Converting ICD-9 Medical Policies in an ICD-10 World
HEALTHCARE IS ALWAYS CHANGING. SO ARE THE STANDARDS THAT DEFINE CONDITIONS AND THE SERVICES USED TO MAINTAIN AND IMPROVE THESE CONDITIONS. YOUR POLICIES MUST REFLECT THESE CHANGES TO STAY RELEVANT AND ENSURE QUALITY CARE IS DELIVERED AT A REASONABLE COST. MAINTENANCE IS DIFFICULT IF THE METHOD FOR MAINTAINING THESE CODES DOES NOT ADDRESS THE ONGOING CHALLENGES OF INTEGRATION AND SYNCHRONIZATION.
With the volume of ICD-10 codes increasing to more than 140,000 and complex combination codes, a new vocabulary and structural changes will push the limit of current policy management processes and require a renewed focus on medical intent. Regardless of how you choose to remediate your medical policies from ICD- 9 to ICD-10, take a moment to review the effectiveness of how your organization currently manages policies.
VitalPolicies is an enterprise tool for payers to manage the creation, maintenance, workflow approval, publication and remediation of policies used to define rationale and rules for payment for ICD-10. VitalPolicies creates an integrated process for defining policies from end-to-end, supporting efficient maintenance and editing of new and existing policies.
Features and Benefits
| Enterprise policy manager | Replaces the typical silos in most policy processes by allowing different teams to communicate through a common platform that manages the definitions and intentions of policy rules. The application ensures policy writers explicitly define what’s covered – in plain English– so coding analysts may see the intent and select the precise code(s). It clarifies interpretation, which increases accuracy in creating, managing and remediating policies.So everyone can be on the same page for:
Creation and management of a set of code files that define the intent of the policy as related to each set of codes (“rules accessible engine”) |
| Upload current policies | The ability to upload current policies and their coding edits provides value today and a pathway to transition to ICD-10. |
| Single point of truth for all policies | A single location that houses all policies, their iterations and codes that represent each policy. |
| Publish policies to any source from one source | The ability to publish policies to the Internet, Intranet, rules engines and other internal applications. |
| Governance | Tracking updates, changes and user access. |
| Library of ICD-10 policies | A library of generic medical policies that have been converted to ICD-10 allowing you to greatly reduce your cost of remediation. |
| Library of terms | Provides a consistent process for definition and maintenance of key vocabulary terms across all policies. |
| Coding library | A robust embedded code research tool to define and build rules related code sets:
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