In a previous blog post, we explained how and why you should test the ICD-10 code set inside your practice. Now, let’s talk about external testing—that is, verifying that all of your outgoing and incoming data transmission processes are completely ICD-10 ready. That way, by the time the transition date—which is set for October 1, 2015, according to recent hints from CMS—rolls around, there will be no question of whether you’ll get paid.
In this article, ICD10Watch editor Carl Natale explains the importance of proper external testing. In his words, such testing should allow you to:
- “Verify that [your] practice can submit, receive, and process data containing ICD-10 codes.
- “Understand the impact that clearinghouse and payer policies will have on the transactions.
- “Identify and address specific problems.”
If you find the task of architecting—and executing—a comprehensive external testing plan to be more than a little overwhelming, relax. As Jennifer Bresnick writes in this EHR Intelligence article, you should employ a “multi-phase approach to testing to cover different testing objectives in a reasonable time frame…” Essentially, treat ICD-10 testing as you would a fine dining experience; you wouldn’t scarf down your appetizer, entrée, and dessert all at once, and you don’t want to dive into all portions of your testing at once.
Instead, break it down into stages, and be sure to set specific, measurable, attainable, relevant, and timely (SMART) testing goals. Then, present your goals and target deadlines to your staff as well as your business partners and vendors. As you’re formulating your plan, be sure to research where your partners are in their own ICD-10 preparations. That way, you’ll know where you might need to build a little bit of cushion into your schedule so you don’t get derailed by surprise setbacks.
Natale pulled the following key action items from the external testing plan CMS provides here:
- Pinpoint and prioritize the parties with whom you need to test
- Make arrangements to submit test claims to your clearinghouse, billing service, and/or payers
- Analyze the results of your test submissions
- Adjust your clinic’s processes accordingly
Furthermore, according to this article, CMS and the Workgroup for Electronic Data Interchange (WEDI) recommend that you perform testing with claims representing all of the code categories your practice uses, especially those that may be susceptible to “common errors, such as mistaking a zero for [the letter] O” so that you will see what happens if your claims don’t go through. And regarding test claims that contain real patient data—a.k.a. protected health information—take heed of these cautionary words from the American Medical Association (AMA): “Be sure to follow all appropriate security and privacy measures to protect the data, such as sending the transactions using a secure connection.”
If your practice only works with a certain clearinghouse or billing service, you’ll have a simplified external testing experience because you really only need to ensure they can receive the codes. However, you should also confirm that such parties are conducting their own testing initiatives with payers and other clearinghouses. Otherwise, it could affect your cash flow.
While many experts recommend that you dedicate six to nine months to your external testing endeavors, we say the more testing you can do, the better. So as we count down the weeks and months to transition time, keep a pulse on your partners’ testing preparations so you can get started as soon as you’re ready.
Does your clinic have a plan for external ICD-10 testing? What testing questions do you have? Share your thoughts in the comment section.