Q and A_WTC HP Medical Coding_25 Nov 24.pdf

PDF 105 KB Posted Nov 25, 2024

Attached to: RFI - World Trade Center (WTC) Health Program's Medical Coding System Transition
Solicitation number: 75D301-24-RFI-541512
Issued by: Department of Health and Human Services Centers for Disease Control and Prevention Office of Acquisition Services

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Written by GovTribe AI · Nov 25, 2024

This document is a Request for Information (RFI) from the Department of Health and Human Services, Centers for Disease Control and Prevention, Office of Acquisition Services, regarding the transition of the World Trade Center (WTC) Health Program's medical coding system from the International Classification of Diseases (ICD)-9 to ICD-10, ICD-10 to ICD-11, and any future versions. The RFI seeks insights and solutions from qualified organizations to identify effective methods for automating the update of member certification files to the most valid ICD codes, ensuring accurate and seamless alignment with current healthcare standards. Key details include: the WTC Health Program currently uses approximately 3,500 unique ICD-9 codes; the government seeks feedback on project timelines, milestones, and deliverables for the transition; and the government is interested in batch importing for efficient data updates. The RFI also provides background information on the WTC Health Program and links to supplemental resources.

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RFI_WTCHP_ICD 9 Transition Solutions RFI_27 Sep 24.pdf	PDF	Sep 27, 2024

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# Section; Page # Text Referenced in the Solicitation Question Government Response

1 II. Background; Page 2

For treatment, a WTC Health Program provider must diagnose a member with a WTC-related health condition and certify that it is linked to the member’s 9/11 exposure…

How many codes ICD-9 codes are in use for WTC diagnosis. How many ICD codes will WTC required to be updated from revision 9 to revision 10 based on their specific criteria for 9/11 members?

The program currently uses approximately 3,500 unique ICD-9 codes, including codes with a 1:1 mapping to ICD-10. All outdated ICD-9 and ICD-10 codes need to be updated to align with the latest healthcare standards applicable to 9/11 certifiable conditions.

2 I. Purpose, Page 2

The purpose of this RFI is to solicit insights and solutions from qualified organizations regarding the transition of the World Trade Center (WTC) Health Program's medical coding system from the International Classification of Diseases (ICD)- 9 to ICD-10...

What fraction of ICD-9 codes will be converted to ICD-10.

All outdated ICD-9 codes, as well as outdated ICD-10 codes, need to be updated. This ensures alignment with the most current healthcare standards for 9/11 certifiable conditions.

3 I. Purpose, Page 2

Some ICD-9 codes map to multiple ICD-10 codes, distinguished by additional metadata. Will the government provide the additional metadata?

The selected vendor should acquire the resources to complete this task. This is a standard resource that vendors should have access to. It is not anticipated that any additional metadata will be provided.

4 I. Purpose, Page 2

Will the government provide mapping guidelines of ICD-9 codes that have multiple ICD-10 codes? If not, will the government collaborate with the contractor to develop the mapping.

These resources are publicly available or can be acquired by the vendor to accomplish this task. This is a standard resource that vendors should have access to.

5 I. Purpose, Page 2

Will the Government provide the contractor with access to current code sets (ICD-9 and ICD-10) specific to providing healthcare services for 9/11 responders and survivors?

The selected vendor should acquire the resources to complete this task. This is a standard resource that vendors should have access to. The selected vendor will be provided with any program-specific codebook.

6 I. Purpose, Page 2

Does WTC use the industry standard of mapping ICD-9 to ICD-10 codes using GEMs?

The WTC Health Program uses the General Equivalence Mappings (GEMs) as a guideline but may require adjustments specific to its criteria for 9/11-related conditions.

7 I. Purpose, Page 2

Does WTC want to use the industry standard of GEMs for mapping ICD-9 to ICD-10 codes? If not, what is the WTC's preference for mapping from ICD-9 to ICD-10 codes.

The WTC Health Program intends to use GEMs for mapping, supplemented by adjustments that meet the specific needs of its certification process and benefit plan structures.

IV. Information Requested, Page 3

Please provide a proposed approach for a high-level project plan, including key milestones, timelines, and deliverables for transitioning from ICD-9 to ICD-10.

What is the system/application the codes are housed in?

The codes are housed within the WTC Health Program’s claims management and certification systems. Additional technical specifications will be shared with the selected vendor.

IV. Information Requested, Page 3

Please provide a proposed approach for a high-level project plan, including key milestones, timelines, and deliverables for transitioning from ICD-9 to ICD-10.

Is the government interested in batch importing for extraction of the data for ICD-10 updates.

Yes, batch importing will be considered as a method for efficiently transitioning and updating certification files. Detailed technical requirements will be provided to the selected vendor.

10 I. Purpose, Page 2

Has government started the transition process from ICD-9 to ICD- 10 internally? If so, how/where is this documented?

