As we have  discussed elsewhere, ICD-10 transition creates significant changes in operations.  These impact all business processes, costs, revenue for providers and health plans. So, how do we know if, and how this is going to work on October 1, 2014?

Health care providers need to know the result of claims processing under ICD-10, but the provider has no direct control over this, and it is not  a vendor process.  ICD-9 and ICD-10 dual coded records help build a cache of data that can then be tested with health care trading partners and systems.

4 ICD-10 testing approach components:

Start at the beginning – the patient workflow, then use clinical scenarios, determine what is being documented, what is being coded, and what the input and output is at each step of the process.

Testing KPIs

ICD-10 Testing should help provider answer these questions:
  • Is the ICD-10 based information being entered so that the record correct?
  • Can the ICD-10 claim be produced accurately?
  • Can the ICD-10 claim be sent to the health plan properly from the business part of the system?
  • Can reporting be produced under ICD-10?

What to Test for

  • Accuracy of each step
  • Integration between steps
  • Productivity/stress testing
  • Comparison of result between ICD-9 and 10

When to Test

  • As early as possible for each step
  • Note that vendor product integration is critical
  • May be able to “simulate” processes that are not yet ready

ICD-10 Testing Services – Where we can help:

  • Step by step testing for health plans and providers
  • End to end testing with all trading partners.

Leave a Reply