Updated on: September 23, 2013

ICD-10 Testing — The Power and Cost-Effectiveness of Collaboration

By Mark Lott
Original story posted on: October 26, 2012

EDITOR’S NOTE: This is the first in a two-part series on the collaborative approach to ICD-10 testing.

The ICD-10 date has been set, organizations are mobilizing, and the airwaves are flush with numerous ICD-10 testing strategies to help the healthcare industry cope with the challenges of both internal and external ICD-10 testing requirements. The issue is that the majority of these testing approaches fall short in one extremely important category—collaboration.

There is not enough time, money, or resources in the industry to accomplish full-scale ICD-10 testing effectively and accurately when each organization implements its testing plans within a silo approach. Why is that, you ask? A silo mentality will incur the highest possible testing costs, reduce the testing scope, and cause a lowering in the overall effectiveness of the testing process, because each entity must incur the full cost and brute force effort of test case preparation, test data creation, and trading partner coordination for end-to-end testing.

The majority of testing strategies being promulgated today also have another critical shortcoming that will cause delays in both ICD-10 trading partner and end-to-end testing: they are all linear in their application. This method requires complete dependence on full remediation at each testing stage before the next set of testing can begin. For example: A provider cannot complete internal testing until its entire vendor stack is installed, and cannot test with its clearinghouses and payers until everything is tested internally. A provider cannot test with its payers until its clearinghouses are ready, it cannot test its revenue cycle management until the payers are ready, and certainly cannot test end-to-end until everyone is ready. The same holds true in reverse: Payers will need to wait until vendors and providers are completed remediated, further delaying the testing process. This approach will dramatically prolong the testing process until the last possible minute. Enough time will not be left to coordinate and test with all the key trading partners prior to October 2014, or to be able to assess the full repercussions on revenue and coding accuracy before going live. One only has to look at 5010 testing efforts to clearly understand all the challenges with a linear-based test approach.

The time has come for the industry to change its thinking on testing and move in a new direction that will enable the success of the industry for all of the regulatory changes that we know are coming. This new testing paradigm is asynchronous and non-linear in its strategy and implementation, which means multiple organizations testing concurrently and using clinically derived shared test data at its core.

This collaborative strategy is a dramatically more cost-effective testing approach that holds promise for reducing ICD-10 internal testing costs by more than 50 percent. Likewise, through the effective use of a non-linear testing method, the industry can reduce the time and resource effort required for end-to-end testing by more than 80 percent.

ICD-10 is an unfunded mandate and must be tested and implemented at the lowest cost possible while simultaneously delivering the highest accuracy of results. Too many testing vendors and consulting organizations use ICD-10 as a way to maximize revenue at every client. Instead, through the power of collaboration, the theory is to minimize the testing costs for each affected entity by leveraging the work efforts and lessons learned across their peers and the entire ICD-10 landscape. In the comparison of ICD-10 testing approaches, a non-linear collaborative testing strategy has the potential of delivering enormous savings to the industry of more than $500,000,000 in direct and indirect ICD-10 end-to-end testing costs. The primary focus, on helping both institutional and provider groups cope with the arduous task of ICD-10 test case preparation and testing while driving costs down by delivering a highly reusable, collaborative approach, is too powerful to ignore.

How are all of these cost and time savings possible? By leveraging a state-of-the-art testing approach that distributes the workload across multiple organizations, utilizes clinically based dual-coded transactions, and shares that test data across the entire healthcare landscape. This testing methodology is being piloted right now all across the country and involves key stakeholders from each industry group contributing to a national ICD-10 testing solution that will deliver a community-based, collaborative approach that empowers all its participants.

The power of this testing approach is that it creates testing artifacts that can be used as “sources of truth” in order to assess the quality and accuracy of computer-assisted coding tools, ICD-10 coding accuracy by medical specialty, documentation improvement opportunities, accuracy of payer mapping based on the GEMs, provider contracting, medical policies, and end-to-end testing and certification. Discover more about this collaborative approach in Part 2 of this testing series, coming later in November.

About the Author

Mark Lott is the CEO of Qualedix QA Services, Inc. Mr. Lott’s 25 year career in software testing and quality assurance expertise in healthcare, pharmaceutical and banking has led to the development of cutting edge testing methodologies and end-to-end testing platform for ICD-10. Mark's career as a successful entrepreneur and executive includes his role as Chairman of HCCO (Health IT Conformance and Certification Organization) where he architected the first HIPAA interoperability testing methodology called CCAP (Common Conformance Assessment Program) for 4010 and certified the majority of EDI validators and translators in use today.

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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.