Finding Healthcare Fraud in ICD-10 Using ICD-9 Investigation Schemas
An ongoing concern within every payer’s special investigation unit (SIU) has been how to adapt existing investigations and future analytics to ICD-10 codes. The thought of having to recreate years of investigative knowledgeware is daunting enough, but the thought of having to figure out the ICD-10 equivalents of the ICD-9 based knowledgeware make it feel akin to climbing Mount Everest. But those ICD-10 codes are hiding out and getting exploited, so something must be done.
Context4 Healthcare, Inc. has a solution. We’ve developed an innovative way to find the ICD-10 equivalents to your ICD-9 based investigation schemas. The ICDTransformer Solution will take the ICD-9 codes, along with other pertinent information about the code, and provide you with exact matches to the appropriate ICD-10 codes that should be used in your schemas.
The ICDTransformer Solution can do its work for you two different ways. First, there is a simple to use web-based user interface that allows you to enter the ICD-9 code and other information, with the solution returning to you either an exact ICD-10 match or a small list of accurate, appropriate ICD-10 codes.
The second way to use the ICDTransformer is highly versatile. The solution can be embedded into your investigation systems through the use of a real-time web services interface. This can be especially helpful as the SIU analyzes data over a period of time that crosses over the October 1, 2015 boundary, with both ICD-9 based claims and ICD-10 based claims needing to be included. The ICDTransformer can provide your investigation process the ICD-10 equivalents of your ICD-9 based data, allowing your analysis to make an apples-to-apples comparison with your ICD-10 based data.
Contact Context4 Healthcare today to learn more about how the ICDTransformer Solution Solution can help you maintain the operational efficiency of your fraud prevention program in an ICD-10 world.
