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Is your organization prepared for the ICD-10-CM/PCS conversion?

Payers must evaluate how ICD-9-CM codes are currently being used throughout their organization to ensure cost neutrality.  The scope of this project should not be underestimated: from the coding of pre-existing conditions during the enrollment process, to determining medical necessity and re-negotiating provider contracts, payers will be required to make thousands of mapping decisions based on unique use cases. 

There are no “off the shelf” ICD-10-CM/PCS solutions for payers. 

While useful, the GEMs mappings only provide a starting place for ICD-10-CM/PCS conversion planning.  In many instances, the GEMs mappings are inconsistent or inaccurate, and in some cases, ICD-9-CM codes remain unmapped.  Additionally, the increased granularity of the ICD-10-CM/PCS codes creates situations where multiple mapping alternatives are possible for a single ICD-9-CM concept.  Selecting the optimal mapping for each use case will require payers to review their current benefit plans and identify ICD-10-CM/PCS codes that reinforce their business rules while accurately capturing clinical information. 

Tackle the complexities of the ICD-10-CM/PCS conversion with a user-friendly, browser-based, terminology management solution. 

LEAP I-10 allows payers to simulate the financial,technology and operational impact of the ICD-10-CM/PCS conversion using organization-specific “what if” scenarios. The solution maps actual claims from individual benefit plans, medical policies and provider contracts from ICD-9-CM to ICD-10-CM/PCS using the Centers for Medicare and Medicaid’s (CMS’s) General Equivalency Maps (GEMs) or any other custom-created maps.

These unique, customized, quick-turnaround simulations generate actionable intelligence and allow payers to mitigate risk by preemptively making well informed, strategic business decisions. Armed with this data, custom maps that accurately link ICD-9-CM diagnosis and procedure codes(CM/PCS) to ICD-10 CM/PCS can be easily developed and tested to evaluate payment neutrality and address any additional areas of risk exposure.

• LEAP I-10 for Payers
  
• Enable Enterprise-Wide Terminology Governance
• GEMs+ Conversion Solution