April 6, 2015

Tackling Tough ICD-10 Testing Choices

By William Van Doornik, RHIA, MS

As healthcare organizations run the marathon sprint to the ICD-10 finish line, testing can seem like the highest hurdle to clear before Oct. 1, 2015. Systems that store, use, send, receive, or report diagnostic codes, internally and externally, to the organization need to be assessed. Processes such as the revenue cycle, registries, eligibility portals, quality reporting, and others also must be evaluated and tested.

Since ICD-10 budgets and time frames are shrinking, tough decisions need to be made about prioritizing testing initiatives, including selecting who should be involved, how much testing should occur, and when to test. Creating a strategy that identifies commonly overlooked challenges and prioritizes testing initiatives can reduce the need for post-implementation remediation efforts and financial losses.

Commonly Overlooked Challenges

While most organizations have completed an IT inventory assessment by now, it’s easy to miss a few items when you consider that every interface, process, and code requires scrutiny. Here are commonly overlooked areas that we have identified working with clients across the country:

  • Registry systems: System extracts, abstract processes, and coding queues are used to aggregate and share clinical quality data with health departments, immunization, and disease registries to maintain regulatory compliance. Processes used to extract and transmit this data need to be validated for ICD-10 compliance.
  • Quality reporting: Extract scripts and quality reporting workflows may also be involved since they transmit codes external to the organization. While ICD-10 emphasizes improved reimbursement, it is also about enhancing care quality. It is important to make sure these systems will transmit the new codes effectively.
  • Vendor readiness: While contracts often hold vendors to a specific date by which they must make upgrades, it may seem like you are getting down to the wire. Collaborate with software user groups, legal counsel, and the ICD-10 project manager to collectively motivate the vendor to stay on track.

Prioritizing Testing Initiatives

Resources, time, budgets, and the availability of a testing plan will dictate who will be involved, the extent, and the type of testing conducted. The Healthcare Information and Management Systems Society (HIMSS) recommends determining and prioritizing “which health plans process the highest volume, highest frequency, and highest value claims” during the testing process.  Here are some strategies to build an effective testing initiative:

  • Make integration testing a top priority. Integration testing involves ensuring that ICD-10 data is flowing smoothly from the time of registration through billing and collections among all the impacted system modules and components. While each stage of testing should build on its predecessors, you want to begin testing now to allow for time to troubleshoot any issues. If it looks like you will have insufficient time and a significant number of systems to test, minimize internal testing and start integrated testing as soon as possible. Additional selective system unit testing may become necessary if issues arise during integrated testing, but the overall timeline may be reduced.
  • Focus on interfaces and building testing scenarios that model what payers will expect from you. Interfaces create a lot of room for error. Issues, such as a shortened field or a point off a decimal, can trigger a cascading sequence of problems downstream to other systems. Extract, transform, and load (ETL) routines and other applications should also be scrutinized during testing. In addition, build testing scenarios that challenge cases with the highest degrees of risk and volume. For example, you may want to see what happens when a patient calls and reschedules an appointment, and how this affects the HL7 interface. In addition, consider the first productive use dates for ICD-10 codes based on payer requirements for prior authorizations, as well as cases with dates of service on either side of the implementation date. At a minimum, try to aim for building at least a dozen high-risk testing scenarios for each phase.
  • Test your highest impact payers first. By applying the 80/20 rule to your organization’s historical data, develop a testing schedule that focuses on the top 80 percent of payers that have the greatest impact on your reimbursement rates. The remaining 20 percent typically involve less common and possibly more complicated arrangements with certain payers, which you may need to manage throughout the transition period.  
  • Include negative testing. Create scenarios that are designed to fail. For example, make sure that ICD-10 codes are not accepted for discharges on or before Sept. 30, 2015 and that ICD-9 codes are not accepted for discharges on Oct. 1, 2015.
  • Recruit extra coding support to minimize post-implementation remediation efforts. In addition to creating a cash reserve to mitigate financial losses during the transition,make sure you have extra coders available – whether through outsourcing or hiring internally – to minimize backlogs after the deadline.

Action Plan Pointers

It’s important to align your schedule with the right staffing mix, test environments, and monitoring systems. Here are several pointers when setting up an action plan:

  • Coordinate testing schedules and plan with key stakeholders. In addition to the IT department and ICD-10 project manager, include those who know your IT systems best, such as the integration team, system administrators, and operational super users. Set expectations with super users’ managers that they will need to be 100 percent dedicated to the testing effort during these times. In addition, the health information management and coding teams can select codes to test, patient financial services can identify different points of patient system access, and other staff members can provide needed system upgrades as well as offer vendor testing materials.
  • Reserve testing resources. Typically, system testing is done in non-production test environments and needs to be reserved for the systems to be upgraded to the ICD-10-compliant versions. Modified versions of the interfaces also will need to be created for the systems being tested. Additional resources for testing may include designated rooms and/or bridge lines for coordinating the testing steps.
  • Block three to four hours for each testing session. ICD-10 testing should not be done in conjunction with other system upgrades or maintenance. Plan for three series of testing for each phase, such as internal, integrated, external, and end-to-end testing.  Since remediation work can be expected between each testing phase, it’s important to identify the time needed for retesting.
  • Track issue remediation progress. You’ll also want to use a monitoring system — such as testing management software or a spreadsheet — to track remediation of identified test issues. While some issues may only require a quick fix, problems that will require an excessive remediation may also require scheduling a follow-up testing session.

ICD-10 is one of the largest and most complicated healthcare reform initiatives ever to hit the U.S. Although it has been a struggle for many organizations, practice and testing will significantly increase odds of success. With a well-defined strategy and implementation plan, there’s still time for healthcare organizations, vendors, payers, clearinghouses, and the government to collaborate to achieve the greatest possible outcome. 

About the Author

With more than 30 years of IT and executive leadership experience, William Van Doornik specializes in health information management, ICD-10 project management, application integration, physician office operations, and clinical quality control. He has guided several hospitals through simultaneous implementations of clinical, revenue, resource, and financial systems. Van Doornik has been published in healthcare industry and scientific journals, as well as presented at the top HIT conferences.

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References

Terry K, Ritchie A, Marbury D, Smith L, Pofeldt E. Top 4 technology challenges for 2015.Med Economics. http://medicaleconomics.modernmedicine.com/medical-economics/news/top-4-technology-challenges-2015?page=full Published December 1, 2014. Accessed March 16, 2015.

Health Information and Management Systems Society. ICD-10 testing guidance: HIMSS ICD-10 task force. http://himss.files.cms-plus.com/FileDownloads/ICD-10%20Testing%20Guidance%2006172014.pdf Published June 2014. Accessed March 16, 2015.

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