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.