Given that there is one more year to go, the majority of the healthcare organizations should be prepared and ready to accept ICD-10 codes. Payers face a major challenge in working with providers and various clearinghouses to make sure they can accept the codes and have done adequate testing well in advance to avoid any last minute glitches. Most payer organizations need to prepare for the testing phase of ICD-10, which is rather cumbersome and painful considering the sheer number of partners involved.
There are five key areas of testing that are often neglected and are very critical at this stage of the ICD-10 migration. The reality check for ICD-10 readiness is more qualitative than quantitative, compared to other implementations. Being ready for ICD-10 does not mean just running through a high volume of claims and validating the results. It starts with the selection of test scenarios, data and validation. Below are five key areas of testing that healthcare payers need to consider:
- Integration Testing (Internal): This stage involves merging all individual components of ICD-10 impacted modules and executing a test to accomplish the flow of ICD-10 data. The key focus during this phase should be to identify any additional components that have to be coded for ICD-10, optimize work flow with the addition or removal of any new steps for review and approval, and validate the test region to make sure all the required components have been integrated.
- End-to-End Testing (Internal): During this phase, all the additional non-impacted modules and systems are moved to the test region. The key focus for organizations should be to validate that the entire system is functioning efficiently with no major issues, validate all internal and external reports and engage business users in validating the ICD-10 data outputs. Additionally, the objective should be to establish a solid test region that mimics production in all aspects and validates that ICD-10 implementation has been completed and the organization is now ready to engage with external entities.
- Trading Partner Testing - Providers (External): Selection of providers is a very critical first step in achieving success in this stage. Testing partners should be a mix of small and large organizations and a good range of all the impacted transactions involving both manual and electronic submissions. Identification of test scenarios for each provider is very critical. It is important to establish the confidence that not just historical transaction data will work, but that it will also be applicable for newly created test data that satisfies all clinical coding rules. It will be ideal if the payer organization implements a certification process for partners passing this phase of testing, so as to recognize the accomplishment and their readiness to submit and accept ICD-10.
- Trading Partner Testing - Clearinghouses (External): Selection of clearinghouses should be based on the channel of submission, transaction volume history and transaction types. The core objective during this phase is to make sure the trading partner transactions are validated against the implementation guides specific to the organization receiving the file. The majority of the time and effort for implementation is spent during this phase, as it’s one of the most important phases for ICD-10 readiness. Also important during this phase will be to make sure the certification process is very strict and has very specific guidelines.
- Trading Partner Testing – Payers (External): Payer-to-payer testing validates integration with other Payers like FEP, Medicare, Medicaid, etc. This phase ensures data that is received is transmitted and accepted seamlessly by the receiving organization. Further, this phase involves a lot of complex calculations on payments with respect to the primary, secondary and tertiary payers.
Organizations have to maneuver the ICD-10 maze very carefully during these important ICD-10 implementation readiness phases and engage with qualified partners and vendors to successfully complete it. One of the best practices successfully implemented by partners, is to involve multiple vendors responsible for each phase of testing. This provides increased visibility and validation to the testing process. ICD-10 is coming. Are you ready?