How to prepare for ICD-10 testing
Remember the good ol' days when test preparation meant pulling an all-nighter before taking the exam? That's not going to cut it when preparing for ICD-10 testing.
According to the Centers for Medicare and Medicaid Services (CMS) Road to 10 website, there are four stages to ICD-10 testing:
Prepare Test Cases
Medical practices need to use real cases and medical records to prepare test cases.
- Identify test scenarios that involve the ICD-9 diagnosis codes used most in the medical practice.
- Find at least 10 medical claims that include the most used ICD-9 codes.
- Assign ICD-10-CM codes for each medical claim.
Create errors with different dates of service
- Use ICD-9 codes on or after Oct. 1
- Use ICD-10 codes before Oct. 1
- These test cases are needed to check if systems will reject the errors.
Perform Internal Testing
This is about ensuring that a medical practice's systems can search on, accept, store, process, send, and receive ICD-10 codes. Test the following systems:
- "Perform eligibility & benefits verification"
- "Process a referral"
- "Process an authorization"
- "Schedule an office visit"
- "Schedule an outpatient procedure"
- "Schedule an inpatient admission"
- "Prepare to submit quality data"
- "Prepare to submit public health data"
- "Update a patient’s history & problems"
- "Enter and process an order"
- "Verify that diagnosis-dependent clinical decision support rules issue alerts"
- "Prepare clinical notes for an encounter"
- "Code an encounter"
- "Generate and process a claim"
- "Perform a claim status inquiry"
- "Reconcile and post a payment"
- "Run frequently used reports"
- "Perform other key tests as needed"
The test results need to be reviewed:
- Document results.
- Investigate reasons for failures.
- Report issues to healthcare vendors.
- Test fixes and changes.
Conduct External Testing
External testing is conducted with healthcare vendors, payers and clearinghouses. The goals are:
- Verify that medical practices can submit, process and receive ICD-10 data.
- Assess the impact of ICD-10 rules and policies on transactions.
- Identify specific issues.
Steps for external testing:
- Schedule testing with healthcare payers and vendors that have most impact on the medical practice.
Submit data to test for:
- Quality reporting
- Public health reporting
Review test results
- Evaluate accuracy.
- Categorize reasons for denials and rejections
- Confirm payments are what's expected
- Review results with testing partners
- Update processes to address issues
Practice and Validate
Basically, this is about dual coding. Select patient encounters for ICD-10 coding. This will provide valuable ICD-10 practice and test clinical documentation for specificity.
ICD-10 testing will be a valuable step in the ICD-10 transition but it will be more complicated than sending medical claims to healthcare payers and asking, "How's that?"