ICD-10 Executive
Overview
Idaho
ICD-10 Site Visit
Training segments to assist the State of
Idaho with ICD-10 Implementation
Segment Two: Business
Requirements Drive the
Technical Updates
January 26-27, 2012
A Brief Synopsis of
ICD-10
Business Requirements
Drive the Technical
Updates
Policy & Claims
Management
Policy Remediation & Best
Practices
Provider Communication
Managed Care
Analytics, Reporting, &
Program Integrity
Agenda

Introduction – What’s Really Involved

Business Requirements

Technology Updates to Support Business Requirements

Vendor Support

Non Functional Requirements
1
More Than an Update to a Code Set
Source: Cognizant Health Care 2009
2
Determining the Requirements
Errors made during
the requirements
stage account for 40
to 60 percent of all
defects found in the
software program
Business Purpose
Business Process
Models
Business
Requirements/
Business Rules
User
Requirements
Functional
Requirements
Historically known as System
Requirements
Non- Functional
Requirements
3
SMA High Level ICD-10 Implementation
Timeline
Awareness
•Awareness, Communication, and Education/Training
Sep 2010 – Mar 2014
Assessment
Remediation
• Plan for ICD-10 Activities
• Develop Change Requests and Requirements
• Perform an Impact
• Develop Policy Updates, Process Updates, and
Assessment
• Develop a Remediation
Strategy
• Finalize APDs
System Updates
• Execute Systems Testing
Sep 2010 – Jun 2011
Jun 2011 – Jun 2012
End-to-End Testing
• Conduct Internal End-to-End Testing (Level I)
Transition
• Implement Policy,
Process, and System
Changes
• Conduct External End-to-End Testing (Level II)
May 2012 – Jul 2013
Impact
Start
Assessment
Program Completed
Sep 2010
Core ICD-10
Strategies
Developed
Remediation
ICD-10 Changes
Completed
Jun 2011
Jun 2012
Window for developing policy, process, and
system updates
Jul 2013 – Oct 2013
ICD-10 End-toEnd Testing
Completed
Jul 2013
ICD-10
Implemented
and Live
Oct 1, 2013
4
Technology updates must be coordinated…
System
Interfaces
Business
Rules
Preparation
& Planning
System
Engineering
Data
Warehouses
/ Data Marts
User
Interfaces
NonFunctional
Requirements
Architectural
Changes
Auditing and
Logging Code
Translation
Data Definition
& Validation
Vendor
Dependency
5
Business Rules

Update the business rules to reflect revised internal business policies:
–
–
–
–
Re-point all rules that use tabled codes to appropriate reference tables
Re-code rules that are hard-coded to reflect the intent of the rules in ICD-10
Update algorithms
Update claim edits
6
Data Definition and Validation
Data Dictionaries
Validation processes
based on date of
service and code
type
Inbound and
outbound
transactions
File format
specifications
Perform updates across systems
7
Architectural Changes: Structural
Changes Influence Systems
Database Size
(increased codes
per claim)
Dual Code Sets
Code type
support
Alphanumeric
Characters
(place holders)
Field Length
(qualifier)
Systems
Retaining/linking
translated code
to original code
8
User Interfaces
Updates will be needed to the following:

Captions

Data Type Support

Field Length

Data Sources

Code Descriptions Displays

Number of Supported Codes Per Claim
9
System Interfaces
Internal Interface

Exchange of information within an organization
External Interface

Exchange of information within an internal
organization and from an external organization
10
Data Warehouses / Data Marts
Impact to Reporting:
Data Warehouse/
Data Mart

Ability to store data

Retrieve and extract data

Transform and load data

Manage the data dictionary

Update defined
aggregation schemes

Evaluate Grouper Logic –
DRG, DXCG, ETG
Report
11
System Engineering
Evaluation of the hardware or systems engineering environment is critical.
 Hardware and processing capacity
 Dual processing supported in operations and testing
 Test Servers to support varying vendor go-live dates
 Inventory equipment and evaluate the transmission capability and physical storage
of hardware
 Data Server’s ability to support increased claims, records, and other data
 Adequate processing and storage capacity for live operations and testing
 Transmission capacity
 Ability to handle increased call volume and system interaction
12
Auditing and Logging Code Translation
The SMA will need a log to identify each ICD translation
created for each system transaction:

Data translated;

Translation direction;

Purpose of translation;

Date of data translation; and

What was the original code and can you retrieve it?

Who or what performed the translation?
13
Vendor Support

Application Support

Interoperability

Programming and Testing

Appropriate mapping and crosswalk programming

Maintenance and Support
14
Non Functional Requirements
Requirements Governance
Non-Functional Requirements Types
Design Constraints
and Qualification
Legal
System Quality Characteristics
Internal Data
Performance
SMAs should maintain
strong Requirements
Governance to assure
there are proper
controls related to:
• The standard
CRUD
(Create, Read, Update
and Delete)
• Change Control Process
Internal Data
Human Factor
Engineering
(Ergonomics)
Section 508
Privacy
Security
States and Modes
Usability
• Approval processes
Operational
Maintainability
15
Closing Points

Communicate to your teams the importance of evaluating
business processes for ICD-10 impacts to further define
supporting requirements for applications, databases and
enterprise infrastructure.

Identify gaps in business requirements to meet ICD-10
compliance. Inventory of Business Requirements

Work with SMEs from business and IT to identify remediation
strategy advantages and disadvantages. Access hardware.

Communicate timelines with vendors and define common
ground to evaluate ICD-10 vendor readiness.
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