Saturday, January 12, 2013

ICD-10 Testing Issues

The two biggest issues that the industry must deal with is that ICD-10 end-to-end testing, from provider to payer and back again, will not have its own stand-alone test environment anywhere in the country and the second is that there is not enough time or resources for each covered entity to test with all their trading partners in order to properly the assess the impact of ICD-10 on workflow and revenue. 

Vendors, providers, payers, clearinghouses and revenue cycle test teams will not have a production image set aside in its own test region where everyone can test from, so end-to-end testing must occur within the existing test environments being used for system, integration and UAT tests. It is also practically impossible to match up common member demographics from payers into every hospitals patient accounting records to ensure transactions can flow end-to-end as well. There is very little testing work that can be accomplished in a silo for ICD-10, the majority of the work effort is collaborative in nature and organizations must adopt a testing methodology with this in mind if cost containment and testing accuracy are important metrics to consider. 

Another testing challenge we currently have is the disparate approach in the methodologies being used by providers and payers. The most logical assumption is that in order to test these new clinical description changes; test cases must be clinical in nature and accurately represent the business side of healthcare. Providers will of course test with clinical records that will have specific ICD-10 codes but payers are mapping transactions without a clinical record and taking their best guess as to what they will receive in production. This disconnected approach to testing will lead to inaccuracies in results, not allow common testing, increase the difficulty in end-to-end testing and ultimately lead to a less than ideal ICD-10 implementation.

It is a well-known truth that there is not enough granular clinical information in a HIPAA 5010/ICD-9 file for accurate determination of the ICD-10 codes. The majority of the provider community itself doesn’t even know yet which ICD-10 codes it will be coding to reflect its business model yet. There are still thousands of hours of ICD-10 training; testing of computer assisted coding tools and manual coding exercises required before the correct determination of true ICD-10 codes can occur. To make the assumption that a GEM based technical mapping tool can accurately depict what providers will send tomorrow, both coded accurately and inaccurately, is a lot more wishful thinking than reality.

The future of successful health care testing will be measured by the interoperability of delivery systems and end-to-end testing activities with common test data will be crucial in developing these new testing strategies. The days of testing a few files through a front-end gateway or just making sure a data file is compliant are long gone. For successful ICD-10 testing; the future holds collaborative testing efforts utilizing interoperable test beds of clinical data and greater clinical understanding among all industry test teams for ensuring that contracts, benefits, adjudication rates, payments and trading partner interoperability all rise to the new level required to succeed in the changing world of federal regulations and health initiatives.

Without increased collaboration, tens of millions of dollars in software, testing resources and implementation time will be wasted as each organization tries to build its own test bed and perform the same tests within a silo as opposed to working together. Without access to a centralized industry test bed, each organization must heavily invest in software, tools and additional resources to create test data. It is a significant investment that deprives strategic initiatives of needed funding and focus. Covered entities cannot afford to continue to incurring license fees, tool costs, training costs, etc., when there are no promises of common testing or cost savings from tools and certainly no guarantee of interoperability with all their trading partners.

The good news is that there are many early adopters currently involved in this new collaborative approach to ICD-10 that are helping the industry move forward with a new testing paradigm and one that holds the promise of a shared services model that delivers dramatic cost savings and reduced testing timelines for all involved. As of today, the Lott Method for ICD-10 end-to-end testing is the only one in the industry currently being piloted across the country that provides key benefits for every covered entity and business partner within a testing model that is specifically designed to drive testing costs down as each new participant joins the collaborative.

There is a better way to accomplish ICD-10, the industry just needs to look outside of the box to see how collaboration is the only way forward for end-to-end testing.

ICD-10 Testing - The Power and Cost Effectiveness of Collaboration

The ICD-10 date has been set, organizations are mobilizing and the airwaves are flush with numerous ICD-10 testing strategies to help the healthcare industry cope with the challenges of both internal and external ICD-10 testing requirements. The issue is that the majority of these testing approaches fall short in one extremely important category – collaboration.

There is not enough time, money or resources in the industry to accomplish full scale ICD-10 testing effectively and accurately when each organization implements their testing plans within a silo approach. Why is that you ask? A silo mentality will incur the highest possible testing costs, reduce the testing scope and cause a lowering in the overall effectiveness of the testing process because each entity must incur the full cost and brute force effort of test case preparation, test data creation and trading partner coordination for end-to-end testing.

