Updated on: September 30, 2014

External ICD-10 Early Bird Test Reservations Give Property and Casualty Stakeholders a Strategic Advantage

By Sherry Wilson and Tina Greene
Original story posted on: September 29, 2014

EDITOR’S NOTE: Authors Wilson and Greene serve as the co-chairs of the Workgroup for Electronic Data Interchange (WEDI) Property & Casualty Subworkgroup.

Even Captain Obvious knows that you need to “book reservations” early for external ICD-10 testing. A successful organizational transition to ICD-10 by the compliance date of Oct. 1, 2015 will require good planning. Preparation is crucial to allow your organization to leverage its ICD-10 investments to meet compliance requirements and achieve a strategic testing advantage.

It is highly likely that those stakeholders who do not engage in early external ICD-10 testing, including payers as well as other trading partners, will be faced with a last-minute rush of requests to test from multiple stakeholders.  These stakeholders not only will request testing, but they may also need additional help with implementation of upgraded solutions. Travelers booking late for a hotel or flight reservation may find that rooms or seats are sold out – or that they have very few options remaining. Similarly, stakeholders waiting until the last minute to engage in external ICD-10 testing with their partners may find their testing plans in significant jeopardy due to the high volume of testing that will be occurring.

How can you alleviate last-minute ICD-10 testing gridlock? Take action now and book your organization’s external ICD-10 testing reservations. Here are some steps to consider when setting up testing strategies with trading partners:

  • ICD-10 financial risk assessment
    Financial risk exists due to provider uncertainty over ICD-10 coding guidelines and payer reimbursement rules. Payers cannot predict how providers will code claims, and providers cannot predict how payers will process and reimburse claims. Understanding financial impacts on stakeholders requires end-to-end claims testing that can only be achieved with payor collaboration. End-to-end claims testing enables both parties to evaluate high-risk outcomes and proactively obtain cost predictability, as well as understand and manage financial risk.
  • Value of early collaboration
    Engaging in early stakeholder collaboration presents your organization with early insight into ICD-10 coding patterns and allows ample time in which to evaluate potential financial impacts.

    Keep in mind that all the stakeholders you may need to test with, which may include clearinghouses and/or other third-party vendors, will need to be taken into consideration. According to industry surveys, many stakeholders may be ICD-10-ready now; however, you should take into account that all stakeholders share the same issues, including time and resource constraints. Execute your collaboration strategy early in the game, or you may find your organization on the ICD-10 waiting list and miss the Oct. 1, 2015 compliance date.

Collaborative ICD-10 test plan considerations

We all know the importance of planning; however, collaborative testing can be a complex process, as it involves many moving parts as well as external interdependencies that cannot necessarily be fully controlled. When addressing property and casualty ICD-10 state requirements, you must take into consideration the possibility of a state not adopting ICD-10, which will require the testing plan to accommodate dual processing (ICD-9 and ICD-10). The following are some important steps to consider that will require thoughtful planning:

  • Assess organizational ICD-10 readiness:
    What is your compliance status of dual processing (ICD-9 and ICD-10) for property and casualty in the states where you conduct business?
    What is the status of your resources, training, and process readiness?
    What is the status of your system and interface readiness?
    What is the status of your testing environment readiness?
    When will your organization be ready for external collaborative testing?
  • Assess components of ICD-10 test exchange:
    Have you defined your property and casualty high-risk claim scenarios?
    Have you defined the scope of testing (non-adjudicated acknowledgement testing/full adjudicated end-to-end testing), including dual processing if applicable?
    Have you defined outcome reports to be able to evaluate and measure cost predictability, financial neutrality (ensuring no changes in payment between ICD-9 and ICD-10), as well as system and process reliability?
  • Assess information exchange ICD-10 readiness:
    Have you confirmed with your payer, clearinghouse, and/or other third-party vendors their ICD-10 readiness and availability for testing?
    Do you know your trading partners’ testing criteria and protocol as well as the data exchange format requirements, including dual processing if applicable?
    Have you identified the payor, clearinghouse, and/or other third-party vendor’s dependencies and potential impacts to your testing strategy?
    Have you “booked reservations” for ICD-10 testing with your collaborative team to ensure a successful implementation prior to Oct. 1, 2015?

Booking reservations: How to get started

First, identify specific criteria prior to “booking reservations” for testing in order to maximize your organization’s ICD-10 investment and move beyond compliance to gain a strategic testing advantage. Specific criteria should include identifying:  

  • High-volume/high-cost partners that are impacted by ICD-10 changes;
  • Specific targeted high-risk claim scenarios for testing;
  • Collaborative, team-aligned interest and readiness;
  • Collaborative team testing availability, estimated timelines for testing, details of the assessment and remediation process; and
  • ICD-10 implementation benchmarks and methods to measure implementation status against compliance with the Oct. 1, 2015 implementation date.

ICD-10 team collaboration provides additional benefits beyond revenue impact. Early booking of “reservations” allows stakeholders time to evaluate end-to-end processing as well as mitigate business disruptions across all trading partners.

Stay informed on ICD-10 testing industry strategies and updates

The bottom line is that you must “book reservations” for testing with trading partners early to ensure that testing and adjustments are made prior to the ICD-10 deadline in order to provide for a successful ICD-10 transition.

Stay informed on ICD-10 testing strategies and industry updates. Reach out to your professional organizations as well as your trading partners for information. In addition, the American Medical Association (AMA), American Hospital Association (AHA), Workgroup for Electronic Data Interchange (WEDI), Cooperative Exchange (national clearinghouse association), Healthcare Administrative Technology Association (HATA, a national practice management association), as well as other organizations offer great resources to help obtain information to assist you with your ICD-10 strategy.

Another online industry resource is ICD10monitor (http://icd10monitor.com/). The format of this website has made it easy to access ICD-10 resources, including specific ICD-10 testing strategies, breaking industry news, ICD-10 alerts, and a weekly ICD-10 podcast representing leading industry speakers offering updates.

About the Authors

Tina Greene is a senior regulatory affairs consultant at Mitchell International.  She has 29 years of industry experience and serves in numerous leadership roles in national standard making organizations.

Sherry Wilson is executive vice president and chief compliance officer for Jopari Solutions. She has more than30 years of industry experience and serves in varies leadership roles with the national standard organizations.

Contact the Authors

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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.

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