July 21, 2014

ICD-10 Testing at Kaiser Permanente

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As an integrated healthcare system, Kaiser Permanente is in a unique position when it comes to testing ICD-10. In order to become ICD-10-compliant, the company must test from the position of both a provider (caregiver) and a payer (insurance plan).

During the coming months, Kaiser Permanente is targeting to test nearly 200 remediated applications individually and internally, collectively with our external trading partners (e.g. clearinghouses, government agencies, vendors, etc.), and also with our external providers.

In order for ICD-10 implementation to proceed smoothly, each type of entity in the healthcare industry must be prepared. One of the goals of testing with our external partners is to understand how their state of readiness will impact us.

Kaiser Permanente has many important phases of testing, including systems integration testing (SIT), workflow integration testing (WIT), user acceptance testing (UAT), parallel testing, external trading partner testing, and end-to-end (E2E) testing. External trading partner testing is an immensely formidable undertaking. We work with more than 100,000 entities to provide care, process claims, submit billing, and more, so we must be smart about with whom we test and what we test.

We used a risk-based approach to identify our top 100 highest-risk external trading partners (as defined by transaction volume and dollar amounts) to engage in ICD-10 testing. The majority (about two-thirds) of those represented larger, external institutional providers. We then looked at second- and third-tier entities (again based on volume and dollars). Finally, we selected a few specialty providers to ensure that we had a well-balanced test group for our external trading partners and E2E testing.

At this time, Kaiser Permanente has successfully received, adjudicated, and remitted hundreds of inbound claims with ICD-10 codes from external providers in two of our seven regions. We intend to complete 2014 testing with external providers by mid-August with four additional Kaiser Permanente regions. 

From a provider perspective, we sent approximately 100 claims to the Centers for Medicare & Medicaid Services (CMS) via RelayHealth during the ICD-10 Testing Week, March 3-7. Our results were positive, and as expected, our claims utilizing the ICD-10 code set were accepted. We anticipate testing with CMS again in 2015 if offered.

In addition to the testing categories mentioned above, Kaiser Permanente developed and tested Convergent Medical Terminology (CMT), more than 144,000 diagnosis clinical terms used by our physicians and clinicians to assign patient diagnoses. We developed CMT as a strategic investment and commitment to improve the quality of care at Kaiser Permanente. CMT provides our clinicians with a much wider range of clinically relevant diagnoses than administrative code sets such as ICD-9 or ICD-10. CMT has been updated for ICD-10 through a thorough process, with input from medical groups in all of our regions. In 2010, Kaiser Permanente donated CMT to the International Healthcare Terminology Standards Development Organization (IHTSDO) for U.S. distribution through the National Library of Medicine, making CMT publically available for use by other providers. Since that time, we have continued to provide updates.

Finally, ICD-10 E2E testing, originally envisioned as the last phase of testing for ICD-10, is currently underway and will be completed in six of our regions by September 2014. E2E testing utilizes approximately 100 scenarios covering multi-application/entity workflows deemed to be at risk as a result of Kaiser Permanente and the industry transitioning to the ICD-10 code set. Scenarios are grouped into workstreams reflecting the data flows, such as:

  1. External providers submitting ICD-10 compliant claims to Kaiser Permanente claims systems for adjudication and payment.
  2. Kaiser Permanente claims systems sending finalized ICD-10 claims data to multiple downstream systems.
  3. KP HealthConnect® sending claims with ICD-10 codes to CMS and Kaiser Permanente claims systems.

E2E testing requires significant planning, scheduling, and maintaining of test environment configurations, as well as diagnosis and procedure data management. Overall, it has provided a high level of confidence around ICD-10 readiness, both for us internally and regarding what we can expect with all of our trading partners.

Kaiser Permanente’s comprehensive approach to testing reflects our commitment to ensuring the success of ICD-10 and our ability to conduct business as usual once ICD-10 goes live, both as a provider and as a payer. It is our highest priority that through this process we protect our patients, members, and external partner relationships.

About the Author

Bryan C. Matsuura is the executive director of the ICD-10 program at Kaiser Permanente.

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