The majority of testing strategies being promulgated today also have another critical shortcoming which will cause delays in both ICD-10 trading partner and end-to-end testing; they are all linear in their application. This method requires complete dependence on full remediation at each testing stage before the next set of testing can begin. As an example; a provider cannot complete internal testing until their entire vendor stack is installed and cannot test with their clearinghouses and payers until everything is tested internally. A provider cannot test with their payers until their clearinghouses are ready, they cannot test their revenue cycle management until the payers are ready and certainly cannot test end-to-end until everyone is ready. The same holds true in reverse that payers will need to wait until vendors and providers are completed remediated further delaying the testing process. This approach will dramatically prolong the testing process until the last possible minute. Enough time will not be left to coordinate and test with all the key trading partners prior to October 2014 or be able to assess the full repercussions on revenue and coding accuracy before go live. One only has to look at 5010 testing efforts to clearly understand all the challenges with a linear based test approach.

The time has come for the industry to change their thinking on testing and move in a new direction that will enable the success of the industry for all of the regulatory changes that we know are coming. This new testing paradigm is asynchronous and non-linear in its strategy and implementation, which means multiple organizations testing concurrently and using clinically derived shared test data at its core.

This collaborative strategy is a dramatically more cost effective testing approach that holds promise for reducing ICD-10 internal testing costs by more than 50%. Likewise, through the effective use of a non-linear testing method the industry can greatly reduce the time and resource effort required for end-to-end testing by more than 80%.

ICD-10 is an unfunded mandate and must be tested and implemented at the lowest cost possible while simultaneously delivering the highest accuracy of results. Too many testing vendors and consulting organizations use ICD-10 as a way to maximize revenue at every client. Instead through the power of collaboration, the theory is to minimize the testing costs for each affected entity by leveraging the work efforts and lessons learned across their peers and the entire ICD-10 landscape as a whole. In the comparison of ICD-10 testing approaches, a non-linear collaborative testing strategy has the potential of delivering enormous savings to the industry of more than $500,000,000 in direct and indirect ICD-10 end-to-end testing costs. The primary focus is on helping both institutional and provider groups cope with the arduous task of ICD-10 test case preparation and testing while driving costs down by delivering a highly reusable, collaborative approach is too powerful to ignore.

How are all of these cost and time savings possible? By leveraging a state-of-the-art testing approach that distributes the workload across multiple organizations, utilizes clinically based dual-coded transactions and shares that test data across the entire healthcare landscape. This testing methodology is being piloted right now all across the country and involves key stakeholders from each industry group contributing to a national ICD-10 testing solution that will deliver a community based, collaborative approach that empowers all of its participants.

The power of this testing approach is that it creates testing artifacts that can be used as “sources of truth” in order to assess the quality and accuracy of computer assisted coding tools, ICD-10 coding accuracy by medical specialty, documentation improvement opportunities, accuracy of Payer mapping based on the GEM’s, provider contracting, medical policies and end-to-end testing and certification. 

NCHICA ICD-10 Testing Pilot

Lott QA Group and NCHICA have agreed to pilot test the Lott ICD-10 testing framework for end-to-end testing and trading partner certification program. This pilot delivers a shared work effort for test data, testing and trading partner coordination with clinically accurate test data at its core.

Software testing to eliminate application and business process errors has always been less expensive than correcting those errors once they reach production. Yet, despite its high ROI, testing is consistently underutilized by the healthcare industry. There has been too much reliance on mocking up data from a technical approach instead of sending and receiving what will actually be used in production.
As an industry we must realize that the human medical condition is not unique to any one entity. Instead, test cases can be designed to be shared across multiple providers, clearinghouses, healthplans and vendors. As unfunded mandates grow the industry must find ways to save millions of dollars in costs to make testing more affordable for all involved. The Lott Method for ICD-10 testing demonstrates this unique collaborative testing framework in a real world setting.

As an industry we must realize that the human medical condition is not unique to any one entity. Instead, test cases can be designed to be shared across multiple providers, clearinghouses, healthplans and vendors. As unfunded mandates grow the industry must find ways to save millions of dollars in costs to make testing more affordable for all involved. The Lott Method for ICD-10 testing demonstrates this unique collaborative testing framework in a real world setting.