ICD-10 Testing - Lessons Learned

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Introduction

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Yaron Kottler

• Sr. Test Specialist & CEO

Tom Parnon

• Director Business• Development

Agenda

• Lessons learned

• Testing challenges

• Solution overview

• Self assessment

• Q&A

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What is your organization’s overall approach to ICD-10 testing?Conduct an ICD-10 impact assessment…

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Survey Question #1:

0%

5%

10%

15%

20%

25%

30%

35%

40%

But don’t test & internal testingonly

& comprehensiveinternal & ext. rev

impact testing

Other

12%

18%

35% 35%

Lessons Learned

• Some organizations mistakenly believe impact assessments are sufficient for revenue impact analysis

• A comprehensive ICD-10 testing effort will require tens of thousands of encounters based on a core dataset of 250 – 5000 medical records

• IT and revenue cycle departments are struggling to secure internal cooperation from medical coders for test data creation

• Data DE identification is Key

• Data Contextualization cannot be avoided – Both content and correlation

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Lessons Learned

• Test Automation is extremely effective for core processes such as Registration, charting and coding

• Automation will not replace exploratory testing, just simplify the setup activities

• Ancillary systems and processes are better tested manually

• End to End ICD-10 testing does not eliminate the need for comprehensive regression testing

• An integrated test environment is essential.

• Fat clients simplify the test automation effort considerably

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Lessons Learned

• Some payers are not cooperating, others are insisting on running the show.

• Some Payers utilize provider specific impact assessments and actual medical records (MRNs)

• Some regions\states have active ICD-10 collaboratives

• Most providers have been slow to reach-out to their most important payer partners to establish a joint approach

• The solution offered by the ICD-10 national testing program completely neglects to cover areas such as internal testing and revenue impact testing.

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QualiTest

• World’s 2nd largest pure play independent testing company and the largest in the USA (Nelson Hall – 2012 & 2013)

• Over 1,600 testing professionals world wide

• QA & Testing focus - QA & testing is all we do!

• Strong focus on the Healthcare Industry - Over 28% of global business and close to 50% of USA business

• A proven Healthcare testing practice with over a dozen current ICD-10 testing projects

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ICD-10 Impact Assessment starting point

Predicted Vs. Actual

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Shared ICD-10

Test Bed

Risk Based ICD-9 CM

Codes

Risk Based ICD-9 PCS

Codes

High Volume Claims

High Dollar Claims

Case Mix Index

DRG Shifts

Has your organization started ICD-10 Testing?

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Survey Question #2:

0%

5%

10%

15%

20%

25%

30%

35%

40%

My organization hasbegun ICD-10 testing

Has only completedthe impact assessment

Planning completed,but have not started

testing

Haven't started

38%

24%

11%

27%

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Solution Overview

Holistic End to End testing

Golden Data Set & managed test

data service

Test Automation Accelerators

Claim Generator Accelerator

• All entities in the healthcare technology workflow are tested using this medical records (Clinical and claims data) test data.

• Testing all internal integrations down to billing and clinical DWH

• Testing of all external partner integrations including payers, clearinghouses and HIEs

• Testing of: business process, operations, revenue neutrality and performance

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Solution Overview Holistic End to

End testingGolden Dataset

Test Automation Accelerators

Claim Generator

Accelerator

• Utilization of real medical records dual coded in ICD-9 & ICD-10

• No coding or GEM tools used in this process

• Your Medical records are coded and verified through peer review by key industry experts

• No conversion of claim data from ICD-9 to ICD-10

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Solution Overview Golden Dataset

Holistic End to End testing

Test Automation Accelerators

Claim Generator

Accelerator

• Utilizing automation to accelerate data entry and testing of all relevant systems

• Utilizing automation accelerators to access and verify data

• Enables better utilization of human capital for investigating fewer potential issues

• Establish a test automation framework for the future

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Solution Overview Test

Automation Accelerator

Holistic End to End testing

Golden Dataset

Claim Generator

Accelerator

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Solution Overview Claim

Generator Accelerator

Holistic End to End testing

Test Automation Accelerator

Golden Dataset

• Utilizing Claim Generator Accelerator to enable direct creation of claim records for standalone\independent revenue impact testing

• Generates EDI X12 837 5010, UB-04, UB-100…

• Enable parallel internal and external testing

• Establish a test framework for the future

What will be the source of your ICD-10 test data?

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Survey Question #3:

0%

5%

10%

15%

20%

25%

30%

35%

40%

We will code our ownICD-10 test data records

We will use a cross-walkmapping tool to convert

ICD-9

We will use 3rd partydual-coded service

Don’t know

38%

25%

8%

29%

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Survey Question #3: Results from May 2013

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Converted Data Vs.

Internally coded test dataVs.

Golden Data Set

Dual Coded Clinical and Claims Data

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The Golden Data Set is:• Purpose generated by dedicated medical coders• Dual coded in ICD-9 and ICD-10• Includes:

o Demographic information o Diagnosis and procedure codes (ICD-9 and ICD-10)o Consult notes, discharged summary o 5010 Claims

• Peer reviewed by:o At least one more independent medical coder

• Beneficial to related ICD-10 remediation activitieso Training o Risk managemento CDI Documentation and process updates

How does your organization plan to enter your ICD-9 and ICD-10 test data into your health information systems?

