ICD-10 and Provider/Payer Testing, Part I

As we near the end of 2013 and ready to ring in 2014, those of us in the healthcare industry are bracing for a whole lot of activity next year especially regarding ICD-10.  For those of us who have been working on with this federal medical coding mandate, it’s only going to get a heck of a lot busier until the official compliance date of October 1, 2014.  And hopefully there will be no Christmas miracle under the tree in a few days for those who haven’t started their ICD-10 implementation activities in earnest.  CMS has been very adamant that the date is not going to slip again.  

That means we have 281 days left.  Yikes.

With the ‘Y2K of healthcare’ on the precipice of the mammoth behemoth that is called the US healthcare industry, many industry groups have shifted their focus on encouraging (and I mean ENCOURAGING in all caps) everyone to test, test, and you guessed it, test some more.  That means, providers need to focus on testing all their internal impacted systems (especially EMR/billing systems, encoders, and other technology that impacts workflow); and providers need to possibly test w/their clearinghouses or billing services to ensure there are no custom edits that contain ICD-9 codes today and the hand-off of claims information can be routed to the payer without interruption.  Remember, time is money when you are a provider.  Any interruption in receiving payment is not a good thing.  Payers need to test w/providers since payers need to have an idea of provider readiness so the different operational areas w/in a insurer can also go on w/out interruption.  Payers do a tremendous amount of data analytics to do such things as determine cash reserves to pay expenses (the bulk of which are claims payments) by doing historical trending of claims.

Over the next series of blog posts, I would like for us to discuss ICD-10 testing and how that can be done.  Can it be a true end-to-end test that is done in a production-like environment and is open to all providers?  Or is this not possible and it needs to be rethought?


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