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Given the hefty cost of implementation, it is imperative to develop an effective testing approach
Driving down a road with unsynchronized traffic lights raises the issue of whether or not engineers tested the lights’ impact on traffic flow. Providers and payers should keep the same theory in mind when conducting testing procedures leading up to the ICD-10 implementation deadline, which the Centers for Medicare and Medicaid Services (CMS) setfor October 1, 2015. Organizations must ensure testing and data quality checks are part of their plan to make certain that they are not only in compliance, but also that the new process performs to user expectations.
The costs for medical practices to implement ICD-10 can range anywhere from $56,639 for a small practice to more than $8 million for a large practice, according to a 2014 report by AMA. The estimates account for significant post-implementation measures, including testing, to ensure the new codes are working correctly.
There’s good news and bad news along the path to ICD-10 compliance.
Let’s begin with the challenges – bad news first. Many practices are struggling to conduct appropriate testing. Their test methods lack complete coverage – limited to costly, sample-based, manual efforts or by point-in-time software solutions. As a result, they have limited visibility into the data, impairing their understanding of where problems may occur.
These unexpected problems are resulting in delays on the provider end which are affecting payers and creating data quality issues. Historically, providers have always delayed a certain percentage of claims in order to resolve them, but this number could rise significantly in the wake of testing uncertainties. Providers may delay filing an increasing number of claims in order to review them during the 60 to 180 day window of time allowed for such purposes. This could impact workflow for payers that are used to receiving a steady flow of claims. Suddenly, they may find themselves facing a lull in work, followed by a surge that could overwhelm staff.
There is also the issue of a two-year grace period recently proposed by physicians in the hopes of facilitating a smoother transition to ICD-10. If approved, the grace period would extend the ambiguity of whether to operate on ICD-9 or ICD-10, increasing the level of complexity for providers and payers alike.
Payers have been ready for a while; they have been conducting tests for about five to six years. With an extension, payers would face the question of whether or not they should update their testing procedures to ensure they are still accurate. And for payers that have set up their systems to perform a hard cutover, a blend of ICD-9 and ICD-10 codes may result in errors. It could also make the process extremely complex, with payers forced to institute and follow rules for both ICD-9 and ICD-10 codes. It would become difficult for payers to make sound judgments on claims.
However, the appeal of the grace period to providers is obvious, as ICD-10 codes introduce significant challenges:
- Testing new systems and the new connections that have emerged since payers started testing ICD-10 codes about five years ago; these pieces change constantly.
- Implementing the spike volume of new ICD-10 Diagnosis codes – from 13,000 codes to a staggering 68,000 codes
- Mapping codes between ICD-9 and ICD-10 to ensure accurate and proper claim processing throughout the lifecycle
- Tracking historical information by diagnosis code and properly accumulating that data over time, based on those codes
So what is the good news in the wake of these developments and challenges? There is a solution. A fully automated solution is imperative for success in meeting these challenges, as it allows the system to perform testing on the entirety of data and delivers results with a full audit and exception trail. And a flexible, adaptable, rules-based solution can offer companies more detailed testing capabilities allowing them to adapt to changing demands.
It is critical that enterprises conduct testing at three levels:
- Intra-system – information as it moves within a system
- Inter-system – information as it moves between systems
- Business process – whether or not information achieves the intent of business processes
In order to prepare fully for ICD-10 implementation at all three levels, organizations should take a consolidated, centralized approach.
- Test for completeness, accuracy and timeliness to ensure that application processing delivers expected results. This is critical, given the large scale data sets involved
- Test data as it moves from system to system to facilitate complete and accurate transmission of quality data
- Test business processes to improve confidence in the new methodologies. They should display accuracy, completeness and timeliness
Do not be caught off guard as the new ICD-10 implementation deadline accelerates and catches up to you. Keeping pace with ICD-10 is fully possible with the right testing approach.
To learn more about best practices for a successful implementation effort, download the Infogix Healthcare eBook.