ICD-10 System Testing Requirements

After two delays and brief periods of tumult and speculation, the Centers for Medicaid & Medicare Services (CMS) is strongly urging the industry to push forward aggressively towards the Oct. 1, 2015, go-live date for ICD-10 implementation.

This means that it’s crunch time! Providers and payers alike have less than eight months to complete all preparations and system testing to avoid penalties. ICD-10 testing is a long and exhaustive process, requiring identification and re-calibration of every system and process that relies on ICD-9 coding.

Patients, partners, and providers all rely on a smooth transition to seamlessly maintain operations and provide a consistent and improved patient care experience. For the best outcome, I suggest these four principles for testing a new ICD-10 system.

Diverse Testing Partners
Make sure the sample of testing partners is diverse – made up of a large variety of provider types – and test with as many as possible, as often as possible. I can’t stress this point enough. The more payers and providers test, the likelihood of catching critical issues before implementation grows, increasing the opportunity for a relatively smooth transition.

The goal here is to test early enough and with enough partners to be able to learn from the results and adjust before going live with an ICD-10-based system. In my experience, more payers are ready to begin testing, while providers are holding out for another deadline extension. The best way to overcome this is for both payers and providers to survey their most actively engaged business partners, and then test to the best of their capabilities.

Transparency & Communication
Be transparent by maintaining open communication with trading partners during end-to-end testing, and keep records.

It’s virtually impossible for payers to test with all of the providers in their networks. If you’re a provider, this may be troublesome because some crucial elements of the system won’t go through live testing prior to the transition.

There is hope for providers in this situation, though. The best way to prepare is to go to the most relevant payers and get the testing information from trial claims with their testing partners. Likewise, payers should make this information readily available to their provider networks. In the end, this practice will benefit both parties when it comes to processing claims in real-time.

Commercially Available Tools
For those who can’t test enough and those behind the curve, my best advice is to choose commercially available tools. These tools will enhance volume testing capacity and help speed up the process of testing variables. Investing in commercially available tools will also cut down on the time that it takes to make changes in IT infrastructure. For example, if an institution is not operating in a cloud environment but they need to be, they can’t just go down to the local computer store to buy a new server. These types of activities have a longer lead-time.

Commercially available tools may also have the added benefit of preserving resources that need to be applied elsewhere.

Manage Rollout Expectations
Payers and providers should manage expectations for the rollout of their new systems because they aren’t likely to be perfect, no matter how much testing is done. It’s important to keep this in mind, but don’t use it as an excuse to delay “ripping off the Band-Aid.”

Consider the other aspects of the system that may require attention beyond testing, like the training of staff to utilize and maintain the new coding system. Has their training been delayed? Did they complete training prior to either of the delays? Training that isn’t put into action is often degraded, so make education and re-education a priority.

Payers and providers that started working on their systems prior to the delays, staggering their implementations, should go back and double check their steps. The shift in timeline could mean that repetition of a number of actions ranging from strategy to re-calibrating early versions to comply with updated regulations.

The Time is Now
In the end, we all must remember that the mandate to switch from ICD-9 to ICD-10 was passed into law because it promotes the delivery of the high quality of care that patients deserve. Ensuring that your system is functional only goes to further our mandate as healthcare professionals, which is a commitment to keeping people healthy. So, if you can test, don’t wait. Do it now!

Erik Newlin is vice president, EDI Platform & compliance at Xerox, and co-chair, ICD-10 Transition Workgroup at WEDI.

About The Author