Posted in ICD-10 & Coding

How to prepare for ICD-10 testing

Carl Natale
by Carl Natale

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.

[Read also: ICD-10 Testing Scenarios: What medical practices need to know]

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:
    • Eligibility
    • Authorization
    • Claims
    • Remittances
    • 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?"