Preliminary data analysis has been completed, but no formal internal transition has started. Data fields have been created and currently exist in the database. The government seeks input from vendors through this RFI to determine the best approach.

11 I. Purpose, Page 2

What is the expected timeframe for completion of the transition from ICD-9 to ICD-10?

The timeline has not been finalized. Feedback from the RFI will help inform a realistic timeframe. The goal would be to have the data reconciled before CY 2026.

12 II. Background; Page 2 The WTC Health Program provides monitoring, screening, and treatment (medical and pharmacy) for 9/11 Responders and Survivors.

Please provide a list of specific health conditions resulting from exposure to airborne toxins, hazards, or any other adverse conditions related to 9/11.

Please review the links provided in this RFI: Information on the WTC Health Program is available at http://www.cdc.gov/wtc. High-level Program statistics can be found at https://www.cdc.gov/wtc/ataglance. The list of the program’s benefit plans, and care suites can be accessed here:

https://www.cdc.gov/wtc/ppm.html#medical_benefitPlans.

13 I. Purpose, Page 2

What is a release date for ICD-11?

ICD-11(International Classification of Diseases, 11th Revision) was officially released on January 1, 2022. This latest version, developed by the World Health Organization (WHO), came into effect globally on that date. WHO continues to support the implementation globally, providing resources and tools to facilitate the transition.

The U.S. has not adopted ICD-11 yet, and no program-specific timeframe has been established.

IV. Information Requested, Page 3

Please provide a proposed approach for a high-level project plan, including key milestones, timelines, and deliverables for transitioning from ICD-9 to ICD-10.

Will the scope of work require the contractor to support traslation of all of the conditons identified on https://www.cdc.gov/wtc/ppm.html#certification_conditions from ICD-9 to ICD-10.

Yes, the Program seeks a solution to automate the process of updating a member's certification file to the most valid ICD code during the transition.

This includes transitioning from ICD-9 to ICD-10, ICD-10 to ICD-11, and any future versions.

Yes, there is a need for translation in the context of cross-walking the mapping from ICD-9 to ICD-10 to ICD-11.

15 I. Purpose, Page 1

Would the government be willing to provide an non-sensitive example record of ICD-9 codes, code text, and additional information that would be used for mapping? If so, please provide an example.

Vendors may reference publicly available resources to understand mapping needs.

16 General N/A

Can the government include additional information regarding the system that tracks the eligibility of the members for the WTC Health Program. Helpful information includes whether the system is a COTS solution such as an EHR/EMR, technology, on-prem versus cloud solution etc.

The intent of this solicitation is a one-time data and records reconciliation to convert ICD-9 codes to ICD-10. The government will provide the dabase to store the reconciled code conversion information. Further technical details will be shared in future acquisition phases as appropriate.

17 I. Purpose, Page 2

Specifically, the RFI seeks to identify effective methods for automating the update of member certification files to the most valid ICD codes, ensuring accurate and seamless alignment with current healthcare standards.

Can the government expand on the current method of updating member certification files both technically and procedurally?

Certification records are a snapshot in time. The results of this one time data reconciliation will be maintained as a separate variable in the database.

Further updates to this field are outside the current scope.

IV. Information Requested, Page 3

3. Please provide a proposed approach for a high level project plan, including key milestones, timelines and deliverables for transitioning from ICD-9 to ICD-10

Does the government have a preferred timeline for the ICD-9 to ICD-10 transition? How about for the ICD-10 to ICD-11 timeframe?

The Program does not have a specific timeline yet and will use RFI feedback to develop timelines for both transitions. The goal would be to have the data reconciled before CY 2026.

III. Supplemental Information, Page 3

This poses a significant challenge: if an ICD code that a member was originally certified for is removed or updated, the system currently lacks the capability to automatically adjust the member's certification file to reflect the most current valid code

Can the government provide information as to their existing ICD cross walk procedures?

Existing crosswalk procedures are primarily manual. The government relies on publicly available crosswalks provided by CMS.

III. Supplemental Information, Page 3

What is the system used to adjust the member's certification file? Is this a manual process? What software is implemented?

Who is currently responsible for this activity, and when does it occur?

The current process is manual and uses customized software. Adjustments are made by program staff as needed based on updated medical information.

The results of this one time data reconciliation will be maintained as a separate variable in the database maintained by the Program. Further updates to this field are outside the current scope.

21 I. Purpose, Page 2 N/A Can the government provide a list of software, technologies, and proceses that will be required to implement these changes?

The program expects the vendor to recommend and propose the software, technologies, and processes necessary to implement the ICD code updates effectively.

22 General N/A Will the government have dedicated staff to work alongside a vendor to do reviews of medical documentation to substantiate payments if required?

Yes, the Program will support the vendor as necessary, including reviewing medical documentation to substantiate payments.

Q&A to Govt

File details come from the government source that posted it. Updated Nov 25, 2024.