7 ICD-10 Testing Steps Healthcare Providers Should Follow
Testing ICD-10 readiness is an essential requirement for successful ICD-10 transition. The basis for successful testing is the use of real medical records exercising each type of case you will be treating and submitting for payment. Health care payers can help you compile test data reflecting your case loads. Testing will be far more practice specific when you use actual data rather than data provided in published test scenarios. You can use concurrent dual ICD-9 and ICD-10 coding. This will enhance your knowledge of the information gap you must fill.
When you follow these seven ICD-10 test steps you are likely to cover your ICD transition testing completely and with fewer errors.
- Provide supporting documentation. ICD-10 codes must be documented so make certain to provide the requisite support information.
- Create a Quality Assurance Plan – This plan will address internal testing, testing of transactions with multiple Trading Partners and the test schedule. Test results will be recorded when testing is executed.
- Consult testing checklists. The Centers for Medicare and Medicaid (CMS) have just updated ICD-10 testing checklists for:
- Small providers
- Large providers
- Vendors to payers
- Vendors to providers
- ICD-10 testing pilot bulletin provides guidelines for end- to- end testing.
- Collaborate with trading partners. These include vendors, Data Trading Partners, clearinghouses and direct submit payers. Decide upon the level and type of participation these partners will have in your testing process. For each cooperating testing trading partner:
- Establish communication pathways.
- Establish test plans and schedules.
- Establish the number of test files to be sent for each individual transaction.
- Obtain a copy of each participating Trading Partner’s Test Plan.
- Review Trading Partner’s Test Plans and provide supplemental information where gaps occur.
- Send multiple test files per transaction whenever possible. This will facilitate error resolution.
- Establish if test data can be identifiable or if it must be de-identified to meet privacy requirements.
- Identify cases where transactions will not be verified by regulatory implementation dates.
- Consult with Companion Guides. This will enable you to exchange electronic transactions successfully with trading partners in the appropriate format.
- Create a comprehensive Test Plan that can be used for each stage of testing. Components of this testing are System Testing, Privacy and Security Testing and end- to- end testing for each partner. A management summary report should accompany test results tracking each test step and its success or failure and include remediation recommendations.
Your test plan’s test cases should include expected results – both positive and negative. Test scripts should include simple as well as complex test cases. Data extraction and reports should also be included. Implementation of current and near term regulations and amendments must have comprehensive test cases. An example is the Administrative Simplification and Affordable Care Act. This requires testing for the following transactions:
- Submission of ASC X12 270 transaction(s) with valid 271 response(s)
- Submission of ASC X12 837 claim transaction(s) with valid 835 response(s)
- Submission of ASC X12 276 transaction(s) with valid 277 response(s)
- Submission of ASC X12 278 transaction(s) with valid 278 response(s)
- Submission of NCPDP X.X retail pharmacy, COB, transaction(s) with valid response(s)
- An acknowledgment receipt for each transaction tested (277CA, 999, TA1)
- CAQH CORE Operating Rules
- EFT and ERA Transactions – These include within deadline re-association and resolution of late or missing EFT or ERA transactions.
- Verify claims eligibility by tracking claims and authorizations through systems while identifying approval, denial defects, coding and payment.
Your test plan should include the testing environment. For production testing, this should be a replica of the production setting and include accurate provider resources and data for ICD-10 implementation. Provider, workflow, policy and diagnostic messages should accurately reflect your anticipated production environment. Don’t neglect to include adopted errata were applicable for each Trading Partner.
- Test Case execution – Execute each test case of your test plan recording the result of each test step in your test script and indicating if that step has succeeded or failed. When failure occurs, explicitly describe the outcome. Multiple test script executions may be necessary until your implementation data and methodology are flawless. Before moving to end- to- end testing, complete at least two internal tests to ensure that things are working well on your end. For end- to- end testing you must collaborate with your partners to schedule tests and analyze results.
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