February 26, 2013

Experts Offer Their Advice: Allow One Year for ICD-10 End-to-End Testing

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A lot can happen in nine months—and that’s exactly the hope of leaders from the Centers for Medicare & Medicaid Services (CMS) and professional organizations when it comes to being ready for end-to-end testing of ICD-10 claims by October 1, 2013. Yes, you read it right: By October 1, 2013—one year before the official October 1, 2014 implementation.

 

This may come as a surprise to some, prompting questions like these: Why should we be testing one year in advance of the actual implementation date? What is end-to-end testing anyway? What is CMS doing to make this happen?

 

Those are just a few of the areas discussed on ICD-10 Monitor’s February 12 Talk-Ten Tuesday broadcast, entitled CMS Pilot for End-to-End Testing: It Takes a Village. Guests included representatives from across the industry:

  • Kari Gaare, CMS health insurance specialist
  • Dean Cook, senior advisor from National Government Services
  • Stanley Nachimson from Nachimson Advisors
  • Ellen Van Buskirk, senior principal in business consulting for Infosys Public Service. Ellen served as one of co-chairs for the WEDI End-to-End Testing Workgroup.

 

Reasons Not to Procrastinate

Believe it or not, some providers and payers are ready for testing now. However, most are not, and, as Stanley Nachimson says, “There is some industry concern that providers and payers might not have tested sufficiently with their trading partners before October 2014 kicks in.”

Where are you in regards to I-10 testing? That’s the question posed in the Talk-Ten Tuesday poll, and just 4 percent responded that they had “successful” testing with all or most of their partners, and 9 percent are “beginning” to have success. “Having trouble” describes the situation for 1 percent. Last but not least, 43 percent are in the beginning phase and 42 percent haven’t started yet.

“Folks better starting thinking about testing plans and setting up a schedule,” advises Nachimson. Those who don’t may be left behind. Those who get in late may be unable to test and will get unexpected results.”

Trust and Cooperation Needed

In an upcoming ICD10monitor e-news article, Ellen Van Buskirk addresses the issue of trust in the trading partner community, saying, “Success can only be achieved by trusting in a common goal and building bridges of shared experience.”

On the Talk-Ten Tuesday broadcast, she said, “We are at a point of sharing information that we don’t normally share. Any time we share health information we need to trust where the information is going and trust our trading partners.”

Building trust requires that providers, clearinghouses, and vendors work together to meet their deadlines, which can be achieved, says Van Buskirk, by setting clear goals and objectives. “The challenge for providers is to be able to understand and identify their trading partners and determine how testing will occur,” she says. “Until we trust that we’re working toward the same goal, we won’t get to the trading partner goal.”

Collaboration Paves the Way

Ghosts of other implementation delays, most recently the switch from the 4010 to 5010, linger, reminding industry leaders that delays are expensive and inefficient. Kari Gaare said CMS realizes that one solution to these outcomes is a better approach for end-to-end testing.

In the beginning of its research, Gaare said that CMS “saw that certain definitions, like compliance, end-to-end testing, and readiness, which are all central concepts when you talk about implementation, have a different meaning to everyone.” To clarify these meanings, the agency contracted with National Government Services (NGS) to develop a standard definition and framework.

As Dean Cook explains, “NGS is working with CMS to identify best practices that will lay the groundwork for efficient and effective testing among health care providers, payers, and vendors.” It also will develop checklists tailored for small and large providers, payers, and vendors that will help guide these groups through the testing process. (Draft versions of the checklists are available on the CMS website at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html.)

In an effort to help the health care community “work smarter, not harder,” Gaare said that CMS will collaborate with HIMSS and the Workgroup for Electronic Data Interchange (WEDI) on their ICD-10 National Pilot Program. CMS and NGS will develop the rules and guidance, which HIMSS and WEDI will follow in the actual testing—a collaboration that Nachimson calls “a fortunate coincidence.”

Mark Your Calendars

On February 28, from 11 am to 5:30 pm (Eastern), CMS and WEDI will co-host a free webinar on end-to-end testing. According to Gaare, the organizers have tailored sessions for small and large providers, clearinghouses, payers, and vendors, and there will be time for follow-up questions from participants. Webinar participants also will find out how they can take part in the ICD-10 National Pilot Program. You can register by visiting the events section of WEDI’s website: http://www.wedi.org.

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.