ICD-10 will impact nearly all of the processes in your practice or organization, and using that fact as the starting point for your ICD-10 testing will make the process smoother and more worthwhile for everyone involved. Although it may not be possible to coordinate or synchronize all aspects of the testing, the more comprehensive your testing plan is, the better prepared your organization will be on Oct. 1, 2015.
In addition to helping you gauge your readiness for ICD-10, effective testing will help you limit the financial risks associated with the change. If any aspect of your practice or organization isn’t ready for ICD-10, now is the time to find out – while there’s still the opportunity to implement a fix, and so you can incorporate the test results into your contingency plans.
With the deadline less than a year away, it’s also time to test your readiness with your most critical payers. Talk to them as soon as possible and schedule a coordinated test. As the deadline approaches, payers will be inundated with requests from procrastinating providers scrambling to implement last-minute testing. So schedule your tests now.
Here’s what else to be aware of as you prepare for ICD-10:
The Need for Comprehensive Testing
Providers need to focus on three key phases of ICD-10 testing:
- People and Processes
- Systems and Software
The People and Processes phase encompasses physicians, coders, and physician documentation, as well as your existing and anticipated coding workflow.
Systems and Software entails evaluating the programs you currently use internally, investing in new software as needed, and testing all of these solutions. Has old software been updated to accept ICD-10 codes? Are your mapping or crosswalk programs working as expected? How effectively are different systems exchanging information? How prepared are your vendors?
For the Payers phase, you’ll need to identify your most critical payers and work with them to schedule tests. Incorporate the results into your financial and operational contingency planning. Although the tests may be limited in scope or differ between payers, the results are still the best predictors of what to expect in the months following implementation.
Physician documentation is the foundation of a successful transition to ICD-10. Insufficiently detailed documentation will lower your coders’ productivity, likely resulting in increased claims denials, and It could even provide grounds for audits if coders are forced to rely too heavily on unspecified ICD-10 codes.
Start by assessing the current state of your documentation. Identify the types of medical claims your practice submits most often, or that which represent especially high-revenue lines, and set up multiple testing dates for your staff to code examples of these claims in ICD-10. This will help you identify how your current documentation process needs to change, and it will strengthen your staff’s ability to code these specific claim types.
Once you’ve completed this step and implemented training to update your documentation processes, you’ll be better positioned to test coder preparedness more broadly. Between now and the implementation date, periodically testing your staff’s ability to code in ICD-10 gives you opportunities to measure their productivity and reward their progress.
Remember, the learning curve for coders is steep. Don’t be surprised if early results from your coding tests show significant room for improvement. For context, here’s a finding from the HIMSS/WEDI ICD-10 National Pilot Program: Even the coders who participated in the program had an average accuracy of only 63 percent.
That underscores why you should focus on measuring and driving progress rather than merely testing coders’ proficiency once or twice as part of a pro forma assessment. Coders need to build their confidence as well as become accustomed to any workflow changes necessary for accurate ICD-10 coding. Encourage them to think critically about how they use crosswalk or mapping tools, ask for their feedback on what additional help or support they need, and recognize them for their improvements during subsequent iterations of the testing. Consider recognizing individual staff members’ accomplishments with small awards for highest accuracy, or setting an overall goal for accuracy and rewarding the entire coding staff when it reaches that level.
Multiple assessments will also give you a more accurate picture of what level of productivity to expect in the months following implementation. This will help you pinpoint the additional investments necessary to mitigate impacts on productivity – investments such as additional training, bringing on additional staff, or outsourcing some coding responsibilities. While the costs of these investments may not be the most welcome prospect, consider the benefits, such as preventing catastrophic backlogs and cash-flow disruptions.
Systems and Software
Designate individuals or a team to undertake and monitor the testing of your systems and software. This decreases the likelihood of errors going unnoticed or slipping through the cracks when you begin testing the flow of information between applications, such as your PM and EHR systems.
And remember, test applications individually first.
Once you’ve determined who’s responsible for implementing and monitoring this phase, you’ll need to test applications individually, ensuring that each is fully compatible with ICD-10 codes. Confirm that:
- ICD-10 codes can be entered, and the application recognizes them as valid.
- The system can accurately export and/or run reporting on ICD-10-encoded data or records.
- The data is flowing to downstream applications and populating everywhere it should along the way.
You can use example codes or scenarios – a good source for these is the same list you used for the documentation and coding testing, namely the type of medical claims your practice submits most often, or claim types that have particularly high financial impact.
If the individual tests indicate a problem, your team should log the issue, and if possible, implement the necessary fix before integration testing.
Let’s get a little more specific in terms of what you need to test. Key goals for this step of integration testing include:
- Ensuring that your practice management system produces an ICD-10-compliant 837.
- Validating dual-coding functionality – there will be instances when you need to code in both ICD-9 and ICD-10.
- Testing and confirming that your clearinghouse can process ICD-10 codes.
- Verifying your reimbursement/proration calculations using ICD-10 codes.
Then, test the interoperability of your systems.
After you’ve tested individual applications and programs, you can begin assessing how effectively these programs are communicating with each other. If information doesn’t move fluidly and without corruption between your critical applications, the negative impact on your workflow could disrupt not only your operations, but also your cash flow.
This is also the time to begin confirming the readiness of your vendors. Pay particularly close attention to:
- The successful transmission of an ICD-10-compliant 837 from your practice management system to your clearinghouse.
- The successful, validated transmission of your clearinghouse’s 837s to payers – especially your most critical payers.
Once you’ve tested and proven that your internal systems are ready for ICD-10, you can move on to external testing.
Prioritize testing your readiness with your most critical payers – in all likelihood, the bulk of your payments come from a small number of payers. Ensuring that your ICD-10 coding and documentation meets the standards and protocols of your most critical payers is the best way to limit negative impacts on your cash flow due to denials.
Be prepared for differences in testing processes among payers. Some may require blinded data, some may offer testing only for specific codes or subsets of codes, and some may already have scheduled specific timeframes for testing.
The outcomes of your payer testing will inform your contingency planning and your ongoing training for coders and physicians. Stay engaged, stay on track, and you’ll reap the benefits come implementation!
About the Author
Betty Gomez is ZirMed’s head of regulatory affairs.