January 26, 2015

ICD-10 End-to-End Testing: Results and What’s Next

By Betty Gomez

In April 2014, ZirMed began its end-to-end testing efforts with commercial payers such as Blue Cross Blue Shield of Florida. We continued testing with several government and commercial payers throughout 2014.

As ZirMed continues to engage in testing with payers, we identify more and more front-end edits to enable miscoded claims to be rejected first by us. This benefits the providers we work with by giving them time to correct the claim before it ever reaches the payer, saving them time and ensuring optimal reimbursement. ZirMed is also in the process of writing rejection messages that will provide an easy-to-understand explanation to address each rejection.

Throughout this initiative, we’ve found that the biggest challenge for providers seems to be the lack of payers offering ICD-10 testing, which limits providers’ options for testing opportunities. However, with a round or two of testing under their belts, many providers are beginning to gain confidence in their ICD-10 coding strategy. We recently interviewed a number of our clients about their latest ICD-10 testing efforts. Here’s what a couple of them had to say about their results to date:

“From our perspective, testing was a great exercise because we were able to identify our errors and make the adjustments that needed to be made,” said Jacqueline Chenault, a coder and biller at Floyd Memorial Canter Center of Indiana. “Our first round of testing revealed some issues, but ZirMed helped walk us through the process so that we were able to get the claims accepted and adjudicated the second time around. We’re looking forward to more end-to-end testing opportunities so that we can fine tune our processes.”

In another example, the testing was seen to build confidence in making an effective transition from ICD-9 to ICD-10.

 “To date, our results have increased our confidence for a successful transition and also incentivized us to continue testing with additional payers and third-party administrators,” said Beth Malchetske, director of business integration and ICD-10 program at ThedaCare. “We’ve leveraged our learning in this process to drive the metrics we plan to put in place from an enterprise perspective prior to the transition. It is a critical strategy to assure that the organization is not negatively impacted by the transition, whether it be with information flow, claims formatting, or payment of services. Early warning signs in the revenue cycle will be key to mitigation.”

Whether you’re far along in your ICD-10 preparation strategy or just beginning, testing is critical. End-to-end testing ensures ICD-10 compliance internally and externally and helps providers anticipate denials and payment impacts.

There are a number of tools and best practices to help you along the way. Remember, there is always room for additional areas of testing in 2015!

About the Author

Betty Gomez is ZirMed’s head of regulatory affairs. 

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