Embed Size (px)
Citation preview
© 2012, Integritas Solu4ons and Rice Consul4ng Services, Inc. 1
Three Success Factors Cri0cal to Developing a ICD-‐10 Tes0ng Strategy
January 31, 2013
Addressing Test Data Concerns in your ICD-‐10
Test Planning
Quick Introduc4ons
• Randy Rice, CTAL – Rice Consul4ng Services – Oklahoma City
• Dr. Tauhida Parveen – Rice Consul4ng Services
• Dexter Oliver – Integritas Solu4ons – Atlanta, GA
© 2012, Integritas Solu4ons and Rice Consul4ng Services, Inc. 2
Three Success Factors Cri0cal to Developing a ICD-‐10 Tes0ng Strategy
Importance of Good Test Data • Organiza4ons across various industries con4nue to
be challenged with delivering quality integrated systems to support major transforma4ons like ICD-‐10
• This was evident during the HIPAA 5010 Conversion – There were issues that span the en4re
healthcare community (Payers, Providers and Clearinghouses alike)
– Data quality issues arose from incorrect data field valida4ons in 5010 causing claims to fail
– Communica4on challenges (Long wait 4mes to get the status of claims for providers from payers)
– Differences in tes4ng environments and produc4on environments led to a higher number of rejected claims (Clearinghouses and payers)
Test Data Requirements
• How do you quan4fy high quality data for your specific ICD-‐10 test effort? – Capture the end-‐to-‐end business processes to understand the upstream and downstream data dependencies (Complete Traceability)
– Analyze & Understand the ICD-‐10 reimbursement impacts across the organiza4on • Poten4al DRG ShiZs (Hospitals) • Iden4fy providers who send claims with DRG’s that may shiZ (Payers)
© 2012, Integritas Solu4ons and Rice Consul4ng Services, Inc. 3
Three Success Factors Cri0cal to Developing a ICD-‐10 Tes0ng Strategy
Understand your ICD-‐10 Data
• The more you know about your data… The more you can op4mize the effec4veness of your tes4ng
• Create a test data management framework to to drive the clinical and administra4ve test scenarios from start to finish.
• The process paths covered are determined by the test data.
The Concept – Provider Perspec4ve
Create Claim Submit Claim Modify Claim
Receive Payment
Apply Payment to Pa4ent
Test Data
Each instance of test data supports and drives a test scenario from beginning to end.
© 2012, Integritas Solu4ons and Rice Consul4ng Services, Inc. 4
Three Success Factors Cri0cal to Developing a ICD-‐10 Tes0ng Strategy
The Concept – Payer Perspec4ve
Receive Claim Process Claim Adjudicate Claim
Process Payment
Apply Payment to Member
Test Data
Each instance of test data supports and drives a test scenario from beginning to end.
Establish Data Classifica4ons
• Environmental data – System configura4ons – User authoriza4ons & creden4als – Configura4on op4ons (Applica4on server
seangs, machine resource alloca4ons)
• Baseline data – Establish a star4ng point for tes4ng and establish
a set of expected results (Very cri4cal step for successful ICD-‐10 internal and end-‐to-‐end tes4ng
• Input Data – Data that you enter into the system under test to
evaluate how it responds to provided input. (ex Coding an ICD-‐10 inpa4ent clinical encounter)
© 2012, Integritas Solu4ons and Rice Consul4ng Services, Inc. 5
Three Success Factors Cri0cal to Developing a ICD-‐10 Tes0ng Strategy
Plan how to Build your ICD-‐10 Test Data
• Direct data entry – Commonly used when the volume of test data needed is low. Manually
code all of the ICD-‐10 data needed to support an adequate test will significantly impact the produc4vity on most HIM opera4ons. There currently isn’t enough ICD-‐10 coders to go around. This approach does not scale well to test large volumes of data.
• Dual Coding\tes4ng – Parallel tes4ng is possible, but takes a very high level of effort to sustain (You must
define how issues will tracked up front). – Entering the same data in mul4ple systems will obviously affect clinical and
administra4ve produc4vity (Addi4onal Staff needed)
• Engineer the crea4on Test Data – Leverage a tool that automate the crea4on of ICD-‐10 codes and provides
the flexibility to allow an experienced professional to code those one to many scenarios that are found when using GEM files.
– Share and reuse the data across communi4es
• Implement change management processes to managing your test data in the various environments
• Establish a plan for Trader Partner Coordina4on
• Develop a Test Case Traceability Methodology (Important for Internal and End-‐to-‐End Tes4ng.
Managing the Test Data process
© 2012, Integritas Solu4ons and Rice Consul4ng Services, Inc. 6
Three Success Factors Cri0cal to Developing a ICD-‐10 Tes0ng Strategy
Ques4ons to Ask and Answer
• How will be monitor and track tes4ng ac4vi4es? (Internal and End-‐to-‐End Tes4ng)
• Do we have insight into our ICD-‐10 impacts? – Financial reimbursement (highest risk) – Pa4ent data – Data analy4cs
• How will be create and control test data?
• How do we deal with issues iden4fied in tes4ng?
Next Steps
• Download the White Paper at: – hlp://integritassolu4ons.net
• Get management’s alen4on and support.
• Schedule a consulta4on. – [email protected] – [email protected]
• Stay up to date with ICD-‐10 events. – hlp://www.cms.gov/Medicare/Coding/ICD10/index.html
© 2012, Integritas Solu4ons and Rice Consul4ng Services, Inc. 7
Three Success Factors Cri0cal to Developing a ICD-‐10 Tes0ng Strategy
Ques%ons and Answers
January 31, 2013
Thank You!
