Encouraging Results and Important Lessons from ICD-10 End-to-End Testing

By Betty Gomez
Original story posted on: September 8, 2014

EDITOR’S NOTE: This part one in a series of end-to-end testing results

ICD-10 may have been delayed until 2015, but many payers are continuing with their original testing schedules. That means providers can’t wait either, because if they do, they risk missing out on opportunities that may not come around again.

ZirMed conducted end-to-end testing with multiple payers this past spring and during the early summer months. The results were encouraging — but they aren’t necessarily representative of what will happen when you test. There are far too many variables in play to make any blanket predictions, so it’s crucial to conduct your own testing.

That said, here’s what we saw: providers submitting professional claims received 835s back from payers, and those that submitted test claims based on paid claims coded in ICD-9 did not see overwhelming differences when they compared the two remits. Nonetheless, the differences these providers did see still could have material and significant impacts on reimbursement.

The story for institutional claims is a bit more complex, but the results there were encouraging as well. Hospitals and others filing institutional claims saw more differences when comparing 835s, which really just underscores the importance of testing early and testing often. Now, those institutions can follow up with their payers to understand what caused the changes, implement a plan of action to address the root causes, and conduct additional end-to-end testing to ensure that their plan effectively minimizes any potential disruption.

When I contacted ZirMed clients and partners to ask about their experiences, there was a common sentiment across providers, from small physician practices to large hospital systems. It was typically something like, “testing wasn’t necessarily easy, but it was manageable — and I’m glad we did it now because otherwise we wouldn’t know that we need to fix X and that need to follow up and test Y.”

Be on the lookout for a follow-up article with feedback from payers. In the meantime, here’s a bit more of what ZirMed’s clients and partners had to say about their end-to-end testing experiences.

Question: How did you conduct testing with payers?

“We identified the claims we wanted to test — claims that had already been coded in ICD-9 and paid — and asked our coders to recode them in ICD-10. Then we sent the coded claims to a third party to create the file for us because our system isn’t ready yet. After that we uploaded the file into ZirMed’s system so the claims could be sent to the payor. Once the payor processed them they returned an 835 through ZirMed — we’re still reviewing the results, but the codes were accepted with no issues.”

– Business analyst, heart and lung clinic (40 providers)

“We uploaded a file of ICD-9-coded claims into the ZirMed system, selected 20 patients, and then edited the claims in ZirMed’s online testing environment. That was easier for us — our system is ICD-10 ready, but it would have taken longer to generate ICD-10-coded claims on our own than it took to edit them in the ZirMed system. The coding manager provided a list of codes that she wanted to test — a variety of codes, and codes that map to multiple ICD-10 codes, because we know that variety is important.”

Supervisor, small hospital (53 providers)

Were there any specific obstacles to testing? How did you overcome them?

“We had to work with our PM vendor to gain access to the ICD-10 codes — the ICD-10 code set isn’t live in our system yet, so we had to turn it on and then turn it off again because the whole system isn’t ready to switch over.”

“We worked with our PM-system vendor to overcome this challenge — we know how to access the codes, but it’s not live data. We also had to conduct our testing after hours so it wouldn’t affect our current day’s work. It’s a bit of a lengthy process, but if you plan it out, stay in touch with all of your vendor contacts, and have a good plan, it works.”

– Office manager, internal medicine provider group (seven providers)

“No major obstacles, but one of our payers required the date of service on test claims to be after the go-live date. Our system doesn’t allow for charges that far into the future, so we had to change the dates manually in the ZirMed system. That said, most payers allow current dates for testing.”

– Coding supervisor/ICD-10 project manager, oncology physicians group (44 providers)

What do you see as your next steps? Were there any takeaways or advice for other providers?

“The testing was actually pretty easy from our perspective because ZirMed did most of the heavy lifting; all we had to do was code the claims in their system, generate the file, and upload it to their testing environment. The results came back within a week. Testing can seem time-intensive since it involves coordination of multiple areas in your organization, but it’s worth it.”

– Business analyst, information technology, community hospital (80 providers)

“Definitely the next step is to continue testing with other payers as they begin to allow end-to-end testing. And this time we’ll do the entire flow, from our system through ZirMed, then to the payor and back to our system with the 835.”

“The advice I would give other providers is to go ahead and test so you can uncover any major issues now, not after go-live. It’s important to understand the issues ahead of time so you can make the appropriate corrections and adjustments. Try to test a variety of codes — from easy to more complex ones.”

– Supervisor/analyst, small hospital (53 providers)

This is just a fraction of the feedback we’ve received so far. Stay tuned to ICD-10monitor for additional insight into how providers are conducting testing with payers, what results they’re seeing, and what payers have to say, too.

And don’t delay your own testing efforts! You have time to prepare — but you don’t have time to waste.

About the Author

Betty Gomez directs ZirMed’s regulatory strategy.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.