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ICD-10 end-to-end testing challenges for providers, payers

By Jennifer Bresnick

Hospitals, smaller practices, payers, clearinghouses, and vendors have a herculean task ahead of them before ICD-10 comes into effect on October 1, 2014, and the prospect of coordinating end-to-end testing is making many people very nervous.  Not only does every link in the chain need to gear up for transmitting claims well in advance of the implementation date, but CMS, WEDI, and other ICD-10 leaders are still laying the groundwork for what can be expected during this lengthy and complicated process.

You can’t do it all

Current industry consensus is that no one will have the time or resources to conduct testing with every single external business partner at the level that claims are actually shuttled back and forth.  There is simply too much to do, and with the majority of hospitals and providers significantly behind the curve already, testing is going to get squeezed into a tighter and tighter time frame.  Each provider-payer and vendor-payer relationship is unique, however, and may branch off into multiple processing paths.

The Workgroup for Electronic Data Interchange (WEDI) suggests that providers choose a few key business partners to work with in order to identify issues that may be common to other transactions.  Sharing these findings with your other partners gives them the chance to identify whether or not the issues are applicable without spending too much time combing through the fine details with everyone.

It’s not all under your control

No one likes to be told that they have to rely almost exclusively on other people for something as confusing, complex, and fundamental as ICD-10, but the fact of the matter is that healthcare is an industry of partnerships, and providers need to take that into account as they schedule their testing.  Not everyone is going to be ready at the same time – some organizations might not be ready at all – and that means a lot of headaches and frustrations when you’re the one trying to drag other businesses to your deadlines.

The solution?  Well, there might not be an easy one, depending on how responsive and cooperative your business partners are.  To avoid panicked shouting into the phone next September, providers who are worried about getting everything done in time should start right now to establish solid relationships and firm plans with their vendors and payers to ensure that everyone is on the same page.

You have to be flexible, proactive, and prepared

There are a lot of resources out there to help providers prepare for this critical phase of the ICD-10 process, including detailed checklists from CMS and numerous pilot programs and collaborations from pioneers in the field.  CMS and WEDI advise that your sample cases span every category of codes your practice typically uses, and that they include common errors, such as mistaking a zero for an O, to figure out what happens when claims don’t go through.

Prepare your staff in advance to conduct these test scenarios, and develop contingency plans for what will happen if your vendor or payer doesn’t get on board when you need them.  Take a multi-phase approach to testing to cover different testing objectives in a reasonable time frame, based on where your partners are in their own implementation plans.  This will ensure the highest quality results without compromising your internal efficiency.

Planning ahead and remaining adaptive and flexible are going to be key to this convoluted process.  Include your partners in your timeline every step of the way to ensure that there are no surprises when testing starts to take off.  Leave extra time in your implementation plan to cope with surprises and delays, and your practice or hospital will be in the best possible position to tackle ICD-10 in the fall.





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