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Friday Aug 14, 2015

The whys and hows of ICD-10 testing now

As I write this, the ICD-10 implementation date is just 47 days away. Hopefully you have tested your systems and processes by now. But if you have not, we’ll discuss how to get started.

It's important to start ICD-10 testing as soon as possible. First, testing is vital to ensure you can actually create and submit claims using ICD-10 come Oct. 1. Second, the earlier you test, the more time you have to resolve any issues you encounter. Finally, testing is one of the best ways to make sure you avoid cash flow issues after the compliance date.

To get started, map out your workflows and identify where you use ICD-10 codes. This includes any system that stores, processes, sends, receives, or reports diagnosis code information. Examples include:

•    Generating a claim
•    Performing eligibility and benefits verification
•    Preparing to submit quality data
•    Updating a patient’s history and problems
•    Coding a patient encounter

Then prioritize your testing by focusing first on the most important workflows using the diagnoses you see most often. Doing so will likely lead you to focus on your highest-risk scenarios (e.g., claims processing).

Testing is not limited to inside your practice. You also need to test with trading partners, such as vendors, clearinghouses, billing services, and health plans. Test with trading partners to:

•    Verify that you can submit, receive, and process data with ICD-10 codes
•    Understand how ICD-10 updates affect the transactions you submit
•    Identify and address specific issues before Oct. 1

Because time is short, test inside your practice and with partners at the same time if you are just getting started. You can check for testing opportunities at the website of the Cooperative Exchange(www.cooperativeexchange.org), an association of clearinghouses.

When testing claims processing with trading partners, be aware that there are two types of testing. In acknowledgement testing, you submit claims with ICD-10 codes. While claims are not adjudicated, you receive an acknowledgement that your claim was accepted or rejected. During end-to-end testing, you submit claims containing valid ICD-10 codes and health plans process the claims through system edits to return an electronic remittance advice.

To get the most out of testing for your practice, you should:
•    Review testing requirements to understand the scope and format of the testing available
•    Focus on your highest-risk scenarios, such as claims processing and the diagnoses you see most often
•    Prioritize testing with health plans, concentrating on those that account for the majority of your claims
•    Test as often as you can

Also, remember that you can test even if you have not yet installed an ICD-10-ready system. One good way to start is to look at the ICD-10 codes for the top 10 conditions you see. Consider volume of conditions and those that account for most of your revenue. Look at recent medical records for patients with these conditions, and try coding them in ICD-10 for practice. Do the records include the documentation needed to select the correct ICD-10 code? You can use any cases of insufficient documentation to create a checklist for physicians and other health care professionals in the practice to consult.

To learn more about getting ready, visit the Centers for Medicare & Medicaid Services website(www.cms.gov) for free resources including the Road to 10 tool(www.roadto10.org) designed especially for small and rural practices, but useful for all health care professionals. You can also check out the AAFP ICD-10 resources online.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted at 10:51AM Aug 14, 2015 by David Twiddy

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

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