Edifecs introduces the healthcare industry’s first product-based testing solution for ICD-10

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Today at the American Health Information Management Association conference, Edifecs introduced Edifecs ICD-10 Testing, a product-based solution that eliminates the healthcare industry’s biggest barriers to effective and efficient ICD-10 testing. While most testing solutions focus on a resource-intensive consulting services approach, Edifecs ICD-10 Testing enables healthcare organizations to automate much of their ICD-10 testing, which can reduce the time and resources needed for testing, improve how well healthcare organizations can predict operational and financial results, and more effectively integrate trading partners into the testing process.

“ICD-10 is not merely a technology problem for healthcare organizations. It’s a business problem, too. If healthcare organizations are unable to test with confidence to ensure they will generate the outputs required to sustain their business model through the ICD-10 transition, then their testing strategy has fallen short,” said Ryan McDermitt, senior director of Product Management for Edifecs. “Edifecs developed an outcome-driven solution that hones in on the business risk of inappropriate ICD-10 code conversion. It replaces guesswork and what would normally require an army of testers with automation, accuracy and peace of mind.”

The need for more effective testing strategies for ICD-10 is particularly important, as it is one of the biggest and most far-reaching initiatives undertaken by the industry in 30 years. Unlike previous mandates that were more technology- and format-focused, ICD-10 will affect nearly every aspect of a healthcare organization’s business, including pricing, claim management and payment processing.

ICD-10 is the tenth revision to a coding system comprising tens of thousands of codes—each defining a particular health condition—that healthcare organizations use in myriad business and clinical processes. This revision adds more than one hundred thousand increasingly detailed codes, which provide meaningful information about health conditions and surgical procedures for analysis and reporting.

Against a backdrop of skyrocketing costs, unforeseen risk and unprecedented levels of integration required to meet the ICD-10 deadline of October 1, 2013, there is also an opportunity. Using the increased granularity of information provided by ICD-10, health insurers and providers alike can enhance administrative performance, improve how they measure the quality of care, provide better data for more precise reimbursement and clinical studies, and improve overall health care performance.

Edifecs ICD-10 Testing is the only healthcare product-based QA solution specifically designed to overcome the unique challenges of ICD-10 migration:

Limited technical and business resources for test planning, execution and analysis 
Healthcare systems and business processes will change dramatically with ICD-10, and testing to ensure accurate migration across the business is a significant challenge. Many organizations will not have the time or resources necessary to deal with the scope of ICD-10. Edifecs ICD-10 Testing provides a more automated approach to generate, repurpose and control ICD-10 test data, providing a framework tool and best practices for testing at this scale.

Significant operational and financial risk without sufficient testing and reporting coverage 
Healthcare organizations will use ICD-10 codes in nearly every business process, including benefits, claim adjudication, medical management, disease management and actuarial analysis. If codes are not mapped properly from ICD-9 to ICD-10, the impact will be significant. Health plans may see unexpected variations in payments, medical and disease management programs can be compromised, and inefficiencies may reduce the number of claims that be processed without manual intervention. Edifecs ICD-10 Testing reduces operational and financial risk by quickly and consistently comparing large volumes of test results between ICD-9 and ICD-10, helping organizations maintain optimal business outputs through the conversion.

Greater levels of external testing 
Traditional trading partner testing (for mandates such as HIPAA 5010) focused on validating file formats. ICD-10 testing must go beyond validation to include the financial implications of claims submitted with ICD-10 codes. There is no way for payers to know which ICD-10 codes providers will use, and few providers are ready to participate in testing with payers. Edifecs ICD-10 Testing supports new levels of external testing by using historical claims data to identify which providers are at most risk for payment variation, so payers can work with them more closely during the transition.

“The tendency among healthcare entities is to interpret ICD-10 as mainly a coding issue to meet compliance demands. That's a shortsighted view. ICD-10 must be a shared responsibility of the IT department and the business,” said Robert Booz, Vice President and Distinguished Analyst at Gartner Inc. “The overall business environment must be addressed, given the significant impact that diagnosis codes and procedure codes have on the fundamental business processes of healthcare payers.” [Source: U.S. Healthcare Payers Should Assess ICD-10 Vendor Capabilities Against Three Issues. Gartner, Inc., August 31, 2011]

Edifecs ICD-10 Testing is one of four products comprising the overall Edifecs ICD-10 Solution—an end-to-end solution specifically designed to support each phase of an ICD-10 project. Healthcare organizations have the choice of deploying each product independently or using them together as an integrated suite. The solution also serves as a reusable testing platform to help healthcare entities complete future testing initiatives more quickly and easily.

About Edifecs, Inc. 
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA 5010 and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com.

Contact Michael Thomas of Raffetto Herman Strategic Communications, PR firm for Edifecs at mthomas(at)rhstrategic(dot)com.