If you are reading this on or after October 1, 2014, the healthcare industry-wide switch to ICD-10 is officially less than one year away.
For the past few years (It seems more like forever . . . ), the focus across the industry has been training for ICD-10, getting familiar with all of the changes the new code set brings, and preparing as best we can for the changes in office procedures these code changes will trigger.
The need for training is on-going, but a new area of focus has entered the ICD-10 picture. It is a logical step on the path to conversion; it is the need for testing our readiness for ICD-10. All of the training in the world is not going to benefit us one bit if the systems our industry run on are not able to handle the new codes.
Just as the degree of ICD-10 training required varies by the size of your operation, so, too, does the amount of ICD-10 testing required vary by operation size. The largest operation in the healthcare industry is the Medicare network, so their systems testing needs to be the most extensive, so it is encouraging that Medicare’s testing plan for ICD-10 readiness has been announced and is getting ready to begin.
As summarized in last month’s issue of SOLUTIONS, the Centers for Medicare & Medicaid Services’ (CMS) testing approach covers four distinct areas:
- Internal testing of CMS claim processing systems
- Provider-initiated testing tools
- Acknowledgement testing
- End-to-end testing
Last month, CMS announced their plan to conduct end-to-end testing by opening up registration for volunteer facilities wanting to participate.
Medicare Administrative Contractors (MACs) are scheduled to conduct end-to-end testing in January 2015. A sample of 50 participants for each MAC will be selected from volunteers to represent a broad cross-section of provider types, claims types, and submitter types. Each selected tester may submit up to 50 claims over the course of the testing period.
The goal of end-to-end testing is to ensure claims with ICD-10 codes can be processed from submission to remittance. This testing will further ensure a successful transition to ICD-10.
CMS defines successful end-to-end testing as being able to demonstrate that:
- Testing entities are able to successfully submit ICD-10 claims to the shared systems,
- Software changes made to support ICD-10 result in appropriately adjudicated claims based on the pricing data used for testing purposes, and
- Remittance advices are produced.