Updated on: September 23, 2013

Test With a Purpose and a Plan

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Original story posted on: December 12, 2012

We all agree that testing is going to be a critical phase of the ICD-10 transition. The system upgrades, testing and adjudication of test data results with external partners will be complex.

The development of your master testing plans will serve as a road map for testing and will define the objectives, approach and methodology of your efforts. Testing plans generally will have variations depending on objectives and scope. However, at a high level they typically include, but are not limited to, the following phases and steps:

Test project preparation and planning phase

  • Assemble a test team, determine the test scope and formulate a high-level test strategy.
  • Plan a test project and a detailed test strategy.
  • Plan an iteration, test level and test types.

Test development, building and quality management phase

  • Design tests, organize test execution and set up test infrastructure.
  • Develop test scenarios, scripts and templates.
  • Install test objects; then monitor and adjust test plans.

Test execution and outcomes phase

  • Verify test infrastructure and test objects, then execute tests.
  • Manage defects, issues and changes.
  • Summarize test execution, evaluate the test project and consolidate test outcomes.

Testing with ICD-10 will require a plan that incorporates ICD-10 content and is risk-based in order to mitigate the significant financial risks inherent in the claims submission process. A material difference in ICD-10 testing will be the approach and focus on test scripts and scenarios, as this is an area that will require ICD-10 coding expertise. We are not just talking about assigning ICD-10 codes to the correct test date or testing based on high-volume, high-revenue risk claims.

The inclusion of ICD-10 coding experts in the testing process – experts with a deep understanding of coding, patient encounters and billing requirements – will be required in order to develop meaningful scenarios and scripts, and to scrutinize system outcomes appropriately. For review, a test script reflects the actual step-by-step actions a tester takes, along with the expected results. A test scenario is a group of one or more test scripts that cover a particular functional area, business process, use case, etc. A good test script should tell a story.

Managing Outcomes

There are fundamental elements of the ICD-10 coding structure that will need to be incorporated into your organization’s master testing plan. These scenarios and scripts must be developed with the end result of testing your systems in order to identify defects. This goes beyond superficial testing by encounter types, coding specificity and e-codes. Replacing ICD-9, logic-based scenarios and scripts with an ICD-10 framework will not in itself provide you with testing data that can be used to test your systems adequately, however.

If your objective is to validate for data and revenue integrity, you must test with scenarios and scripts that test beyond system output. Standard testing for ICD-10 will not be enough for a seamless transition to the new code set.

Utilizing a solid testing methodology will be the only way to guarantee continuity of business processes and an uninterrupted cash flow.

About the Author

John Pitsikoulis, RHIA, is a Strategic Advisory Services Client Executive and ICD-10 Practice leader at CTG Health Solutions (CTGHS). John is responsible for the strategic advisory services such as ICD-10, EMR clinical documentation integration program, and Computer Assisted Documentation Services. John has over 25 years of Health Information Management (HIM), coding, and compliance consulting experience working with clients on ICD-10 services, RAC, coding, and clinical documentation improvement engagements.

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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.

John Pitsikoulis, RHIA, is the ICD-10 practice leader and an AHIMA ICD-10-Approved Trainer for Nuance Communications. John has more than 28 years of revenue cycle, health information management, coding, and compliance consulting experience. John has developed and led several corporate and client strategic engagements for managing the conversion to ICD-10, including ICD-10 assessments, implementation planning, integrated testing, education plan management and revenue preservation strategies.