November 20, 2012

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

By Mark Lott

EDITOR’S NOTE: This is the second of a two-part series taking a close look at a collaborative approach to ICD-10 testing.

The first of the two biggest issues the industry must deal with is that end-to-end testing, through which information flows from provider to payer and back again, will not have its own standalone test environment anywhere in the country. The second big issue is that there is not enough time or resources for covered entities to test with all their trading partners and thus properly assess the impact of ICD-10 on workflow and revenue.

Vendors, providers, payers, clearinghouses and revenue cycle test teams will not have a production image everyone can test from set aside in their respective test regions, so end-to-end testing must occur within the existing test environments currently being used for system, integration and UAT tests. It is also practically impossible to match common member demographics from payers with every hospital’s patient accounting records to ensure that transactions can flow well end-to-end. There is very little ICD-10 testing work that can be accomplished in a silo; the majority of the work is collaborative in nature, and organizations must adopt a testing methodology with this in mind, particularly when cost containment and testing accuracy are important metrics to consider.

Another testing challenge we currently face involves the disparate approaches in the methodologies being used by providers and payers. The most logical assumption is that, in order to test these new clinical description changes, test cases must be clinical in nature and accurately represent the business side of healthcare. Providers will, of course, test with clinical records that have specific ICD-10 codes, but payers are mapping transactions without a clinical record and taking their best guess as to what they will receive in production. This disconnected approach will create inaccuracies in results, will not allow common testing, will increase the difficulty in end-to-end testing and ultimately will lead to less-than-ideal ICD-10 implementation.

It is a well-known truth that there is not enough granular clinical information in a HIPAA 5010/ICD-9 file for accurate determination of applicable ICD-10 codes. The majority of the provider community itself doesn’t even know yet which ICD-10 codes it will be coding to reflect its business model. There are still thousands of hours of ICD-10 training to be done and much testing of computer-assisted coding tools and manual coding exercises required before the correct determination of ICD-10 codes can occur. To make the assumption that a GEM-based technical mapping tool can depict with an acceptable degree of accuracy what providers will send tomorrow, whether coded accurately and inaccurately, is tantamount to  wishful thinking.

The future of successful healthcare testing will be measured by the interoperability of delivery systems and end-to-end testing activities, with common test data proving crucial in developing these new testing strategies. The days of testing a few files through a front-end gateway, or just making sure a single data file is compliant, are long gone. For successful ICD-10 testing, the future holds collaborative efforts involving interoperable test beds of clinical data and greater clinical understanding among all industry test teams for ensuring that contracts, benefits, adjudication rates, payments and trading partner interoperability all rise to the level required to succeed in the changing world of federal regulations and health initiatives.

Without increased collaboration, tens of millions of dollars in software, testing resources and implementation time will be wasted as each organization tries to build its own test bed and perform the tests within a silo, as opposed to working together. Without access to a centralized industry test bed, each organization must invest heavily in software, tools and additional resources to create test data. That is a significant investment that deprives strategic initiatives of needed funding and focus. Covered entities cannot afford to continue to incurring license fees, tool costs, training costs, etc. when there are no promises of common testing or cost savings from tools – and certainly no guarantee of interoperability with all trading partners.

The good news is that there are many early adopters currently involved in this new collaborative approach to ICD-10, all of which are helping the industry move forward with a new testing paradigm that holds the promise of a shared services model capable of delivering dramatic cost savings and reduced testing timelines for all involved. As of today, this ICD-10 end-to-end methodology is the only one in the industry being piloted across the country that provides key benefits for every covered entity and business partner within a testing model specifically designed to drive testing costs down as each new participant joins the collective.

There is a better way to accomplish ICD-10 – the industry just needs to think outside of the box and acknowledge that collaboration is the only way forward for end-to-end testing.

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.