Updated on: March 16, 2016

More Important than Testing: The Preparation Done Beforehand

Original story posted on: March 17, 2014

One of the primary benefits of the recent front-end testing of ICD-10 claims was the psychological one, said Tim McMullen, executive director of the Cooperative Exchange, an association representing clearinghouses. He also noted that it showed providers how easy or hard it was to code in ICD-10, and it gave clearinghouses an indication of which customers were not quite ready.


“It got providers moving,” McMullen said on the March 11 “Talk-Ten-Tuesday” broadcast. It was a “great benchmark in that it got providers to begin to pay attention. It wasn’t a nebulous out-there thing; it was ‘this week we can start testing.’ ”

Of course, there are many steps that providers and clearinghouses must take before they can conduct front-end or end-to-end testing and another guest on Tuesday’s broadcast provided an overview of how Holy Spirit Health System—a local, independent facility in Harrisburg, Penn.—did it.

Bob Gibson, a senior consultant at Leidos Health who is currently on long-term assignment as Holy Spirit’s ICD-10 project manager, describes the facility’s testing experience plus the preparation required to get to that point. He believes that preparation was the key “enabler” for them “to get into the testing game.”

During front-end testing week, Holy Spirit submitted two batches of claims: one batch of hospital claims through one clearinghouse and one batch of cardiology claims through another clearinghouse. Although the facility did receive acknowledgements from the clearinghouses, it has not received any individual claim information.

McMullen said immediate report of individual claim information is not uncommon, since the clearinghouses first must analyze the results. He also reported that most clearinghouse members had no or few issues.

Similar experiences to Holy Spirit were reported by listeners who responded to the broadcast’s Ten-Ready Poll question: What was the outcome of your front-end testing?

  • 48 percent reported that they had received acknowledgement that test claims were accepted

  • 1 percent reported that they had received acknowledgement that claims were rejected

  • 36 percent did not receive any acknowledgment

  • 13 percent reported that the testing did not work

”A couple of the problems that caused rejection were that some folks were still sending I-9 and I-10 codes on claims. There also were some date-of-service issues,” McMullen said.

Before Testing

Much has been said about the importance of testing, but Gibson believes that it’s the preparation you do before testing that makes the difference. He summarized four key components: coder training, system compliance, dual coding, and payer testing.

In early 2013, two staff members attended the American Health Information Management Association’s (AHIMA) training course and returned to become the internal experts and coaches for other employees. All coders completed ICD-10 classes over the summer of 2013.

“Our objective was to have the prerequisite coding training complete, so we could start dual coding on Oct 1, 2013,” said Gibson. “In parallel, we inventoried our information systems. We discovered a wide range of readiness. We’re very dependent upon the responsiveness and delivery schedule of our vendors and continue to monitor this.”

Gibson and his ICD-10 preparation team knew that a staggered delivery schedule would impact the ability to conduct comprehensive integrated testing. They also knew that they couldn’t let that stand in the way of doing at least some testing.

Early on, they focused on the key revenue cycle systems and had updates in place by late summer 2013. The team worked closely with vendors to test the interface and reached the point where they could code in both ICD-9 and ICD-10 on the Encoder side and create historic claims on the billing side.

“With this work in place and coder training complete, we felt we had the foundation to start dual coding on Oct. 1, which we did,” Gibson said. “Our actual process when we began was more like double coding. The coder would code the medical record in ICD-9 then start again and do it in ICD-10.”

During this process, they also learned some “interesting things” about ICD-10 documentation gaps and began plugging them. Gibson shared two surprising findings from this initiative.

“As expected, we identified documentation gaps but not nearly as many as we anticipated. Our provider documentation is generally pretty good,” he said.

“A more surprising discovery, and equally important, is that medical records frequently did include information that supported ICD-10 assignment, but our coders didn’t know where to look for it because the information wasn’t needed for I-9. This has helped identify different coder training needs beyond formal training curriculum.”

McMullen applauded the Holy Spirit team for pinpointing the documentation issues right at the beginning. He also noted that conducting internal testing is a key to a smooth transition.

Volunteer for Testing

When the Centers for Medicare & Medicaid Services (CMS) initially announced that it wouldn’t be offering end-to-end testing, Gibson and the team were discouraged, and it made them wonder if commercial payers would follow suit. With this question on their minds, they realized that payers and clearinghouses had no obligation to conduct end-to-end testing or to include them in any testing.

“So we decided the best course of action was to solicit payers and tell them that we were willing, ready and able to test with them. We couldn’t sit back and wait for the phone to ring because it may never do so,” he said. “This process of openly and loudly volunteering has paid major dividends.”

Today they are working with three major marketplace payers, soon to be four, and will plan and conduct end-to-end testing with each, beginning with one payer on May 1. Each test conducted will be based on previously submitted and adjudicated ICD-9 claims. Staff will recode in ICD-10, and each payer will adjudicate the new claims and return remittance advice for analyses.

“This means that we will be able to compare actual ICD-9 reimbursement for the same patient with the same medical-surgical problem with its ICD-10 equivalent,” said Gibson. “Needless to say, this will be extraordinarily useful information.”

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.
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.