The U.S. Department of Health and Human Services (HHS) released the final rule in Jan 2009 that requires the adoption of ICD-10 code sets by healthcare organizations with a compliance date of Oct 1, 2013. ICD-10 consists of ICD-10-CM which is a U.S. clinical modification to the WHO ICD-10 code set to report diagnoses and ICD-10-PCS which is a U.S. creation to report inpatient hospital procedures. ICD-10-CM replaces the current ICD-9 Vol I and II code sets and ICD-10-PCS replaces the current ICD-9 Vol III code set effective the compliance date.

ICD-10 code sets are significantly different from the current ICD-9 and have a pervasive impact on all healthcare business processes, operations and IT systems. The ICD-10 code set offers increased degree of specificity, greater consistency within the code set and an improved ability to describe a condition through combination codes. The updated code sets will have material impact on provider reimbursements by payer. The code sets enable significant improvements in care management, public health reporting and patient understanding.

In order to assist healthcare entities with meeting the ICD-10 transition deadline, Wipro Healthcare has invested in the development of a structured methodology supported by a number of tools that accelerate the strategy, planning and implementation of the ICD-10 compliance initiatives. Wipro currently offers the following services to healthcare payers and providers and integrated delivery networks to help them achieve a smooth transition to using ICD-10 code sets.

• A comprehensive methodology and framework to plan and execute the ICD-10 Transition Program and prioritize the components of the program
• An impact assessment framework that uses blue-print processes and questionnaire relative to Payer and Provider segments to assess the detailed impact to operations, IT systems and people
• Bi-directional mapping facility as an enterprise API and Web tool to manage the cross-walk between the code sets
• Models to analyze neutrality in payer reimbursements to providers when switching to ICD-10 based contract policies and benefit packages and derive concrete policy and rule changes
• Configuration and set up policy, edit rule changes in specific administrative systems such as Facets, QNXT etc.

• Business Policy Testing framework for Facets, QNXT or other legacy environments that provides an inventory of test cases that can be customized to your environment
• Integration Testing for ICD-10 using HIPAA 5010 transactions using WiTES, our original 5010 Test Accelerator tool ported now to enable ICD-10 testing
• Neutrality Simulation Testing for Providers that allows integration testing with Payers and ensure that the transition will remain revenue neutral

Wipro will work with your organization to help guide the transition to ICD-10 at an accelerated pace using our pre-built jump-start solutions that will be customized to your specific needs.