March 4, 2013

End-to-End Testing Highlights ICD-10 Symposium

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Providers, payers, clearinghouses, and vendors were all on board during Sunday’s ICD-10 symposium, where the hot topic was end-to-end testing for ICD-10.

From HIM professionals to CMS representatives, more than 300 attendees heard afternoon speakers present the justification, rationale, and tool sets available for end-to-end testing of ICD-10 claims.

Attendees were encouraged to open dialogues with clearinghouses and payers.

“Payers want to work with providers who are doing dual coding,” said Surya Vadlamani, a symposium panelist and chief information officer for JVion, a healthcare technology company.

Another panelist, Ed Hock, senior director for the Advisory Board Company, echoed the same sentiment.

“Providers should ask clearinghouse and payer trading partners when they will be ready to start receiving claims in ICD-10” said Hock. “And while no one has all the technology in place to conduct complete end-to-end testing, everyone can take small steps and start where they are, even if it takes manual efforts.”

Dual Coding

Several presenters identified dual coding as one of these small, but essential, steps.

Dual coding is a precursor to end-to-end testing and an exercise every HIM department should begin now. Not only does dual coding assess coder knowledge and hone ICD-10 coding skills, it also identifies gaps in clinical documentation and focuses CDI efforts. Cardiology, orthopedics, and obstetrics were identified as key service lines for ICD-10 coding and documentation readiness.

End-to-End Testing

Concluding the afternoon, representatives from CMS, HIMSS, and the Workshop for Electronic Data Interchange (WEDI) presented updates on their respective tool sets and guidelines for end-to-end testing.

The HIMSS/WEDI Multi-Stakeholder Pilot is the only program of its kind for across-the-enterprise testing of ICD-10 claims. The organizations are building test scenarios using real cases and all available clinical documentation. Cases are fully vetted by an array of program participants and coded by AHIMA-certified ICD-10 coders.

Health Record Services (HRS) is one outsourced coding firm involved in the HIMSS/WEDI Pilot. The coding company has been coding cases and fine-tuning scenarios alongside other HIM professional service firms. Beyond the 100 to 200 test scenarios that will be made available for free on the HIMSS website, providers are encouraged to develop their own.

HIMSS/WEDI will be conducting pilot tests with their initial scenarios between now and July 2013. The second half of 2013 extends this testing phase with full industry testing of standard scenarios in 2014. Providers should see the first set of scenarios this summer.

Kari Gaare, JD, MHA, health insurance specialist for CMS, described its initiative as a universal testing process and methodology for all regulatory changes from the healthcare simplification set. CMS is not developing software, testing data, or a testing environment. Output from their efforts will be available to everyone and shared nationwide.

Eighteen industry collaboration partners are involved in the CMS program and attendees were encouraged to participate in weekly listening sessions and submit questions via email. The program is currently in phase two, with phase three slated for July through September 2013.

The bottom line for all ICD-10 stakeholders is to ensure revenue accuracy. Accuracy trumps neutrality post-ICD-10 go-live. Vendors, providers, clearinghouses, and payers must all be in sync for success. If either party makes an error, there will be problems with revenue integrity.

End-to-end testing is the only way to identify hot spots in revenue flow and know what you’ll need to fix once ICD-10 goes live.

About the Author

Beth Friedman is founder and principal of The Friedman Marketing Group (TFMG), a full-service public relations agency for healthcare. She is an active member of AHIMA, HFMA, and HIMSS, with 10 years' provider experience in coding and HIM.

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