In my first article, “ICD-10 transition: No Big Deal or Deal breaker?” the revenue cycle implications of the ICD-10 transition were briefly discussed. In my blog postings, I will share with you different aspects of this transition to help you prepare for the October 1, 2014 deadline. The smaller the provider, the more difficult the transition and state of readiness becomes, mostly due to internal resources. This post will tell you why early and robust testing is important to minimize revenue-cycle disruption after October 1, 2014.
What does ICD-10 “testing” mean and involve? Testing means sending claims and/or data to your payers, third-party partners, clearinghouses, and all other interested parties to see whether or not you, and they, are ready to process the information in accordance to the ICD-10 standards and formats. The issue is how smoothly this transmission occurs and the state of readiness to carry on operations effective October 1, 2014 without disruption. Examples of data to test are: claims, eligibility/benefit information, 835/837’s, claim responses, state reporting, and public health registries to name just a few. Testing has already begun and the results are quite mixed. Generally speaking, we are finding out that it has proven more difficult than originally anticipated.
Connectivity, coordination, and interfacing is very complex. Just getting your organization to begin documenting the updated information is a time-consuming task in itself. Every one of your electronic partners will be at a different stage of readiness. Some have already begun testing only to find they truly are not ready or the system does not work as intended. Others are developing remediation plans based on the testing results and feedback and it becomes an iterative testing loop. Your partners need to track all the testing results, develop remediation actions, and then communicate with you what happens next. Likewise, your organization should be going through the same process with each of your third party electronic partners. For example, eligibility and benefits transmissions are typically not great right now, but will likely be worse with ICD-10 transition. You will have to track each vendor's 270/271 transmissions, testing timelines, remediation measures (both theirs and yours), and assess your level of response and risk prior to October 1, 2014.
Specific areas for you to consider when thinking about the testing segment of your ICD-10 Transition Plan:
- Identify all data elements within your systems (and on paper!) that contain ICD-9, DSM, and DRG codes sets
- Determine clinical documentation and coding readiness to ICD-10/DSM-5
- Determine training dates to begin dual-coding processes
- Run internal testing processes, regression testing, and identify remediation plans/actions
- Obtain vendor-partner timelines for acceptance testing
- Identify claim volumes per payers to help you prioritize testing and assess impact and risk
Do not assume that others will take care of the transition for you. I frequently hear, “My EHR vendor is taking care of the ICD-10 transition for us!” If you sit back and let this happen, your regulatory and revenue systems will not be ready. Have a question? Send it along and I will address FAQ's in future posts!