Making ICD-10 testing matter

By: Carl Natale

There’s a lot being said about the importance of ICD-10 end-to-end testing. But why?

Healthcare providers need to know what they are looking for.

A set of testing goals will help guide medical practices to some worthwhile lessons:

  • How much medical coding productivity can be expected.
  • Will accuracy be a problem with medical coders familiar with ICD-10 codes?
  • What systems use ICD codes.
  • How much reimbursements can change.
  • Where documentation needs to improve.

To reach these goals, medical practices:

  • Documentation: Include the clinical documentation that supports your test ICD-10 codes. This¬† is not just medical notes. Needed information may be found in lab reports and other test results.
  • Real medical records: Test the types of cases you actually will be treating and submitting for reimbursement. This is the best way to judge the impact of ICD-10 implementation on a practice. Don’t just test scenarios that match healthcare payers’ mappings.
  • Dual coding: This can be expensive and time consuming but it will expose any problems with new equipment and systems, create test data that can be used and give your staff valuable practice.
  • Quality assurance: The plan needs to track internal testing, testing of transactions with multiple trading partners, the testing schedule and testing results.
  • Trading partners: Develop testing plans with mission critical vendors and payers that includes:
    • Contacts who can answer questions and a communication process to work through issues
    • Schedules
    • Number of test files that can be sent for each transaction (Multiple test files for each transaction allows any errors encountered to be resolved and verify they are corrected.)
    • A copy of the partner’s test plan.
  • Review results: Medical practices will need to review and analyze any testing results. Barbara Hinkle-Azzara, RHIA, Vice President of HIM Operations at HRS, suggests these questions to guide ICD-10 testing reviews:
    • What specific areas need to be addressed with respect to coding quality?
    • What is our exact coder productivity in ICD-10?
    • Are there any revenue cycle gaps? If so, what can I do to address them now?
    • Is our claims data clean? You’ll be using this data for ongoing comparison and benchmarking for many years to come.
    • What cases are being denied in testing?
    • Has our testing gone far enough? Is additional testing required?

ICD-10 testing will be a valuable step in the ICD-10 transition but it will be more complicated than sending medical claims to healthcare payers and asking, “How’s that?”