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.

3 comments:

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