatives

  • QualityAssurance of New Business Initiatives
  • ClaimsProcessing system upgrades and enhancements
  • Customized Portals
  • Integration with Payers, Providers, Trading Partners and other Stake Holders
tap|QA ICD-10 Transition – What is our Approach?

Our approach to enabling clients to be ready for October 1st 2013 is our ICD-10 Compliance Strategy. In our process we utilize 5 Quality Milestone Deliverables to ensure a successful initiative.

Impact Assessment

  • This should include which parts of your organization are in scope and how your EcoSystem as a whole will be impacted.  Our Quality Assurance view will enable you to understand those impacts and the required quality initiative.

Mapping Process (GEMS)

  • The Mapping Process will not be a crosswalk. Instead using GEMS serves as a starting point to assist in transitioning from ICD-9 to ICD-10.  We utilize GEMS four files as a mechanism for understanding forward and backward mappings between the ICD-9-CM and ICD-10-CM/PCS coding systems.

Business Requirements & Quality Assurance

  • Every policy, procedure, contract, and other business objects currently affected by the use of ICD-9 codes must be reviewed. Your ICD-10 Quality Initiative will be examined for business functionality and to determine if different actions need to be taken due to new granularity and redefinition of diagnosis and procedure codes.  This will provide you with the details for creating traceable requirements and estimates for resource planning.

Data & Environments

  • Each provider should consider their specialty by taking a set of claims, change them to the new coding and then submit to multiple payers to see how they will be paid. All clients will need to have the testing environments available to Payers, Providers and Trading Partners for testing along with multiple test data sets.

Integration Impact

  • The terminology used for ICD-9 codes is very different from the ICD-10 codes. There is a high likelihood that there will be a lot of errors in coding. Your organization will need to be able to validate the impact of what is currently coded and what will need to be coded with ICD-10.  Understanding the different impact points of trading partners, vendors, payers, providers and physicians is crucial.