Guest Post: Your checklist for ICD-10 end-to-end testing

Carl Natale
by Carl Natale

Starting the end-to-end testing process for ICD-10 as soon as possible is critical, as payers have said they do not have the bandwidth to test with all providers and will be testing on a first come, first serve basis.

Guest post by Elizabeth MogenrothIf you do not take the initiative to get on their list early, you may not be able to test at all.

My recommended ICD-10 readiness timeline for system testing is as follows:

  • Interface testing – Completed by March 2014
  • Payer testing – Completed by August 2014
  • Clearinghouse testing – Completed by September 2014
  • End-to-end testing – Completed by Sept. 30, 2014
  • End-to-end testing: to the payer and back

You should plan to test with both payers and clearinghouses in tandem to ensure there are no issues from start to finish. Once you have worked with the payer and the clearinghouse to confirm readiness and set a schedule, you need to begin testing the actual transmission of data. End-to-end testing will vary, but here are some general steps to follow:

  1. If you have a vendor who does charge capture, begin testing by sending the file to that vendor.
  2. After the charges are coded, ensure the information can be exported via an HL7 interface back to your facility.
  3. Receive and process the information in the billing system.
  4. From the billing system, ensure you can send the file to the clearinghouse.
  5. Confirm the clearinghouse can send information to the payer.
  6. Test receipt of payer transmittal from the electronic transaction file showing how they processed the claim.

End-to-end testing should be completed with ample time to incorporate any changes. Keep in mind that providers are not in control of vendor systems, and you will need to give vendors enough time to implement necessary changes.

Additional recommendations

The key takeaway is to start putting testing strategies in place as soon as possible so you can identify, communicate and quickly mitigate any issues. My additional recommendations are:

  • Understand that even though you think you have planned for every contingency, it is still likely that something will fail. Be prepared to retest.
  • Test all possible scenarios, including both ICD-9-CM and ICD-10-CM (and ICD-10-PCS if applicable).
  • Make sure all vendors have understood needed changes and made necessary accommodations.
  • Provide codes you are particularly concerned about to payers. The final goal in end-to-end testing is to see how payers will handle codes.

Elizabeth Morgenroth, CPC, Revenue Cycle Business Analyst at T-System Inc., has 16 years of healthcare experience in the payer, provider and vendor areas of service. While with Blue Cross and Blue Shield of Kansas, she provided coding assistance to all professional specialties statewide. Morgenroth was responsible and integral to the entire revenue cycle process for a family practice in Lawrence, Kansas with four physicians and five physician assistants. While working for Clinical Coding Solutions, she performed professional and facility coding for nearly all specialties. In her current position, she is responsible for encoder tool development and ICD-10 readiness for T-System revenue cycle solutions. Morgenroth attended the American Health Information Management Association (AHIMA) Academy for ICD-10-CM and ICD-10-PCS and is an AHIMA Approved ICD-10-CM and ICD-10-PCS Trainer.