ICD-10 Myth Buster: Do GEMs provide simple one-to-one Reimbursement Mappings?
NCHS and CMS have published General Equivalency Mappings (GEMs) as a translation reference between I-10 and I-9 diagnosis and procedure codes. These “one-to-one” mappings translate one I-10 code to either one I-9 code or one cluster of up to six ICD-9 codes. This is why the mappings are referred to as both one-to-one and one-to-many. I-9 Code Clusters In […]
How to identify and deny duplicate claims within EZ-CAP®
While SymKey’s Batch Processing module allows you to create virtually limitless custom scenarios to modify or process claims, there are also several pre-programmed scenarios built into the SymKey® Professional and Hospital Claims modules. Denying Hard Duplicates with SymKey® for EZ-CAP® One of the most widely used SymKey® for EZ-CAP® scenarios automatically denies a list of […]
Free ICD-10 Implementation Tools
Don’t lose sight of the ICD-10 deadline! October 1, 2013 is closer than you think… Did you know? You should have already completed ICD-10 impact assessment, risk analysis, and mitigation planning. If you haven’t, you’re in good company – industry surveys indicate that the majority of healthcare payers are behind on their ICD-10 implementation. Myth […]
ICD-10 Myth Buster: Is the ICD-10 implementation really just a simple code mapping effort?
Many people still believe that the new ICD-10 CM and PCS code set transition from ICD-9-CM will simply involve one-to-one mapping, but it will also require one-to-many general equivalency mappings (GEMs). This will require analysis, system reconfiguration, and thorough staff training. One-To-Many Example With the new ICD-10 coding, sports injuries will be coded with the […]
Implementing Successful Health Care Payer Core Claims System Conversions
Over the span of my career, I have led or been involved in numerous system installations and conversions. It seems like each project involves an out of date or unsupported primary/legacy system that needs to be replaced, which means that a new and exciting system is waiting out there to improve the client’s productivity. As […]
Automate Routine Tasks to Increase Employee Efficiency
HCIM’s SymKey® Kwik Actions™ application increases the efficiency and productivity of Claims Operations staff by automating routine tasks within and around their health care benefit administration system. Kwik Actions are custom developed “hotkeys” that users may utilize on demand to perform a predetermined set of screen navigation steps (keystrokes, mouse clicks, screen navigation and database […]
Estimated Costs and Benefits of Adopting the new ICD-10 Coding System
According to the RAND Science and Technology Policy Institute’s comprehensive technical report on The Costs and Benefits of Moving to the ICD-10 Code Sets, providers will incur costs for computer reprogramming, the training of coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians. The cost of sequential conversion (10-CM […]
Reduce Operational Costs to Alleviate the Burden of Economy & Health Care Reform
Continuing economic pressures and recently enacted Health Care Reform mandates place additional pressure on all health plans and managed care/payers to improve their operational efficiencies and reduce associated costs. Future reductions in Medicare reimbursement rates and increased competition will also require everyone to “do more with less money.” Industry mandated changes for HIPAA X12 5010 transactions […]
HIPAA Transition from 4010A to 5010 – Part 3 of 3
CMS Progress in Implementing the New Standards CMS is well into the process of readying its FFS Medicare systems to handle the 5010/D.0 standards. All Medicare systems will be ready to handle the new standards by January 1, 2011. Medicare plans for its systems to handle the current 4010A standard and the new 5010/D.0 standards […]
FAQ: I see the Batch Processing module is included in my license. Where do we start?
Answer: In SymKey for EZ-CAP v. 1.30 and higher, click the “Documentation” link in the “Help” section on the left side of the SymKey main menu. Select the “Batch Processing Technical Procedure Guide” from the “Documentation” sub menu. The guide provides a detailed overview of the available functionality as well as instructions on how to build and use a Batch […]
