Prioritizing ICD-10 testing, with the most critical scenarios taking place first, is advisable as a preferred strategy. Areas of focus include business, clinical and operational functionality. Individual health care payers must each schedule their own end to end testing. Test plans, real medical data and collaboration with partners are all part of the process.
Creating accurate test data for ICD-10 is challenging as this type of data has never before been implemented in full-scale production environment in the U.S. For some indication as to what may happen, we should look north: ICD-10 has been in full production in Canada since 2002. According to AHIMA, Canadian productivity decreased from 4.62 charts per hour just before ICD-10 implementation to 2.5 charts per hour 3 months later, but rebounded to 3.75 charts by 2003 (1 year later). Conversion participants note that both analytical tools and human decision making tools are necessary for success.
ICD-10 implementation will ultimately provide precise diagnoses and treatments, more accurate payments and better tracking of treatment results. Coding mismatches are likely to affect operations for some time: the US Dept of Health and Human Services anticipates an increase in claim errors of 6% to 10%.
Positive Outcomes of Testing
Operational Stability - Accuracy measures such as those for claims payment are maintained at productive levels with new codes.
Clinical equivalency - ICD-9 and equivalent ICD-10 codes define the same characteristics of patient care, and the outcomes meet medical requirements.
Benefit consistency - ICD-9 or ICD-10 code equivalents result in the identical member coverage, with no increase in premiums or co-pays.
Financial consistency - This is the state where benefit payment by the insurer together with recipient copay result in payment coverage.
Real Test Data
Real patient medical data from your practice will provide a solid base for your testing. Using records that reflect the types of cases you treat and submit for reimbursement is the best way to asses the impact of ICD-10 implementation on your practice. Use of test scenarios that match healthcare payers' mappings rather than your practice data is unwise.
Test each of the transaction that will include ICD-10 codes. Transactions and work processes should include claims submission, eligibility and quality reporting.
The AMA provides a fact sheet to meet October 2015 ICD-10 readiness.
Testing Readiness for ICD-10 Overview
Software upgrades are likely to be necessary for your current systems in order for you to be able to send and receive the ICD-10 codes required for reporting and transactions. You must test the systems that send and receive diagnosis codes. Your practice management system is an example. Make certain that the ICD-10 codes are sent from your system, received by the target system, and processed appropriately. HIPAA providers, payers, and clearinghouses are responsible for their own ICD-10 compliance.
The three necessary testing areas to cover are:
- Sending ICD-10 transactions and reports directly or through a clearinghouse
- Receiving ICD-10 transactions and reports and processing them in your systems
- Ensuring payments and cash flow will continue after October 1, 2015
Internal testing is conducted inside a practice. Completing internal testing will allow you to identify and ultimately resolve any internal systems issues related to ICD-10 codes. Testing manual and workflow processes is also important. If your practice works with a billing service, coordinate with them on necessary data collection.
External Testing involves sending and receiving ICD-10 related transactions to your business associates and partners. If the test transactions you’re sending with ICD-10 codes include real patient protected health information (PHI), take care to ensure data privacy. This testing will allow you to identify ICD-10 code issues arising in sending or receiving data. Successful completion of “end-to-end” testing with your partners means that you’re ready to process live transactions.
Overall testing can take 8 to 12 months. Compliance is required for payment as of October 1, 2015.
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