June 25, 2013

End-to-End Testing Project Delivers Valuable Data

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When it comes to preparing for, and implementing, ICD-10, the benefits of, and information from, The HIMSS/WEDI ICD-10 National Pilot Program, which continues through July 31, are “vast,” said Mark Lott, principal with the Lott QA Group, which is involved in the pilot program’s “scope/testing methodologies and processes,” according to the HIMSS website (http://www.himss.org/icd10nationalpilotprogram).

 

On ICD10Monitor’s June 11 broadcast of “Talk Ten Tuesday,” Lott reported on the progress of two pilots that are, at this point, in the dual-coding process and testing phase. Not only are the pilots “going really well,” he says, they are also answering some of the questions on the minds of healthcare leaders. For example:

  • Initial coding accuracy is 60 to 70 percent on initial test cases, and it is improving over time.
  • Proficiency is about 25 to 30 minutes per claim. As Lott said, “Obviously, we have to look for those numbers to reduce as we continue testing.”
  • General equivalence mappings (GEMs) are only picking up the right code less than 50 percent of the time. “We highlighted that because people are relying on GEMS to test with and it’s not going to reflect their business on what they’re doing,” Lott reports.

In spite of the above good news, Lott and his group have uncovered a couple of things of concern. For example: A lot of the payer environments and vendor environments are using outdated code sets. They still have 2011 or 2012 ICD-10 codes, so codes aren’t being found, which causes errors,” he said.

The 200 institutional and professional test cases put together by the HIMSS coding community should be released to the public for use by July 31. The cases are free as part of the HIMSS I-10 Playbook.

The pilot project ends on July 31, but transitions to a national testing program that will be live on Aug. 1. This program will allow everyone—hospitals, providers, vendors, coders, clearinghouses, payers, and medical billers—to come into a centralized platform for testing. This platform will have thousands of dual-coded records that will allow everyone to see very specific medical records and specific specialties being passed from providers to hospitals through vendors. However, says Lott, “Not everyone can test so we will have to leverage the things that are tested and share them with everyone.”

Nonetheless, there will be cases for everyone and, Lott says, “If we don’t have it, we’ll go get it; it’s a very collaborative process.” Participants also can donate records. The cost for the centralized platform and dual coding will vary from $100 for providers to $5,000 to $10,000 for larger hospitals. This information will be on a new website related to the topic available before the end of the month. For this information and more, check with http://www.himss.org/icd10nationalpilotprogram.

Last but not least, according to the HIMSS web site, “An analysis of the Pilot Testing outcomes data will be published in the HIMSS ICD-10 PlayBook by mid-September to assist all stakeholders’ preparation for ICD-10. The report will contain lessons learned and recommendations gleaned from the Pilot Program.”

 

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.
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.