ICD-10 testing phase – 5 key points to consider

Given that there is one more year to go, the majority of the healthcare organizations should be prepared and ready to accept ICD-10 codes. Payers face a major challenge in working with providers and various clearinghouses to make sure they can accept the codes and have done adequate testing well in advance to avoid any last minute glitches. Most payer organizations need to prepare for the testing phase of ICD-10 which is rather cumbersome and painful considering the sheer number of partners involved.

In this blog, I will address the five key areas of testing that are often neglected and are very critical at this stage of the ICD-10 migration. The reality check for ICD-10 readiness is more qualitative than quantitative, compared to other implementations. Being ready for ICD-10 does not just mean running through a high volume of claims and validating the results. It starts with the selection of test scenarios, data and validation.

  • Integration Testing (Internal): This stage involves merging all individual components of ICD-10 impacted modules and executing a test to accomplish the flow of ICD-10 data. The key focus during this phase should be to identify any additional components that have to be coded for ICD-10, optimize work flow with the addition or removal of any new steps for review and approval and validate the test region to make sure that all the required components have been integrated.
  • End to End testing (Internal): During this phase, l the additional non-impacted modules and systems are moved to the test region. The key focus for organizations should be to validate that the entire system is functioning efficiently with no major issues to validate all internal and external reports and to engage business users in validating the ICD-10 data outputs. Additionally, the objective should be to establish a solid test region that mimics production in all aspects – one that validates if ICD-10 implementation has been completed and the organization is now ready to engage with external entities.
  • Trading Partner Testing – Providers (External): Selection of providers is a very critical first step in achieving success in this stage. Testing partners should be a mix of small and large organizations and testing should involve a good range of all the impacted transactions both manual and electronic. Identification of test scenarios for each provider is very critical. It is important to establish the confidence that not just historical transaction data would work but will also be applicable for newly created test data that satisfies all clinical coding rules. It will be ideal if the payer organization implements a certification process for partners passing this phase of testing, so as to recognize the accomplishment and their readiness to submit and accept ICD10.
  • Trading Partner Testing – Clearinghouses (External): Selection of clearinghouses should be based on the channel of submission, transaction volume history and transaction types. The core objective during this phase is to make sure the trading partner transactions are validated against the implementation guides specific to the organization receiving the file. The majority of the time and effort for implementation is spent during this phase, as it is one of the most important phases for ICD-10 readiness. Also important during this phase will be to make sure the certification process is very strict and has very specific guidelines.
  • Trading Partner Testing – Payers (External): Payer-to-payer testing validates integration with other Payers like FEP, Medicare, Medicaid, etc. This phase ensures that data that is received is transmitted and accepted seamlessly by the receiving organization. Further, this phase involves a lot of complex calculations on payments with respect to the primary, secondary and tertiary payers.

Organizations have to maneuver the ICD-10 maze very carefully during these important ICD-10 implementation readiness phases and engage with qualified partners and vendors to successfully complete it.  Finally, one of the best practices successfully implemented by partners is to involve multiple vendors for each phase of testing. This provides increased visibility and validation to the entire testing process.

This article was originally published on Healthcare IT News on September 12, 2013, and is re-posted here by permission.

Baskar Mohan

Director - Healthcare Practice, Virtusa. Baskar has more than 18 years of professional IT experience with over 13 years of US project experience. He has worked in the Healthcare industry for the past 11 years both on the payer and the provider systems. He has extensive knowledge of the Blues and has worked with them in many corporate initiatives including the HIPAA 4010A1 conversion, SSNE and the NPI project. On the payer side, Baskar has worked on EDI and core claims systems. During his tenure at BCBSMI, Baskar has worked in EDI, Membership & Billing, Facility, Professional, Dental, FEP & NASCO to name a few. Baskar has also very good exposure to the government run Medicare & Medicaid programs and has worked for the Dept of Health Services, Sacramento, California. He also has executed a number of projects in healthcare related to BPM. Baskar is very knowledgeable of the Pega platform and in specific the Healthcare payer framework, Insurance Industry framework & CPM. More recently he has executed projects related Governance, Risk and Compliance using Pega for providers very specific to CoBIT & HIPAA. As a Chief Architect, Baskar is responsible for designing solutions for 5010 & ICD10 solutions. He has created go to market solutions to help customers transition to 5010 & ICD10. As a Program Manager, he is responsible for delivery & execution of all projects both onsite & offshore and currently manages a team of resources. As a Client Services Director, Baskar is responsible for revenues for healthcare book of business, assist the sales team with pre-sales, account radiation and client management. Baskar has experience working with global clients across, USA, UK, France & Netherlands.

More Posts