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Survey Question #4:

0%

5%

10%

15%

20%

25%

30%

35%

40%

Manually In an automatedfashion with the use

of accelerators

Both Don’t know

40%

12%

21%28%

Data Entry and Test Accelerators

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Utilizing test automation accelerators to rapidly enter and verify data

• Expedites test data entry

• Eliminates human error

• Enables low involvement of business users

• Increases test coverage

• The only method to enable real end-to end-testing at a reasonable cost

• The 1st step in automating tests for long term efficiencies

Clinical History and Medical Coding

HIM History and Physical

DATE OF ADMISSION: 02/12/2011

CHIEF COMPLAINT: Chest pain.

HISTORY OF PRESENT ILLNESS: The patient is an 81-year-old gentleman with past medical history of coronary artery disease status post three-vessel bypass surgery in the 1990s with a total of 8 stents subsequently. He also has a history of diabetes, hypertension, dyslipidemia. He has chronic stable angina managed with nitroglycerin patches and Ranexa. Last night he developed increasing chest pain and had recurrent rest pain this morning. Some mild diaphoresis. Denies orthopnea, paroxysmal nocturnal dyspnea or edema.

PAST MEDICAL HISTORY: As above.

MEDICATIONS:1. Aldactone 25 mg daily.2. Aspirin 325 mg per day.3. Imdur 40 mg t.i.d.

Accelerators

Manually

Data Entry

Providers

Admin/Fin Apps

REG

ADT

HIM

SCH

MPI

Bill/AR

Clinical Apps

Pt. CareOELabORRx

RADResultsEMRCARDDiet

Therapies

Accelerators

Manually

Comparison

Expected 5010 ClaimISA*00* *00* *ZZ*QUALITEST**ZZ*QUALITESTQAGROUPTEST*130405*0801*^*00501*013752785*1*T*>~GS*HC*QUALITESTQAGROUP*940360524*20130405*080132*13755551*X*005010X223A2~ST*837*000000043*005010X223A2~BHT*0019*00*000000039*20130405*080142*CH~NM1*41*2*TEST*****46*TEST~PER*IC*CHS*TE*8043273100*EM*TEST@TEST.COM*FX*8043235848~NM1*40*2*PAYER*****46*1122334455~HL*1**20*1~PRV*BI*PXC*282N00000X~NM1*85*2*MEMORIAL MEDICAL*****XX*1111111112~

Actual 5010 ClaimISA*00* *00* *ZZ*QUALITEST**ZZ*LQUALITESTQAGROUPTEST*130405*0801*^*00501*013752785*1*T*>~GS*HC*QUALITEST*940360524*20130405*080132*13755551*X*005010X223A2~ST*837*000000043*005010X223A2~BHT*0019*00*000000039*20130405*080142*CH~NM1*41*2*TEST*****46*TEST~PER*IC*CHS*TE*8043273100*EM*TEST@TEST.COM*FX*8043235848~NM1*40*2*PAYER*****46*1122334455~HL*1**20*1~PRV*BI*PXC*282N00000X~NM1*85*2*MEMORIAL MEDICAL*****XX*1111111112~N3*1 MAIN ST~N4*TORRANCE*CA*905055002~REF*EI*951644042~PER*IC*MEMORIAL MEDICAL*TE*5551212151~HL*2*1*22*1~

Data Entry and Test Accelerators

Automation Accelerators Demo

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Demo

When do you expect all of your major systems to be upgraded and ready for ICD-10 testing?

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Survey Question #5:

0%

5%

10%

15%

20%

25%

30%

35%

By the end of 2013 By the end of March2014

After April 1st 2014 Don't know

14%

34%

29%

23%

Claim Generator Accelerators

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Utilizing test automation accelerators to rapidly generate claim records to enable stand alone

external revenue impact testing

Demo

Solution Benefits• A high quality approach delivering maximum test coverage

• End to End internal and external business process testing

• Complete testing: business process, operations, revenue neutrality and performance

• Reduced testing effort and duration – use of accelerators and fewer false negatives

• Enable standalone external revenue impact testing

• Golden Data Set is the only solution unless your test data is available now. Added value to multiple remediation activities such as training, risk management and process updates

• Can reduce ICD-10 testing costs by up to 70%

• Can be done as a turnkey fixed price engagement

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What we recommend organizations should ask themselves now?

• Do you have an impact assessment including analytics?

• Can you generate the test data in time?• Will your payer partners test with you?• What is needed for your payer partners to

adjudicate your test claims?• When will your internal systems be upgraded?• Will your internal systems be tested in time to

support external testing or should external testing be conducted in parallel (or even before) internal testing?

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For more information

Contact Tom Parnon

1-(203)-202-2682 ext. 202

ICD10@qualitestgroup.com

Visit the QualiTest website:www.QualiTestGroup.com

or look for QualiTest on: