August 4, 2014

It’s a Date! ICD-10 Testing: Let’s Finish What We Started

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We’ve got a date!

Much of the healthcare industry was stunned on March 31, when Congress announced that due to passage of the Protecting Access to Medicare Act of 2014, ICD-10 could not be implemented before Oct. 1, 2015. Things looked dismal, as though all hope was lost for a time, with providers stuck not knowing whether ICD-10 was coming or going. 

Doubts, skepticism, confusion, and frustration initially seemed to overwhelm many who already have spent millions aiming for what seemed to be an ever-moving go-live target date. On the other hand, a few rejoiced because ICD-10 was being put on the backburner for a period of time (or perhaps, maybe, hopefully, forever). However, as the drama unfolded, it became evident that the majority of providers started making good use of the additional grace period by focusing on fine-tuning their ICD-10 testing and other preparation efforts.

Now that the Centers for Medicare & Medicaid Services (CMS) has issued the final rule indicating that Oct. 1, 2015 will be the new ICD-10 implementation date, organizations are once again rekindling the energy that drove their ICD-10 teams to accomplish great feats that have never been attempted before. This time, everyone is focused on a solitary goal: to finish an incomplete federal mandate and tackle the conversion to ICD-10 in an effort to tie up loose ends and deliver success. We must bring our coding systems up to par with the current practice of medicine with little revenue impact and minimal operational disruption to every provider.

As you peruse the refresher below, remember that ICD-10 is making testing experts out of all of us. Prior to ICD-10, the healthcare industry really didn’t know how to test comprehensively. After ICD-10, each organization will have a centralized testing center capable of mastering ICD-10. 

How do you do this? Document your processes well; develop a comprehensive, repeatable process and plan; and continually improve and transform your previous basic, ground-floor “testing into a science” paradigm that lives on and will benefit other implementation initiatives beyond ICD-10. Don’t be afraid to try out new concepts, processes, and approaches. Expand your current testing team to include others that will help your tests become more robust and thorough. 

A quick testing refresher and a few steps to take:

  • Develop an ICD-10 test strategy.
  • Be as granular as possible when crafting  ICD-10 test plans: test for the requirements.
  • Involve all impacted applications, interfaces, systems, processes, reimbursements, payors, and people in testing efforts.
  • Create detailed test scenarios and test scripts to account for high-volume and high-dollar services, plus complex patient visits/account types (with patient transfers, holds,  multiple service locations, and departments all involved).
  • Attempt to finish all upgrades and initial remediation by December 2014 or sooner.
  • Allocate 2015 to finalize testing activities.
  • Ensure adequate IT staff allocation for preparing systems for the ICD-10 conversion; test with end-users in user acceptance testing.
  • Limit the number of IT projects unrelated to ICD-10 until after Oct. 1, 2015 as much as possible – keep ICD-10 a priority.
  • Simplify conflicting projects that cannot be avoided.
  • Determine your vendors’ state of readiness and your level of risk – develop Plan A, B, or C contingency plans if  products and services will not be ready in time.

Additionally, check to make sure that the following basics are tested and included in your test strategy and test plans:

  • Patient scheduling
  • Patient registration
  • Medical necessity process
  • Provider documentation templates (if implemented)
  • Clinical documentation improvement and query applications/management tools
  • Order sets
  • Charge master
  • Encoder with dual ICD-9/ICD-10 environments
  • Clinical decision support
  • Computer assisted coding with NLP
  • Speech recognition with NLP
  • Referral management systems
  • Claims submission/clearinghouse
  • Patient billing
  • Payment and adjustment processing
  • Denials management
  • Contract management
  • Business/clinical intelligence applications
  • State and federal reporting systems

Keep ICD-10 efforts moving and do whatever is necessary to cross the finish line. ICD-10 will be one of the very basic foundations that prepare the U.S. healthcare system for the next advances in the practice of medicine. Now that we have a date, let’s finish what we started.

About the Author

Juliet Santos is the ICD-10 principal consultant for Leidos Health. Santos formerly was EVP of Lott QA Group and assisted with the creation of the ICD-10 PlayBook, ICD-10 National Pilot Program, and the ICD-10 National Testing Platform.

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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.
Juliet A. Santos, MSN, CCRN, FNP-BC

Juliet Santos is the ICD-10 principal consultant for Leidos Health. Santos formerly was EVP of Lott QA Group and assisted with the creation of the ICD-10 PlayBook, ICD-10 National Pilot Program, and the ICD-10 National Testing Platform.