Sometime before Oct. 1, medical practices need to test if the new ICD-10 procedures and tools will work.
The goals are to:
- Verify that medical practices can submit, receive, and process data containing ICD-10 codes.
- Understand the impact that clearinghouse and payer policies will have on the transactions.
- Identify and address specific problems.
The American Medical Association (AMA) simplifies the testing process to:
- Test various transactions with your trading partners to ensure that the ICD-10 codes can be properly transmitted and interpreted by the various systems
- Review test results from trading partners
- Correct any issues identified during testing
That's somewhat less than helpful. So let's take a look at some help from the Centers for Medicare and Medicaid Services (CMS):
Prepare Test Cases
Real world test cases need to be assembled before you start testing.
Identify test scenarios.
- Isolate the ICD-9 diagnosis codes you use the most. Superbills, encounter forms, system reports, and the Common Codes in your action plan can you help you pinpoint this information.
Find encounters which represent the scenarios.
- Locate at least 10 existing encounters/claims which include the ICD-9 diagnosis codes you identified in step one.
Prepare test cases.
Prepare test cases using the encounters identified in step two. Utilize the ICD-9 codes found in the encounters/claims to help identify relevant ICD-10 codes for each scenario. Refer to the following sources of information:
- Tabular form of the 2014 release of ICD-10-CM codes and descriptions published by the National Center for Health Statistics (NCHS) (Open the ICD-10CM_FY2014_Full_PDF.zip file then unzip and save the PDF file named “ICD10CM_FY2014_Full_PDF_Tabular” to your local device)
- Online ICD-10-CM search tools/applications
- Hard copy or electronic publications of 2014 ICD-10-CM code books
- Common Codes from your action plan
- 2014 General Equivalence Mappings (GEMS) Diagnosis Codes and Guide from CMS
- Crosswalks from your system vendors and largest payers
Note – Your practice should natively code in ICD-10. Only use crosswalks and mappings as a point of reference. By natively coding in ICD-10, your practice will be in a better position to select specific codes reflecting patient complexity of care.
Include different dates of service in your test cases.
- For most of the cases, use ICD-10 codes and simulate a date of service on or after 10/1/2014.
- Incorporate at least one case using an ICD-9 code and simulate a date of service on or after 10/1/2014. This case should fail since ICD-10 codes are required with dates of service on or after 10/1/14.
- Include at least one case using an ICD-10 code and simulate a date of service before 10/1/2014. This case should fail since ICD-9 codes are required for dates of service before 10/1/14.
Conduct External Testing
External testing with vendors and payers will help you validate that transactions containing ICD-10 diagnosis codes can be sent and received successfully.
Prioritize the stakeholders with whom you need to perform external testing.
- Plan to test with the vendors or payers that have the greatest revenue impact on your practice first.
- Schedule a time to test with each vendor or payer.
Submit test data to your clearinghouse, billing service and/or payer(s).
Submit data to your vendors or payers using your test cases:
- Send the data electronically if you have a system with the capability to do so.
- If your system is unable to send electronic test transactions, submit test data using a mutually acceptable medium such as paper, a spreadsheet/Excel file, or direct entry through the vendor's or payer's website.
Billing services and clearinghouses should take the data you submit and:
- Generate electronic test transactions.
- Send electronic test transactions to applicable payers on your behalf.
- Forward test results to you once the transactions have been processed.
Consider direct testing with payers when:
- Your practice currently submits claims and other transactions directly to payers.
- Your clearinghouse or billing service can’t assure you that they will be ICD-10 compliant and/or they are unwilling to test with you. Direct payer engagement may help to mitigate this risk.